Perineal urethrostomy in the male horse: a review of the indications, surgical technique, outcome, and complications
Keywords:
Perineal urethrostomy, corpus spongiotomy, urethral rent, hemospermia, hematuria
Abstract
Perineal urethrostomy is a surgical technique performed for temporary or permanent urine diversion from the penile urethra in male patients with obstructive urinary outflow disease, extensive trauma or invasive tumor affecting penis and prepuce, to access the urethra or bladder to remove uroliths, and to treat horses affected with hemospermia or hematuria secondary to urethral rents. Perineal urethrostomy has been advocated as the treatment of choice in geldings where hematuria does not resolve with conservative treatment and in stallions with hemospermia caused by urethral defects. Most cases of geldings with hematuria are resolved with a single perineal urethrostomy surgery; however, stallions with hemospermia might need a second surgery. Perineal urethrostomy also enables access to the urinary bladder in male horses with cystoliths following minimal dissection and without accessing the abdominal cavity. The most common complications directly related to this surgery are hemorrhage, urine scalding, and urethral stricture at the surgical site. The aim of this article is to review comprehensively the indications for perineal urethrostomy surgery, illustrate the surgical technique approach, and discuss outcomes and complications.
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References
1. Schumacher J, Varner DD, Schmitz DG, et al: Urethral defects in geldings with hematuria and stallions with hemospermia. Vet Surg 1995;24:250–254. doi: 10.1111/j.1532-950X.1995.tb01326.x
2. Taintor J, Schumacher J, Schumacher J, et al: Comparison of pressure within the corpus spongiosum penis during urination between geldings and stallions. Equine Vet J 2004;36:362–364. doi: 10.2746/0425164044890571
3. Sullins KE, Bertone JJ, Voss JL, et al: Treatment of hemospermia in stallions: a discussion of 18 cases. Compend Contin Educ Pract Vet 1988;10:1396–1403.
4. Glass KG, Arnold CE, Varner DD, et al: Signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy or corpus spongiotomy: 33 cases (1989–2013). J Am Vet Med Assoc 2016;249:1421–1427. doi: 10.2460/javma.249.12.1421
5. Sisson S: Equine urogenital system. In: Getty, editor: Sisson and Grossman’s the Anatomy of Domestic Animals. 5th edition, Philadelphia, PA; Saunders: 1975:524.
6. Lloyd KC, Wheat JD, Ryan AM, et al: Ulceration in the proximal portion of the urethra as a cause of hematuria in horses: four cases (1978–1985). J Am Vet Med Assoc. 1989;194(9):1324–1326.
7. Beckett SD, Purohit RC, Reynolds TM: Corpus spongiosum penis pressure and external penile muscle activity in the goat during coitus. Biol Reprod 1975;12:289–292. doi: 10.1095/biolreprod12.2.289
8. Pearson LK, Campbell AJ, Tibary A: How to diagnose and treat hemospermia: a review and case series. Proc Am Assoc Equine Pract 2013;59:40–50.
9. Rijsselaere T, Van Soom A, Maes D, et al: Effect of centrifugation on in vitro survival of fresh diluted canine spermatozoa. Theriogenology 2002;57:1669–1681. doi: 10.1016/S0093-691X(02)00663-5
10. Turner CE, Walbornn SR, Blanchard TL, et al: The effect of two levels of hemospermia on stallion fertility. Theriogenology 2016;86:1399–1402. doi: 10.1016/j.theriogenology.2016.04.084
