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Jurnal Laporan 3
Jurnal Laporan 3
Jurnal Laporan 3
C
linically, urethral obstructions typically occur because of a mucus
plug, calculus, or stricture. Other causes include a mechanical
obstruction secondary to urethral spasm or a neoplastic process.
While both male and female cats may develop clinical signs consistent with
lower urinary tract disease (eg, stranguria, hematuria, pollakiuria), the
male urethra is narrower, longer, and predisposed to obstruction.
Pathophysiology
The most common cause of urethral obstruction in cats is an underlying
idiopathic sterile cystitis. Idiopathic cystitis may result from a neurohu-
moral alteration, notably an imbalance between the sympathetic nervous
system and the hypothalamic–pituitary–adrenal axis, causing blood flow
alterations, increased circulation of inflammatory mediators and subse-
quent edema, smooth muscle spasm, and discomfort. Ultimately, the combination of inflamma-
tion, a mucus plug, and urethral spasm can result in urethral obstruction.
More severe systemic signs may include weakness, collapse, and cardiac arrhythmia. Hyperka
lemia, common in cats with prolonged obstruction, affects the electrical conduction through the
heart by raising the resting membrane potential of myocytes. As the resting potential becomes less
negative, sodium channels are affected, resulting in bradycardia. Severe hyperkalemia may result
in bradycardia, sinoatrial arrest, and the potential for asystole.
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desirable (eg, heart disease), propofol be as high as 100 to 150 mL/hr. Some cats cats have a true bacterial urinary tract
can be substituted. After the patient has require high fluid rates to match the sig- infection on presentation, and inappro-
been sedated or anesthetized, urinary nificant urine production. priate antibiotic use may result in a
catheter placement can begin. drug-resistant infection. Urine culture
Other important postprocedural treatment should be submitted if the urinalysis sed-
Postprocedural Care goals include pain management (buprenor- iment examination shows evidence of
Most patients remain hospitalized for 36 phine, 10–15 µg/kg IV q4–6h or butorpha- bacteria, either via cystocentesis or after
to 48 hours for continued monitoring nol, 0.1–0.4 mg/kg IV q4–6h), urethral initial catheterization.
(including urine volume), balanced spasm treatment (phenoxybenzamine,
fluid therapy, and assessment of urine 0.25–0.5 mg/kg PO q12–24h; prazosin, Renal values (blood urea nitrogen, creati-
character. 0.25–1 mg PO q8–12h), and electrolyte nine) are often evaluated q24h, with
monitoring. Electrolytes should be moni- abnormalities expected to resolve in 24 to
Patients with more serious illness or azo- tored q12–24h, or more often if significant 48 hours with appropriate fluid therapy
temia are also monitored for postobstruc- abnormalities exist. Hyperkalemia may be and urinary volume monitoring, pro-
tive diuresis, a clinical syndrome leading noted on presentation, but hypokalemia vided there is no underlying renal
to significant urine production resulting may be seen after obstruction relief and disease.
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from osmotic diuresis and medullary postobstructive diuresis.
washout. These patients must be moni-
tored closely, as their urine volume may Antibiotics are often unnecessary; few PTFE = polytetrafluoroethylene
Step 1
Author Insight Gentle
Place the patient in lateral massage of the extruded
or dorsal recumbency. If penis is advised before
there is significant fur catheter placement as a
around the prepuce, clip mucous plug or small ure-
gently to maintain a sterile thral stone is often mas-
field. Pull the prepuce cau- saged out of the urethra,
dally to straighten out the relieving the obstruction
urethra so that it is parallel and allowing for easier
with the spine. catheter placement.
Step 2
Author Insight The
Without excessive force, amount of saline used to
insert a lubricated flush the bladder varies.
3.5-French semirigid, Some clinicians flush
open-ended polypropylene until the aspirated urine
urinary catheter into the runs clear. However, a
tip of the urethra (A) and bladder that is very
advance it to the site of inflamed may have
obstruction (B). Once the sloughing, which could
catheter is inserted into the A lead to worsening inflam-
distal penis, flush gently mation and blockage.
using 0.9% sterile saline to
relieve the obstruction and
then advance the catheter
into the bladder (C).
Author Insight
Catheter placement may
require several tries.
The clinician must be B
patient to avoid ruptur-
ing the urethra.
Step 4
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PTFE = polytetrafluoroethylene
Step 5
Place stay sutures into the prepuce (A), then place white adhesive (waterproof) tape on the red rubber catheter adja-
cent to the prepuce (B). Use nylon (nonabsorbable) suture to secure the white tape to the stay sutures (C and D).
A B
C D
Author Insight The method used to attach the indwelling catheter to the prepuce depends on the catheter
type. A PTFE (Slippery Sam) catheter with end hole has a flange near the end with preplaced holes for suture
material to pass through. A red rubber (feeding tube) catheter (pictured here) requires adhesive (waterproof)
white tape for suturing.
Step 6