Perineal urethrostomy is a surgical procedure used in dogs to treat urinary blockage. Urethrostomy occurs more often in male dogs, but can also be performed on females when their urethra becomes blocked through trauma, stones, or other conditions. Veterinarians will often attempt to treat blockage through other, less invasive, procedures such as prescription medicines or therapy, before attempting a perineal urethrostomy. Once performed, it is considered a permanent solution to urethra blockage but does not treat the underlying condition that originally caused stone or blockage formation. For this reason, some animals may still experience blockage after a perineal urethrostomy, if their condition is severe.

Prior to the surgery, your vet will order a full blood panel on your dog. This will test the blood for diseases or deficiencies that may indicate an underlying condition or create some other complication during surgery. Your dog will also need to be anesthetized during the procedure, and your vet will conduct a thorough physical exam to confirm they are otherwise healthy.

During the procedure, a veterinary surgeon will make a small incision that will be the new location from which your dog will urinate. In male dogs, this is in the perineum, or the area between the rectum and the scrotum. Your vet will excise, or cut into the existing penis, enlarging the opening of the urethra to create a large enough hole for sludge or stones to pass through. The urethra is then rerouted through the new opening. Several stitches will be made in order to seal up the incision and also to anchor the urethra in place. 

In most animals, perineal urethrostomy completely resolves any blockage or trauma. Some dogs may have severe underlying conditions which cause the formation of larger or higher quantities of stones. In some of these cases, dogs may continue to have blockages even after surgery. Additionally, in dogs with stones, perineal urethrostomy treats the symptom, not the underlying condition. Stones may continue to form in the bladder or kidneys which may cause persistent infection or blockage farther up in the urinary tract.

Your dog will need to stay overnight at your veterinarian’s office for monitoring after surgery. After your dog is allowed to return home, they will need to be kept in a quiet and comfortable place in order to allow proper time for their incision to heal. Your dog will also need to wear a cone or similar device to prevent them from worrying or removing the stitches or incision area. 

Your vet will provide an oral antibiotic which should be administered to help prevent any infection after surgery. It is important that you continue to administer the medication until all doses have been given. You should also attempt to keep a routine schedule for giving antibiotics since timing is important to help fight possible infection. Your vet will want to schedule a follow-up exam to confirm the surgery has the desired effect and to remove any stitches, if non-dissolving sutures were used.

Given that this is a major surgical procedure, the costs for perineal urethrostomy can run quite high. Most estimates put the total cost in the range of $2,000 to $3,500. This includes preoperative blood work, surgery, anesthesia, and follow-up medications and doctor visits. Exact costs for your dog will vary depending on weight and age and whether there is any additional trauma to the area that needs to be corrected.

While this is the cost of the procedure itself, may owners will have spent much more in emergency care prior to the procedure to clear previous blockages. In all cases, alternative courses of treatment have proven ineffective and perineal urethrostomy is the only remaining option.

As with any surgery, perineal urethrostomy creates some risk for complication and infection. With proper aftercare and support, most animals will go on to lead long and happy lives. The majority of stone formers will be able to urinate normally and there will be little to no side effects. Some animals may suffer from urine scalding after a perineal urethrostomy. This can be resolved through the use of wipes after your dog urinates and regular cleaning of the area.

There is currently no known method of prevention for urinary stones. Some veterinarians have found limited success in reducing the amount of protein in the diet. In most cases, the cause of stone formation is unknown. Affected animals should be eliminated from the breeding pool to prevent passing on of any genetic conditions.