Surgery is usually required to remove uroliths or relieve the blockage. Farm management practices should also be reviewed to determine whether diet or other factors could increase the risk of urolithiasis within the herd.

Urethral Process Amputation:

The urethral process is a very short, narrow tube-like structure on the tip of the penis, and because of its location and size is the most common site for uroliths to obstruct. “Amputation” or removal of this process with a scalpel blade may allow uroliths within this process to pass, but recurrence of obstruction is likely, particularly if uroliths are also present higher up in the urethra. If this is the case, additional surgical procedures are needed.

Perineal Urethrostomy:

The urethra and its surrounding tissues can be easily felt in the back end (“perineum”) of sheep and goats 2-3 inches below the anus and just behind the rear legs. When uroliths block the penis or when the urethra has ruptured downstream from this area, a new opening can be made in this location to allow the animal to urinate like a female. This procedure is sometimes performed under heavy sedation with regional anesthesia (nerve blocks), but in valuable animals or pets it is often performed under general anesthesia. An incision is made through the skin and into the urethra, and the new urethral opening is sewn directly to the skin. The animal then urinates down and backwards instead of forwards.

Tube Cystostomy:

In animals with urethral obstruction or rupture, urine must be diverted away from the urethra to allow swelling to subside and tissues to heal. Tube cystostomy involves surgically placing a rubber tube in the bladder and exiting the tube through the belly wall adjacent to the prepuce (Figure 4). This procedure is performed in conjunction with urethral process amputation and surgical removal of uroliths from the bladder. Once the swelling in the urethra has resolved, any uroliths that were not removed at surgery often pass in the urine either through the urethra or the tube. Once the animal is healed, the tube can be removed.

Although a tube cystostomy may be performed with sedation and local nerve blocks, general anesthesia is often used. This permits optimal sterile technique and time to remove uroliths from the bladder or repair it if it has ruptured, and allows the surgeon to thoroughly flush the abdomen before placing the tube. Once the tube is in place, it can be attached to sterile collection system or covered with a one-way valve to allow urine excretion.

Prepubic Cystostomy:

For animals that have strictured (narrowed) perineal urethrostomy sites and subsequent re-obstruction, a permanent opening can be made between the bladder and the belly wall near the prepuce. This procedure is also called bladder “marsupialization”.

Urethral Translocation:

This complicated procedure involves attaching the urethra in the belly to the lower half of the penis or prepuce. It can be attempted to “by-pass” a ruptured urethra (or failed urethrostomy).

Because of potential complications, advanced urethral surgeries may require specialized training, particularly when the patient is a valuable breeding animal or beloved pet. Your veterinarian will recommend/refer you to the appropriate facility with an ACVS board-certified veterinary surgeon experienced in these techniques.