Urethrostomy dog

Urethrotomy and urethrostomy in the dog An incision, or urethrotomy, is made into the urethral lumen to remove or relieve an obstruction temporarily. When permanent diversion of urine flow proximal to an obstructed, severely damaged, or diseased urethra is required, a urethrostomy is performed. Urethrostomy is also performed to diminish t Everything You Need to Know About a Urethrostomy in Dogs A urethrostomy is a surgical procedure that creates an opening in the dog's urethra, the tube that carries urine from the bladder. The procedure is done to correct obstruction to urine flow, a life-threatening condition Urethrostomy is a useful procedure to bypass the penile urethra, when a disease such as a stricture, stone or tumor is preventing urination Urethrostomy is most commonly used in male dogs that have developed urinary blockage multiple times In some cases the urethrostomy usually is a permanent and is not reverse Scrotal urethrostomy is preferred over other locations in dogs for the following reasons: The scrotal urethra has the widest diameter, which decreases the risk of postoperative stricture and facilitates postoperative excretion of recurrent calculi

Urethrotomy and urethrostomy in the dog - PubMe

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 Urethrotomy is a surgical procedure to create a temporary opening in the urethra of a male dog. The aim is to retrieve a lodged foreign body such as a bladder stone that has passed down into the urethra The urethra is the tube that carries urine from the bladder out of the body. In the male dog, it passes along the back side of the dog and between the rear legs. Within the penis, the urethra lies within a trough of bone, the os penis, and becomes narrower

Recurrent cystitis is a possibility after scrotal urethrostomy since the urinary stoma is more proximal and larger than normal; this complication was reported in 15% of cases in one study. (Bilbery 1991) Finally, recurrent urethral obstruction is also possible and has been reported in 5% of dogs. (Bilbery 1991 Urethrostomy in the dog can also be performed when penile amputation is necessary for neoplasia or other conditions, such as hypospadias. Several types of urethrostomy have been described for dogs, but scrotal urethrostomy is currently the procedure of choice.(1-3) After castration and scrotal ablation, the urethra is opened at the level of the. This dog had recurrent urinary calculi and had a scrotal urethrostomy to help prevent recurrent obstruction Scrotal urethrostomy is a permanent urinary diversion procedure performed in dogs that have chronic or recurrent urethral blockage due to urinary calculi. Urethral calculi in male dogs may cause partial or total urethral obstruction by lodging in the urethra, usually at the base of the os penis Urethrotomy: is a temporary procedure to bypass the penile urethra when a disease such as stricture, stone or tumor is preventing urination. This procedure is performed in dogs. In dogs, it is the creation of an opening at the base of the os penis near the scrotum which allows the dog to urinate and pass small stones

Animal Surgical Center of Michigan - Veterinarian in Flint, MIPERINEAL URETHROSTOMY - Southpaws

Urethrostomy results in a permanent opening for the urethra and is performed proximal to the site of narrowing, obstruction, or destruction of the urethra. Perform urethrostomy in the male dog in the perineal, scrotal, prescrotal, or prepubic location. • Urethrostomy is most often performed in the scrotal position, because the urethra is wide and superficial at this location. Minimal. The most common surgical procedure in male dogs is known as a scrotal urethrostomy. Please see the additional DVSC page on Perineal Urethrostomy to read about the most common surgical procedure in male cats. A scrotal urethrostomy is a surgically created new opening in the urethra to bypass the narrow area where obstruction usually occurs

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Urethrostomy in Dogs - petplace

  1. In dogs, English Bulldogs seem to have a breed predisposition, possibly as a congenital defect due to abnormal separation of the embryonal cloaca into the urethra and rectum. Clinical signs include hematuria and dysuria secondary to urinary tract infection. Simultaneous passage of urine from the anus and urethra during micturition may be noted
  2. Dr. Don Waldron demonstrates Canine scrotal urethrostomy
  3. In male dogs, urethrostomy can be performed at prescrotal, scrotal, perineal, subpubic and prepubic locations; in female dogs, it is limited to a prepubic location. Scrotal urethrostomy is preferred because the urethra in this region is superficial, wide and has relatively less cavernous tissue, which results in less postoperative hemorrhage
  4. A perineal urethrostomy is a surgical procedure that widens the opening of the urethra (the tube that carries urine from the bladder to outside of the body) and it is performed on both cats and dogs. In male cats, the urethral canal becomes narrow and can be prone to blockages from mucous plugs, stones or sediment in the urine

