수컷 개에서 발생한 요도 조임근 기능 부전에 의한 배뇨실금의 방광 고정술을 이용한 외과적 치료 증례

Cystopexy to Treat Urinary Incontinence Due to Urethral Sphincter Mechanism Incompetence in a Male Dog

  • 윤헌영 (건국대학교 수의과대학 수의 외과학교실) ;
  • 신동욱 (건국대학교 수의과대학 수의 외과학교실) ;
  • 정순욱 (건국대학교 수의과대학 수의 외과학교실)
  • Yoon, Hun-Young (Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University) ;
  • Shin, Dong-Wook (Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University) ;
  • Jeong, Soon-Wuk (Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University)
  • 심사 : 2014.10.07
  • 발행 : 2014.12.31

초록

배뇨실금, 변비를 보이는 중성화된 수컷 요크셔테리어가 내원하였다. 신체검사에서 배뇨곤란 증상이 확인되었고 신경학적 이상은 발견되지 않았다. 또한 요검사에서 세균이 확인 되지 않았으며 직장 검사에서 정상 크기의 전립선을 확인 할 수 있었다. 요도 카테터는 저항감 없이 삽입 되었으며 비뇨기계 조영 촬영에서 골반강 내에 위치한 방광이 확인 되었다. 이소성 요관과 같은 선천적 이상은 확인 되지 않았으며 골반강 내 방광을 동반한 요도 조임근 기능 부전증이 진단 되었다. 방광을 복강내 정상 위치로 환납하기 위한 방광 고정술이 결정 되었다. 와욕 봉합을 이용 방광목 부분을 복벽 및 치골 앞 인대에 고정하였으며 추가적으로 방광 외측 부분을 복벽에 고정하였다. 방광 상단 부위는 복벽 절개창 부위에 고정 하였다. 수술 후 배뇨를 돕기 위해 방광내 카테터를 장착하였으며 수술 후 3일 째 제거하였다. 카테터 제거 후 3 일째 정상 배뇨가 확인되었으며 수술 후 2 달째 방광 조영 촬영을 통해 방광이 복강 내에 정상적으로 위치한 것을 확인하였다. 보호자와의 지속적인 전화 통화를 통해 수술 후 3년 11개월까지 정상 배뇨를 확인하였다.

A castrated male Yorkshire Terrier dog was presented for urinary incontinence and constipation. On physical examination, the dog showed difficult urination. There were no neurological abnormalities and no bacterial detection on urinalysis. Rectal examination revealed a regular, normal-sized prostate. Urethral catheterization was performed easily. Excretory urography and retrograde positive contrast urethrocystography showed displacement of the urinary bladder to the intrapelvic region. There was no evidence of an ectopic ureter. A tentative diagnosis of urethral sphincter mechanism incompetence accompanied with a pelvic bladder was made. Cystopexy was decided to place the urinary bladder to its normal position. The neck of the urinary bladder was anchored to the body wall and prepubic tendon using mattress sutures. Additional sutures were placed to appose the lateral part of the urinary bladder and abdominal wall. A simple interrupted suture was placed to tack the apex of the urinary bladder on the abdominal incision line. A urinary catheter was placed in the urinary bladder to provide post-operative evacuation. The catheter was removed when the dog was able to urinate with minimal straining at 3 days post-operatively. The owner reported that the dogs showed normal urination without straining at 3 days after the catheter was removed. Excretory urography revealed that the urinary bladder was located on its normal position at 2 months post-operatively. Subsequent communication with the owner by telephone revealed that the dog was in good urination at 3 years 11 months post-operatively.

키워드

참고문헌

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