11. Möller G, Azevedo LR, Trein CR, et al: Effects of hemospermia on seminal quality. Anim Reprod Sci 2005;89:264–267.
12. Schott II HC, Woodie JB: Urethra. In: Auer JA, Stick JA, Kümerle JL, et al: editors. Equine Surgery. 5th edition, St Louis, MO; Saunders Elsevier: 2018:940–949. doi: 10.1016/B978-1-4377-0867-7.00066-1
13. Sancler-Silva YF, Silva-Junior ER, Fedorka CE, et al: New treatment for urethral rent in stallions. J Equine Vet Sci 2018;64:89–95. doi: 10.1016/j.jevs.2018.02.014
14. Voss JL, Pickett BW: Diagnosis and treatment of hemospermia in the stallion. J Reprod Fertil Suppl 1975;23:151.
15. Madron M, Schleining J, Caston S, et al: Laser treatment of urethral defects in geldings and stallions used as the primary treatment or in combination with a temporary subischial incision: Eight cases (2003–2011). Equine Vet Educ 2013;25:368–373. doi: 10.1111/eve.12050
16. Hackett ES, Bruemmer J, Hendrickson DA, et al: Buccal mucosal urethroplasty for treatment of recurrent hemospermia in a stallion. J Am Vet Med Assoc 2009;235:1212–1215. doi: 10.2460/javma.235.10.1212
17. Ball BA: Diagnostic methods for evaluation of stallion subfertility: a review. J Equine Vet Sci 2008;28:650–665. doi: 10.1016/j.jevs.2008.10.003
18. Tibary A. Endoscopy of the reproductive tract in the stallion. In: Samper JC, Pycock J, McKinnon AO: editors. Current Therapy in Equine Reproduction. St Louis, MO; Saunders: 2007:214–219.
19. Varner DD, Blanchard TL, Brinsko SP, et al: Techniques for evaluating selected reproductive disorders of stallions. Anim Reprod Sci 2000;60:493–509. doi: 10.1016/S0378-4320(00)00115-9
20. Pinto MR, Neild DM, Benegas D, et al: Successful treatment of seminal vesiculitis with Imipenem-Cilastatin in a Stallion. J Equine Vet Sci 2014;34:544–548. doi: 10.1016/j.jevs.2013.10.001
21. Bedford SJ, McDonnell SM, Tulleners E, et al: Squamous cell carcinoma of the urethral process in a horse with hemospermia and self-mutilation behavior. J Am Vet Med Assoc 2000;216:551–553. doi: 10.2460/javma.2000.216.551
22. Trela JM, Dechant JE, Culp WT, et al: Use of an absorbable urethral stent for the management of a urethral stricture in a stallion. Vet Surg 2016;45:41–48. doi: 10.1111/vsu.12530
23. Fubini SL, Delco M: Surgery of the equine urinary tract. Vet Clin N Am Equine Pract 2022;38:141–153. doi: 10.1016/j.cveq.2021.11.010
24. Diaz-Espiñeira M, Escolar E, Bellanato J, et al: Structure and composition of equine uroliths. J Equine Vet Sci 1995;15:27–34. doi: 10.1016/S0737-0806(07)80577-6
25. Duesterdieck-Zellmer KF: Equine urolithiasis. Vet Clin N Am Equine Pract 2007;23:613–629. doi: 10.1016/j.cveq.2007.09.003
26. Schumacher J, Vaughan JT: Surgery of the penis and prepuce. Vet Clin N Am Equine Pract 1988;4:473–491. doi: 10.1016/S0749-0739(17)30624-7
27. Hawkins JF: Surgical treatment of urolithiasis in male horses. Equine Vet Educ 2013;25:60–62. doi: 10.1111/j.2042-3292.2012.00449.x
28. Laverty S, Pascoe JR, Ling GV, et al: Urolithiasis in 68 horses. Vet Surg 1992;21:56–62. doi: 10.1111/j.1532-950X.1992.tb00011.x
29. Abutarbush SM: Diseases of the Urinary System. Ames, IA; John Wiley & Sons: 2015:559–577. doi: 10.1002/9781119265399.ch11
30. Vigani A, Garcia-Pereira F: Anesthesia and analgesia for standing equine surgery. Vet Clin N Am Equine Pract 2014;30:1–17. doi: 10.1016/j.cveq.2013.11.008
31. Schumacher J, Schumacher J, Schmitz D: Macroscopic haematuria of horses. Equine Vet Educ 2002;14:201–210. doi: 10.1111/j.2042-3292.2002.tb00173.x
32. Schumacher J, Varner DD: Abnormalities of the penis and prepuce. In: McKinnon AO, Squires EL, Vaala WE, et al: editors. Equine Reproduction. 2nd edition, Ames, IA; Wiley-Blackwell: 2011:1130–1144.