Animal Surgical Center of Michigan - Veterinarian in Flint, M

A perineal urethrostomy (PU) is a surgical procedure that is most commonly performed on male cats with a urinary obstruction. Male cats develop urinary obstructions much more readily than female cats, due to differences in urinary tract anatomy between the two sexes. A PU creates a new urinary opening that decreases the length of the urethra and allows urine to bypass this narrowed region Recently completed scrotal urethrostomy on a dog. Urethrostomy is a surgical procedure that creates a permanent opening in the urethra, commonly to remove obstructions to urine flow. The procedure is most often performed in male cats, where the opening is made in the perineum

Scrotal urethrostomy is the location of choice for urethrostomy in dogs. It is a convenient location for surgical manipulation, this area of the urethra generally bleeds less, the urethral diameter will accommodate passage of most urethral calculi, and there is less urine scald postoperatively Urethrostomy in female dogs or cats is limited to a prepubic location. Figure 117-8 Perineal urethrostomy in the male dog. A, The dog is placed in a perineal position with the tail pulled forward. B, The retractor penis muscle is exposed and retracted, and the urethra is incised on the midline For this reason, many owners of dogs with cystinuria who form stones opt for a scrotal urethrostomy even if their dog is not obstructed, because with this procedure, male dogs will tend to pass stones the way female dogs do, and the risk of obstruction is reduced, or even eliminated. (Female dogs with cystinuria rarely get a urinary obstruction. As previously mentioned, the Perineal Urethrostomy surgery is defined as a salvage procedure to allow for your pet to urinate. Since an enlarged prostate gland can potentially impair urination and the new surgically created exit that allows for urination will be located along the scrotum in males, neutering your cat is mandatory ($35) Urethrotomy and Urethrostomy in the Dog Daniel D. Smeak, DVM, DACVS An incision, or urethrotomy, is made into the urethral lumen to remove or relieve an obstruction temporanly. When permanent diversion of urine flow proximal to an obstructed, severely damaged, or diseased urethra is required, a urethrostomy is performed

Prepublic urethrostomy in the dog and cat, when used in the appropriate condition, can provide excellent urinary function. Nine animals, two dogs and seven cats, are presented here as a clinical. Four dogs had minor complications recorded at suture removal (minor dehiscence (n=1), mild bruising and swelling around the urethrostomy site and mild haemorrhage at suture removal (n=2), and granulation at the edge of stoma (n=1)). One dog had a major complication (wound dehiscence and subsequent stricture of the stoma) Bilbrey S A, Birchard S J & Smeak D D (1991) Scrotal urethrostomy - a retrospective review of 38 dogs (1973-1988). JAAHA 27 (5), 560-564 AGRIS FAO. Dean P W, Hedlund C S, Lewis D D et al (1990) Canine urethrotomy and urethrostomy. Comp Cont Ed Pract Vet 12 (11), 1541-1554 VetMedResource. Other sources of informatio

How Is a Urethrostomy Performed? In intact male dogs, the scrotal urethrostomy procedure will begin with neutering. Once the male is neutered, the vet will make an incision site at either the penile body or perineum. This is called a perineal urethrostomy. The difference between these two will be the location of the urethral opening A prescrotal urethrostomy creates an opening between the prepuce and scrotum. The animals penis is left intact, and in most cases, the dog will continue to demonstrate the same behaviors, even though the urine is voided from a different area. What is the post-operative care for a urethrostomy Urethrostomy - Dog Procedure Pre-scrotal, scrotal, perineal and prepubic Elliptical incision at base of scrotum/remnant Dissect to urethra and incise over catheter (3-4cm in length) Tacking sutures to pull urethra ventrally SC or SI small gauge non absorbable - mucosa to skin • Bilbrey SA, et al. Scrotal urethrostomy: a retrospective review of 38 dogs (1973-1988) The urethra is the tube that carries urine from the bladder out of the body. In the male dog, it passes along the back side of the dog and between the rear legs. Within the penis, the urethra lies within a trough of bone, the os penis, and becomes narrower. Calculi (stones) that develop within the urinary tract will often become stuck within the urethra behind this bone Urethrostomy in female dogs or cats is limited to a prepubic location. Figure 117-8 Perineal urethrostomy in the male dog. A, The dog is placed in a perineal position with the tail pulled forward. B, The retractor penis muscle is exposed and retracted, and the urethra is incised on the midline

