Scrotal Urethrostomy

Scrotal urethrostomy is chosen when the penile or pre-scrotal urethra is too damaged, scarred, or obstructed to function, and when the problem cannot be resolved with catheterization or less invasive management. Specific indications include:

• Urethral stricture (scarring) from repeated catheterizations, trauma, or infection that permanently narrows the lumen
• Irreparable urethral trauma — from dog bites, pelvic fractures, or urethral tears
• Large urethral stones lodged within or proximal to the penile urethra that cannot be flushed or removed endoscopically
• Urethral tumors limited to the penile segment where local excision is not feasible

Because the scrotal urethra is anatomically the widest portion of the male canine urethra, a stoma (opening) created there is much less prone to recurrent obstruction than one created farther down toward the penis tip.

Scrotal urethrostomy is performed under general anesthesia with full monitoring. In intact (unneutered) dogs, the scrotum and testes are typically removed at the same procedure before the urethrostomy is performed. The major steps include:

• The scrotal skin is incised and the urethra is exposed at this naturally wide region
• An incision is made directly into the urethra, opening it longitudinally
• The edges of the urethral mucosa are sutured directly to the surrounding skin with fine, absorbable sutures — creating a smooth, permanent stoma
• A catheter may remain in place for one to three days to protect the new opening during early healing
• Damaged or diseased tissue distal (closer to the tip) to the new opening is removed if indicated

Because dogs requiring scrotal urethrostomy often have concurrent kidney stress from obstruction, stabilization may precede formal surgery planning:

• Bloodwork including kidney values (BUN, creatinine), electrolytes, and a complete blood count
• Urinalysis and urine culture — infection is common when obstruction has been present
• Radiographs to locate urethral stones and evaluate the bladder
• Abdominal ultrasound to assess the bladder and upper urinary tract for concurrent disease
• IV fluid support if kidney values are elevated before surgery proceeds
• Food withheld the night before; IV fluids continued throughout the perioperative period

Dogs typically stay in hospital one to two nights after scrotal urethrostomy. Key home care steps include:

• Entire healing period (10–14 days): an e-collar must be worn at all times — licking the new opening is the leading cause of stricture complications
• Days 1–14: rest and leash-only activity to minimize swelling and protect sutures
• Days 1–10: some blood-tinged urine from the new opening is normal and expected
• 10–14 days: recheck visit for suture removal and assessment of urinary flow

Normal-appearing urination should establish itself within one to two weeks as swelling resolves. If urine flow seems weak or the stream is narrow, contact the hospital promptly — early stricture is most successfully managed quickly.

Scrotal urethrostomy is a durable solution with good long-term outcomes when performed for appropriate indications. Risks to be aware of include:

• Stoma stricture — the most important complication, nearly always caused by self-trauma (licking); the e-collar is essential
• Urinary tract infection — the wider, shorter urethral opening is somewhat less resistant to ascending bacteria; annual urinalysis is recommended
• Post-operative hemorrhage from the vascular scrotal region — usually minor and self-limiting
• Urine scald if the stream direction changes significantly, though dogs typically adapt posture naturally

For dogs with urethral cancer, the prognosis also depends on tumor staging and whether the disease is localized. The surgical team discusses the full picture with owners before proceeding.