33. DeBowes RM: Surgical management of urolithiasis. Vet Clin N Am Equine Pract 1988;4:461–471. doi: 10.1016/S0749-0739(17)30623-5
34. De Bernardis NP, Seabaugh KA, Ismay J, et al: The use of pneumatic impact lithotripsy and a retrieval pouch to create a closed system for removal of cystic calculi in standing male horses. Equine Vet Educ 2019;31:659–665. doi: 10.1111/eve.12843
35. Katzman SA, Vaughan B, Nieto JE, et al: Use of a laparoscopic specimen retrieval pouch to facilitate removal of intact or fragmented cystic calculi from standing sedated horses: 8 cases (2012–2015). J Am Vet Med Assoc 2016;249:304–310. doi: 10.2460/javma.249.3.304
36. Trotter GW, Bennett DG, Behm RJ: Urethral calculi in five horses. Vet Surg 1981;10:159–162. doi: 10.1111/j.1532-950X.1981.tb00652.x
37. Kilcoyne I, Dechant JE: Complications associated with perineal urethrotomy in 27 equids. Vet Surg 2014;43:691–696. doi: 10.1111/j.1532-950X.2014.12169.x
38. Wilson DA, Kramer J, Constantinescu GM, et al: Perineal urethrotomy in males. In: Manual of Equine Field Surgery. St. Louis, MO; Saunders Elsevier: 2006:211–214.
39. Lees GE: Use and misuse of indwelling urethral catheters. Vet Clin N Am Small Anim Prac 1996;26:499–505. doi: 10.1016/S0195-5616(96)50080-X
40. Schott HC. Hematuria. In: Sprayberry KA, Robinson NE: editors. Robinson’s Current Therapy in Equine Medicine. 7th edition, St Louis, MO; Saunders Elsevier: 2015:456–459.
41. Menendez MI, Fitch G: Use of a laparoscopic retrieval device for urolith removal through a perineal urethrotomy. Vet Surg 2012;41:629–633. doi: 10.1111/j.1532-950X.2012.00967.x
2. Taintor J, Schumacher J, Schumacher J, et al: Comparison of pressure within the corpus spongiosum penis during urination between geldings and stallions. Equine Vet J 2004;36:362–364. doi: 10.2746/0425164044890571
3. Sullins KE, Bertone JJ, Voss JL, et al: Treatment of hemospermia in stallions: a discussion of 18 cases. Compend Contin Educ Pract Vet 1988;10:1396–1403.
4. Glass KG, Arnold CE, Varner DD, et al: Signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy or corpus spongiotomy: 33 cases (1989–2013). J Am Vet Med Assoc 2016;249:1421–1427. doi: 10.2460/javma.249.12.1421
5. Sisson S: Equine urogenital system. In: Getty, editor: Sisson and Grossman’s the Anatomy of Domestic Animals. 5th edition, Philadelphia, PA; Saunders: 1975:524.
6. Lloyd KC, Wheat JD, Ryan AM, et al: Ulceration in the proximal portion of the urethra as a cause of hematuria in horses: four cases (1978–1985). J Am Vet Med Assoc. 1989;194(9):1324–1326.
7. Beckett SD, Purohit RC, Reynolds TM: Corpus spongiosum penis pressure and external penile muscle activity in the goat during coitus. Biol Reprod 1975;12:289–292. doi: 10.1095/biolreprod12.2.289
8. Pearson LK, Campbell AJ, Tibary A: How to diagnose and treat hemospermia: a review and case series. Proc Am Assoc Equine Pract 2013;59:40–50.