Canine Urethrostomy Veterinary Surger

Perineal urethrostomy is a surgical procedure that is performed on males to create a permanent opening into the urethra through an incision in the skin of the perineum. The perineum is the area of skin between the scrotum and the anus. The urethra is the tube like structure through which urine passes from the bladder through the penis to exit. Intermittent urine scald, recurrent urinary tract infections, and recurrent obstruction from struvite calculi were each noted in 20% of dogs after scrotal urethrostomy in one report. 85 Stricture is rare and is likely a result of a previous insult (e.g., calculus), poor surgical technique, or postoperative self-trauma Differential diagnosis may include frequent erections seen in young small-breed dogs and early paraphimosis. Elimination of the primary cause is the goal of treatment. However, spontaneous remission may be seen. Amputation of the penis and scrotal urethrostomy may be necessary if the underlying cause cannot be identified and corrected 21 of 27. 22 of 27. 21-04-30-00254 D057 CHARLEY and RED (m) (male) Dachshund. Salt Lake County, UT ID: 21-19,20. 21-04-30-00254 D057 CHARLEY and RED (m) (male) ID: 21-19,20. Dachshund. Charley and Red are a BONDED PAIR that must be adopted together. Charley is the brown and white piebald dachshund -..

Transpelvic urethrostomy using an ischial ostectomy has been performed by specialist surgeons with good results. 11. However, this radical approach was not a treatment the author was familiar with or comfortable performing. Scrotal or perineal urethrostomy in the dog is a widely recognised and well-documented procedure SPAY - DOG - $235 (in addition to other procedure) SPAY - DOG - $375 . If your pet is in heat - Pyometra pricing will apply. Spay is the term used for removal of the uterus and ovaries. This procedure is usually recommended for young pets as a preventative measure, not only to prevent pet overpopulation, but for many medical reasons. A perineal urethrostomy will decrease the likelihood of future obstruction but will not prevent the symptoms of cystitis or lower urinary tract disease that already may be present. The potential complications of surgery include the development of bleeding or swelling at the surgery site (usually transient) and stricture (scarring and narrowing.

Preputial urethrostomy is also easier to perform in those dogs in which penile amputation is required adjacent to the preputial fornix. A release incision cranial to the prepuce can be used to facilitate caudal displacement of the preputial mucosa, which facilitates urethral anastomosis to this structure Depending on the site of the lesion, ureterostomy can be prescrotal, scrotal, perineal, or prepubic in dogs. Scrotal urethrostomy is preferred if castration is an option and if the lesion is distal to the scrotum. Perineal urethrostomy is routinely performed in cats; however, prepubic and subpubic urethrostomy procedures are also described

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Veterinarian Response: You can see incontinence in this situation occasionally but it probably is not nerve damage from the surgery; more likely a result of bladder atony. The sphincter of the urethra is at the base of the bladder, not at the end of the urethra. When cats get blocked he is not able to urinate and the bladder gets distended Scrotal Urethrostomy for Urethral Obstruction Your dog has undergone a procedure called a scrotal urethrostomy. This means a new exit hole has been made for the urine, below the anus and between the rear legs. The procedure is performed when a male dog repeatedly re-obstructs and cannot urinate on its own urethrostomy are discussed. This technique was used in the treatment of 55 cats with penile urethra obstruction presented to our clinic. Among them 52 cats showed uncomplicated recovery. Following anastomosis, a male dog urethral catheter with an outer diameter of 2.6 mm was placed in each patient

Perineal Urethrostomy in Dogs - Conditions Treated

  1. Perineal UrethrostomyDescription Figure 1 A perineal urethrostomy (PU) is the surgical formation of a permanent opening of the urethra at the perineal surface. Urethrostomy can be performed in the prescrotal, scrotal, perineal, or prepubic areas in dogs, depending on the location of the lesion. Indications A perineal urethrostomy is indicated for recurrent, obstructive calculi tha
  2. Wong, W. T. (1984) Perineal Urethrostomy in a Dogwith a Severed Penis. Pertanika, 7 (3). pp. 47-48. Abstract. The successful surgical management of a dog with a severed penis is reported. The principles and technique of perineal urethrostomy in the dog are discussed. Download File. Preview. PDF.
  3. Old dogs with pendulous scrotums. Scrotal urethrostomy. Feline perineal urethrostomy. Severe scrotal hematoma after routine castration . Testicular disease (orchitis Orchitis / epididymitis, neoplasia Testicle: neoplasia) extending into scrotal tissue. Advantages. Simple. Quick. Relatively complication-free. Disadvantage
  4. Antepublic urethrostomy in the dog. Yoshioka. J Am Anim Hosp Assoc 1982 Comparison of the healing of prescrotal urethrotomy incisions in the dog: sutured versus nonsutured. Weber WJ, Boothe HW, Brassard JA, Hobson HP. Am J Vet Res, (6):1309-1315 1985 MED: 3927800.
  5. ant Indications. Perineal urethrostomy can be used for obstructive urolithiasis. Perineal urethrotomy (not sutured to skin) can be performed as a temporary measure, maintaining fertility in males. PU is a short term fix in most ru

