Salvage Surgery Including Rectal Wall Vas Deferens Pexy for Recurrent Bilateral Perineal Hernia with Bladder...

Bladder retroflexion associated with perineal hernia may cause urinary dysfunction, and surgical correction can be challenging after repeated procedures because of extensive adhesions and altered anatomy. An 11-year-old, 7.5 kg, castrated male Pomeranian was referred for recurrent bilateral perineal hernia, bladder retroflexion, and persistent urinary dysfunction after multiple perineal and abdominal surgeries. A previous attempt at abdominal bladder reduction and cystopexy had failed because adhesions prevented adequate mobilization of the bladder. During salvage surgery, bilateral perineal adhesiolysis was performed first to release the displaced urinary tract structures, followed by an abdominal approach to restore the bladder to its normal intra-abdominal position. Modified bilateral vas deferens pexy was then performed by fixing the residual vasa deferentia to the rectal wall, and each side of the pelvic diaphragm was reconstructed according to the available tissues and defect configuration. Retrograde urethrocystography performed 8 days postoperatively demonstrated short-term anatomical correction, with restoration of the normal positions of the bladder, bladder neck, and urethra. Urinary function gradually improved but had not completely normalized by 150 days. Without further objective imaging, long-term mechanical stability and prevention of recurrence could not be established. This case describes a multimodal salvage strategy for recurrent bilateral perineal hernia with markedly altered anatomy after repeated surgery.