9. Rijsselaere T, Van Soom A, Maes D, et al: Effect of centrifugation on in vitro survival of fresh diluted canine spermatozoa. Theriogenology 2002;57:1669–1681. doi: 10.1016/S0093-691X(02)00663-5
10. Turner CE, Walbornn SR, Blanchard TL, et al: The effect of two levels of hemospermia on stallion fertility. Theriogenology 2016;86:1399–1402. doi: 10.1016/j.theriogenology.2016.04.084
11. Möller G, Azevedo LR, Trein CR, et al: Effects of hemospermia on seminal quality. Anim Reprod Sci 2005;89:264–267.
12. Schott II HC, Woodie JB: Urethra. In: Auer JA, Stick JA, Kümerle JL, et al: editors. Equine Surgery. 5th edition, St Louis, MO; Saunders Elsevier: 2018:940–949. doi: 10.1016/B978-1-4377-0867-7.00066-1
13. Sancler-Silva YF, Silva-Junior ER, Fedorka CE, et al: New treatment for urethral rent in stallions. J Equine Vet Sci 2018;64:89–95. doi: 10.1016/j.jevs.2018.02.014
14. Voss JL, Pickett BW: Diagnosis and treatment of hemospermia in the stallion. J Reprod Fertil Suppl 1975;23:151.
15. Madron M, Schleining J, Caston S, et al: Laser treatment of urethral defects in geldings and stallions used as the primary treatment or in combination with a temporary subischial incision: Eight cases (2003–2011). Equine Vet Educ 2013;25:368–373. doi: 10.1111/eve.12050
16. Hackett ES, Bruemmer J, Hendrickson DA, et al: Buccal mucosal urethroplasty for treatment of recurrent hemospermia in a stallion. J Am Vet Med Assoc 2009;235:1212–1215. doi: 10.2460/javma.235.10.1212
17. Ball BA: Diagnostic methods for evaluation of stallion subfertility: a review. J Equine Vet Sci 2008;28:650–665. doi: 10.1016/j.jevs.2008.10.003
18. Tibary A. Endoscopy of the reproductive tract in the stallion. In: Samper JC, Pycock J, McKinnon AO: editors. Current Therapy in Equine Reproduction. St Louis, MO; Saunders: 2007:214–219.
19. Varner DD, Blanchard TL, Brinsko SP, et al: Techniques for evaluating selected reproductive disorders of stallions. Anim Reprod Sci 2000;60:493–509. doi: 10.1016/S0378-4320(00)00115-9
20. Pinto MR, Neild DM, Benegas D, et al: Successful treatment of seminal vesiculitis with Imipenem-Cilastatin in a Stallion. J Equine Vet Sci 2014;34:544–548. doi: 10.1016/j.jevs.2013.10.001
21. Bedford SJ, McDonnell SM, Tulleners E, et al: Squamous cell carcinoma of the urethral process in a horse with hemospermia and self-mutilation behavior. J Am Vet Med Assoc 2000;216:551–553. doi: 10.2460/javma.2000.216.551
22. Trela JM, Dechant JE, Culp WT, et al: Use of an absorbable urethral stent for the management of a urethral stricture in a stallion. Vet Surg 2016;45:41–48. doi: 10.1111/vsu.12530
23. Fubini SL, Delco M: Surgery of the equine urinary tract. Vet Clin N Am Equine Pract 2022;38:141–153. doi: 10.1016/j.cveq.2021.11.010
24. Diaz-Espiñeira M, Escolar E, Bellanato J, et al: Structure and composition of equine uroliths. J Equine Vet Sci 1995;15:27–34. doi: 10.1016/S0737-0806(07)80577-6
25. Duesterdieck-Zellmer KF: Equine urolithiasis. Vet Clin N Am Equine Pract 2007;23:613–629. doi: 10.1016/j.cveq.2007.09.003