The prepubic urethrostomy procedure has been shown to be a long-term diversion technique in dogs with intrapelvic urethral damage. This case report describes the clinical presentation and successful surgical man - agement of an intrapelvic urethral stricture in a four month old male intact Labrador Retriever with hypospadias. The dog was presented for assessment of dysuria, stranguria, urinary. Four dogs had minor complications recorded at suture removal (minor dehiscence (n=1), mild bruising and swelling around the urethrostomy site and mild haemorrhage at suture removal (n=2), and.

Urethrotomy in Dogs - Conditions Treated, Procedure

A Perineal Urethrostomy is a surgery performed on male cats who have a urinary blockage. Urinary obstruction may be caused by small stones, crystals, mucus, or severe inflammation. If blockage cannot be relieved, or if the cat has repeat episodes of urinary obstruction, then we perform Perineal Urethrostomy to alleviate the problem A urethrostomy is the creation of new and permanent urethral orifice. The three urethrostomy locations in the male dog are prepubic, scrotal and perineal. The perineal region is by far the least desirable both because of the problem of urine leakage and urine scaled of the perineal skin and scrotum and because of the difficulty of suturing of.

Urinary Obstruction in Dogs American College of

  1. Traditional technique for perineal urethrostomy. Step 1. Position the cat in perineal position, with padding under the cranial thighs to prevent neurovascular injury during restraint. Aseptically prepare the perineal area, which usually requires removing the urinary catheter if one was placed before surgery. Step 2
  2. The dogs aren't so sure about the cat having the whole upstairs to himself though! I have let one dog up at a time to visit with him (so he isn't too bombarded). They are still a bit suspicious, as his incision must smell funny to them. And, of course, Rocky doesn't want dog noses in his bottom (who can blame him!
  3. Your dog will need to take antibiotics for 4 to 6 weeks with many different urine tests to ensure that the infection is clearing up. Your dog would need to make sure that your dog is eating and drinking water every day to recover. If your dog also has kidney disease along with their kidney infection, they may need to eat a kidney-focused diet
  4. DOI: 10.1111/j.1748-5827.2010.00912.x Corpus ID: 30579287. Transpelvic urethrostomy in a Staffordshire bull terrier: a new technique in the dog. @article{Liehmann2010TranspelvicUI, title={Transpelvic urethrostomy in a Staffordshire bull terrier: a new technique in the dog.}, author={L. Liehmann and R. Doyle and R. M. Powell}, journal={The Journal of small animal practice}, year={2010}, volume.
  5. Informational Videos Common Orthopedic Procedures: Cruciate Ligament Repair (Extracapsular Repair, TTA, TPLO) Femoral Head Ostectomy (FHO) Fractured Bone Repair Patella Luxation Correction Soft Tissue Surgeries: Laryngeal Paralysis Anal Sacculectomy Cystotomy Perineal Urethrostomy (PU) - Cat Scrotal Urethrostomy - Dog Subtotal Colectomy - Cat Total Ear Canal Ablation Don't se

Canine Urethrostomy - Post-op Veterinary Surger

A urethral obstruction is a serious, life-threatening condition, therefore urethtrostomies are often performed on an emergency basis. In male cats, a perineal urethrostomy, or PU, is performed and in dogs a scrotal urethrostomy is performed A urethrostomy is a surgical procedure that creates an opening in the urethra, the tube that carries urine from the bladder. The procedure is done to correct obstruction to urine flow, a life-threatening condition. Even partial obstruction to urine flow can lead to serious complications such as urinary tract infection and loss of bladder tone

URETHROSTOMIES Karen Tobias, DVM, MS, DACVS University of Tennessee, Knoxville TN Canine Scrotal Urethrostomy Scrotal urethrostomy is most commonly performed in dogs with recurrent cystic and urethral calculi. Other indications include penile neoplasia, trauma, or urethral stricture. In dogs, the scrotal urethra is wide, distensible, and superficial, which makes it the preferred site for. Creation of a urethrostomy on the ventral body wall cranial to the pubis Indications-Recurrent pelvic urethral obstruction-Failed perineal urethrostomy that cannot be revised Ventral midline in female dogs and all cats Parapreputial in male dogs Complications:-Urine scald-UTI (lifelong Abx)-Incontinenc Every owner of a male cat should be familiar with this emergency condition. The recognition of straining to urinate is the key. Urine flow must be re-established by trained veterinary personnel to prevent death

