Wednesday, September 12, 2012

1088. Complications from 3 blocked bladder surgeries

This article shows that different vets may come to a surgical plan for complicatons of blocked surgery differently.

In summary, this 4-year-old Shih Tzu was seen by me as a puppy 4 years ago and treated twice for minor ailments. He had a blocked bladder some 7 months ago and was seen by my associate vet who diagnosed bladder stones after radiography. The owner took his dog to another vet for surgery as this vet was recommended. The vet made a hole in the urethra behind the os penis (lst urethrostomy) and the dog peed through it for the next 7 months. Then it had a blocked bladder with stones and was operated (lst cystostomy) by a vet in big vet practice 4 months ago. The dog developed same problems 3 weeks ago and the same practice operated to remove the stones from the bladder (2nd cystostomy).

However, the whole penis, prepuce and scrotum were swollen and after paying over $2,000, the owner was asked to pay $1,200 for another surgery to open a new hole in the urethra (2nd urethrostomy) as the dog could not pee properly. The owner would not want to spend more money since the stones were removed and X-ray after surgery showed no stones. He could not understand why there was a need for the $1,200 surgery to open another hole further back in the urethra and to close up the first hole done by the first vet.

The niece knew Dr Daniel and so the case came back to Toa Payoh Vets. The owner complained about a big swollen scrotal sac (which had  fluid, according to the vet in the big vet practice, using ultrasound) and a large swelling of over the left inguinal area. Every day for the past 3 days, blood-tinged fluid of 30 ml would be aspirated from this inguinal area. Was it urine or not? Was it peritoneal fluid from a stitch breakdown in the linea alba of the 2nd bladder cystotomy or not?

I sent the SC fluid to the lab for analysis.

I took 2 hours this morning to cut off the infected scrotal sac, tied up the two inguinal rings, removed the two stitches of the original urethrostomy done by Dr Daniel who wanted to close it so that the dog could pee normally from the penile end. I discovered a 2 mm hole and so there could be leakage as well as from the bend of the urethra (only a small cathetheter could be passed through the bend, whereas a bigger one could pass through the penile urethra).

The uncle came again as in the past days, in the evening and asked for explanation. "It took 2 hours just to operate on this dog," I said. "The shorter the anaesthesia, the safer for the dog. No point being the best vet surgeon in the world if the done dies on the operating table due to a lengthy surgery," I advised him. He understood me. This case demanded a lot of communication and only by tomorrow morning will I know if the left inguinal area will swell again, as in the past 3 days.

The lab people phoned me and asked how to check whether the SC fluid is urine or not. "I presume you check for urea," I said. "Oh, you want the chemistry," the lab tech said.

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