26. Schumacher J, Vaughan JT: Surgery of the penis and prepuce. Vet Clin N Am Equine Pract 1988;4:473–491. doi: 10.1016/S0749-0739(17)30624-7
27. Hawkins JF: Surgical treatment of urolithiasis in male horses. Equine Vet Educ 2013;25:60–62. doi: 10.1111/j.2042-3292.2012.00449.x
28. Laverty S, Pascoe JR, Ling GV, et al: Urolithiasis in 68 horses. Vet Surg 1992;21:56–62. doi: 10.1111/j.1532-950X.1992.tb00011.x
29. Abutarbush SM: Diseases of the Urinary System. Ames, IA; John Wiley & Sons: 2015:559–577. doi: 10.1002/9781119265399.ch11
30. Vigani A, Garcia-Pereira F: Anesthesia and analgesia for standing equine surgery. Vet Clin N Am Equine Pract 2014;30:1–17. doi: 10.1016/j.cveq.2013.11.008
31. Schumacher J, Schumacher J, Schmitz D: Macroscopic haematuria of horses. Equine Vet Educ 2002;14:201–210. doi: 10.1111/j.2042-3292.2002.tb00173.x
32. Schumacher J, Varner DD: Abnormalities of the penis and prepuce. In: McKinnon AO, Squires EL, Vaala WE, et al: editors. Equine Reproduction. 2nd edition, Ames, IA; Wiley-Blackwell: 2011:1130–1144.
33. DeBowes RM: Surgical management of urolithiasis. Vet Clin N Am Equine Pract 1988;4:461–471. doi: 10.1016/S0749-0739(17)30623-5
34. De Bernardis NP, Seabaugh KA, Ismay J, et al: The use of pneumatic impact lithotripsy and a retrieval pouch to create a closed system for removal of cystic calculi in standing male horses. Equine Vet Educ 2019;31:659–665. doi: 10.1111/eve.12843
35. Katzman SA, Vaughan B, Nieto JE, et al: Use of a laparoscopic specimen retrieval pouch to facilitate removal of intact or fragmented cystic calculi from standing sedated horses: 8 cases (2012–2015). J Am Vet Med Assoc 2016;249:304–310. doi: 10.2460/javma.249.3.304
36. Trotter GW, Bennett DG, Behm RJ: Urethral calculi in five horses. Vet Surg 1981;10:159–162. doi: 10.1111/j.1532-950X.1981.tb00652.x
37. Kilcoyne I, Dechant JE: Complications associated with perineal urethrotomy in 27 equids. Vet Surg 2014;43:691–696. doi: 10.1111/j.1532-950X.2014.12169.x
38. Wilson DA, Kramer J, Constantinescu GM, et al: Perineal urethrotomy in males. In: Manual of Equine Field Surgery. St. Louis, MO; Saunders Elsevier: 2006:211–214.
39. Lees GE: Use and misuse of indwelling urethral catheters. Vet Clin N Am Small Anim Prac 1996;26:499–505. doi: 10.1016/S0195-5616(96)50080-X
40. Schott HC. Hematuria. In: Sprayberry KA, Robinson NE: editors. Robinson’s Current Therapy in Equine Medicine. 7th edition, St Louis, MO; Saunders Elsevier: 2015:456–459.
41. Menendez MI, Fitch G: Use of a laparoscopic retrieval device for urolith removal through a perineal urethrotomy. Vet Surg 2012;41:629–633. doi: 10.1111/j.1532-950X.2012.00967.x
Published
2023-07-07
How to Cite
Ruiz A., & Arroyo E. (2023). Perineal urethrostomy in the male horse: a review of the indications, surgical technique, outcome, and complications. Clinical Theriogenology, 15, 58-64. https://doi.org/10.58292/ct.v15.9641
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