Presentation on theme: "Urethral Stricture and Perineal Urethrostomy in a Ferret January 22, 2014 Erica Rangel Pre-Clinical Advisor: Dr. Jamie Morrisey Clinical Advisor: Dr. Andrew."— Presentation transcript:
Urethral Stricture and Perineal Urethrostomy in a Ferret January 22, 2014 Erica Rangel Pre-Clinical Advisor: Dr. Jamie Morrisey Clinical Advisor: Dr. Andrew Cushing
Our Patient 3.5 year old, male castrated ferret Ferret Fun Facts! --= “mouse eating stinky thief” --strict carnivoresMustela putorious furo --Male ferret is a hob, female is a jill -- A group of ferrets is called a business
A Complex History 9/15/12: Presents to CUHA ER for stanguria; acidodic, hyperkalemic, azotemic Radiographs revealed mineralized opacities in the urinary bladder and urethra Cystotomy and urethrotomy surgeries performed DX: cystine urolithiasis Prognosis: Guarded
Pre-op OS PENIS U CATH
STONE FREE !!! Post-op Urethrotomy
History continued… Represented for stranguria 11/1/12 and 6/23/13 Negative for uroliths and urinary infection Urinary catheter passed and clinical signs resolved with conservative management Diagnosis not obtained (but stricture suspected) Maintained on oral medications at home: prazosin 0.13 mg PO q24, diazepam 0.25 mg PO q12, meloxicam o.3 mg PO q24 and acepromazine 0.1 mg PO PRN
Presentation on 12/15/2013 24 hours of stranguria progressing to anuria Unresponsive to medical management PHYSICAL EXAM FINDINGS: BAR, euhydrated Vitals normal--T: 101.3 P: 200 R:32 Painful on abdominal palpation: tense turgid bladder, could not be manually expressed Mass near left kidney?
Stabilization Sedation: midazolam 0.5 mg/kg IM + butorphanol 0.2 mg/kg IM Pass urinary catheter: 3.5 French red rubber 40 ml urine removed Buprenorphine 0.01 mg/kg SQ LRS 20 ml/kg SQ QATS: PCV 40 (mild anemia), TS 6.2, Glu 114, AZO 16-26
Photo credit: C Brown Urinary Catheterization
Urinary Obstruction: Our Top Differentials and Diagnostic Tests Urolithiasis urinalysis and imaging Prostatomegaly or prostatic cysts ultrasound Urethral Stricture (secondary to trauma: surgery and repeated catheterization) contrast cystography Neoplasia age rules down, blood work, imaging Neurologic (overstretched or upper motor neuron bladder?) no other clinical signs rules down
Prostatomegaly: Complex Etiology Secondary to adrenal disease affects zona reticularis increase in ANDROGENS (not cortisol!) prostatic hyperplasia compresses urethra
Usually see other signs of adrenal disease like bilateral alopecia (60%) or increased aggression Adrenomegaly on imaging/palpation? Diagnose by clinical signs, definitive diagnosis requires sex hormone panel
Transfer to Exotics on 12/16/13 Bladder turgid again in AM BAR and otherwise stable OUR PLAN: Abdominal Ultrasound under sedation Continue buprenorphine 0.02 mg/kg SQ q8 Diazepam o.05 mg (up to 0.2 mg) PO q12 Place indwelling catheter Submit urinalysis
Photo Credits: C Brown and C Polluck
Urinalysis Unremarkable Specific Gravity 1.026 pH 6.5 Trace protein, 2+ Heme Sediment Exam: <5 WBC/HPF 20-100 RBC/HPF Many epithelial cells No bacteria No crystals No casts
Ultrasound Findings Possible bilateral mild adrenomegaly, but normal prostate Minuscule peritoneal fluid Top differential: perineal hernia with caudal bladder entrapment Surgery scheduled for later that afternoon
More Imaging: Contrast Cystography Definitive Diagnosis: penile urethral stricture with severely dilitated pelvic urethra and iatrogenic urethral tear secondary to cystocentesis
Another surgery 12/19/13: Microscopic Perineal Urethrostomy
Post-Operative Care Continue to monitor for urination Mild incontinence noted keep abdomen and stoma clean and dry! Monitored in ICU 24 hours: IV fluids 3ml/hr, buprenophine, meloxicam, ampicillin sublactam Jugular catheter removed, transitioned to oral meds Discharged 12/20/13 --Meloxicam 0.2 ml PO SID x4 --Diazepam 0.1-0.2 ml q12 PRN --TMS 15 mg/kg q12 PO x10 days --Tramadol 5 mg/kg 0.35 ml PO q12-24 PRN x7 days
Patient continues to urinate well at home No more incontinence No longer on any medications Energy level off the walls Needs to come back for 3 week recheck O very thankful Outcome
Lessons Learned Don’t overly rely on one diagnostic Don’t assume what “financial” means to your client Look for horses before zebras—ferret perineal hernia never documented in literature
Acknowledgements Dr. Morrisey Dr. Cushing Dr. Tarbert Dr. Ash Dr. Knapp Hoch Dr. Flanders Dr. VanHatten Dr. Yeager Catrina Turner Jeff McCall My rotation mates and the Class of 2014!!!
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