Urethral Prolapse Repair

Surgical repair is recommended when urethral prolapse does not resolve with supportive care, or when the prolapsed tissue is large, ulcerated, or causing significant bleeding. Reasons the surgical team recommends intervention include:

• Visible bleeding from the tip of the penis or urethral opening that is recurrent or heavy
• The prolapsed tissue is ulcerated, necrotic (dying), or has been present long enough that it cannot be manually reduced
• The pet is excessively licking or straining due to discomfort from the exposed tissue
• Recurrence after initial manual reduction (pushing the tissue back in without surgery)

Concurrent castration (neutering) is usually performed at the same time, because reproductive hormones and sexual excitement are believed to contribute to prolapse events in intact males.

The surgical approach depends on the severity of the prolapse and the condition of the tissue. Options include:

• Reduction and tacking (mucopexy): the prolapsed mucosa is gently reduced back into position and secured with sutures placed through the penile tissue to prevent it from prolapsing again — used when the tissue is still viable and healthy
• Resection and anastomosis: when the prolapsed tissue is necrotic or too badly damaged to save, the affected segment is excised and the healthy urethral edges are sutured to the penile skin, creating a clean union — the reconstruction maintains normal urine flow

Both procedures are performed under general anesthesia with full monitoring, and castration is incorporated into the same anesthetic event whenever possible.

Preparation for urethral prolapse repair is relatively straightforward compared with more complex urinary surgeries:

• A physical examination to characterize the prolapse — how much tissue is involved, whether it is still viable, and whether the urethra is otherwise functional
• Pre-anesthetic bloodwork, particularly in young dogs where underlying conditions are uncommon but should be excluded
• Urinalysis to check for concurrent urinary tract infection
• Discussion of concurrent castration, which is strongly recommended to reduce the likelihood of recurrence
• Food withheld the night before surgery

Recovery from urethral prolapse repair is generally quick, especially in young, otherwise healthy dogs:

• Entire healing period (10–14 days): an e-collar must be worn without interruption — licking the surgical site is the primary cause of complications
• Days 1–7: some blood-tinged urine and mild swelling at the tip of the penis are expected and typically resolve within a week
• Days 1–14: restricted activity; leash walks only to minimize swelling and protect sutures
• 10–14 days: recheck appointment to examine the repair and confirm normal urination

Most pets urinate normally within twenty-four to forty-eight hours of surgery. If the pet is not passing urine or shows signs of straining, contact the hospital immediately.

Urethral prolapse repair is generally a low-risk procedure with a good success rate. Potential complications include:

• Recurrence of prolapse — reduced significantly by concurrent castration and the use of tacking sutures; most recurrences are related to ongoing sexual excitement or straining in intact animals
• Urethral stricture — rare, but more of a concern after resection procedures; normal urinary flow at the recheck visit is reassuring
• Self-trauma leading to suture disruption if the e-collar is removed early

With concurrent castration and careful post-operative management, the large majority of affected dogs recover without recurrence and return to normal, comfortable urination.