Veterinary Key Points: Scrotal Urethrostomy in Dogs: Good

Perineal urethrostomy (PU) in the cat

Scrotal urethrostomy in a dog with recurrent urinary

The dog was maintained on a systemic antibiotic. To prevent self-inflicted trauma to the urethrostomy site an Elizabethan collar was used and a tranquil­ lize~ given for 7 days. The dog recovered une­ ventfully and when examined 8 weeks later did not show any evidence of stricture or urine scald. DISCUSSION Urethrostomy in dogs is not a commonl Perineal urethrostomy in cat, and scrotal urethrostomy in dog, are selected surgical procedures to treat urethral obstruction in those species. When they are not feasible, antepubic urethrostomy (AU) should be considered. We have performed AU on three castrated male cats with urinary obstruction and a male dog with pelvic urethra damage. a salvage procedure in dogs that required a prepubic urethrostomy secondary to intrapelvic urethral trauma with subsequent stricture formation (2). Pavletic and O'Bell applied preputial urethrostomy to a dog with penile necrosis (5). To our knowledge, these are the only published reports of the use of preputial urethrostomy in dogs

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How to perform a scrotal urethrostomy and stop the stone cycl

Prolapse of the urethral mucosa is a rare condition that occurs in male dogs. Young, intact, brachycephalic dogs, such as bulldogs or Boston terriers, are commonly affected. The cause of the prolapse in most cases is unknown, but may be related to excessive sexual excitement or underlying urogenital disorders such as urethritis or urethral calculi Pyelonephritis is an upper urinary tract infection. Many dogs have no clinical signs when they have pyelonephritis, although they may have signs of lower urinary tract disease. Pyelonephritis is usually caused by a bacterial infection that moves up the urinary tract from the bladder to the kidneys. There are several developmental, medical, and procedural conditions that increase the risk for. KC Ronkette. Surgical Nurse. KC came to MVSS in 2017 from Small Miracles Cat and Dog Rescue. KC has been providing nursing care for animals in the veterinary field since 2004. Learn More. Ilene Windman, RVT (2004) Surgical Nurse. Ilene joined the MVSS family in 2018 with 21 years experience in the veterinary field

Urethrostomy and Urethrotomy - Metropolitan Veterinary Cente

This is the dreaded cruciate ligament surgery in dog knees. All by itself, this surgery is a multi-billion dollar a year veterinary industry. Seeing as it's the most common surgery they perform, it's now become the vet surgeon's bread and butter, which is probably why a vet surgeon will always be the best choice should your dog need one Specialties: Advanced specialty surgeries for dogs and cats, including but not limited to: knee surgeries(TTA, TPLO, extra-capsular repair, Tightrope), hip surgeries, TPO, patellar repair, fractures, spinal surgeries, total hip and knee replacements, GI surgeries, ENT surgeries such as for chronic ear infections, laryngeal paralysis and oral tumors, thyroid surgery, mass removal, hernia repair. urethrostomy.pdf What does this procedure involve? A perineal urethrostomy (pictured right) creates a new urethral opening in the perineum (the skin between the scrotum and the anus). This means that your urine does not need to pass along the entire length of the urethra in the penis. It is a good option for men who do not wan pseudohermaphrodite in a dog treated with clitoridectomy with urethrostomy. Case : A 7-month-old, mixed-breed dog was referred due to the presence of a flaccid structure similar to a small penis, containing an os clitoris , bulbourethral glands, and urethra protruding from the vulva

Urethrostomy in a street dog after traumatic penis damage Urogenital surgery Kutlis, an eleven year old, 9kg, Lithuanian street dog, presented with acute urinary outflow obstruction. A bite wound months before had led to him losing the front half of his penis. He had reportedly been managing to pee until a couple of days before we saw him Urethritis is a condition that occurs in dogs when they suffer inflammation of the urethra. Urethritis can make it difficult for your dog to urinate, and it has a number of causes. Read on to learn more about urethritis in dogs. Causes of Urethritis in Dogs. Urethritis usually occurs due to an infection or cancer in or near the urethra Take This Urethrostomy Quiz Give 3 responses to this question. June 9, 2016. By PHIL ZELTZMAN, DVM, DACVS, CVJ. Postop picture of a 7-year-old male Yorkie. A permanent urethrostomy in a male dog is preferably performed in the scrotal area. Give 3 reasons for that preferred location. Pages: 1 2. Suggested Veterinary Products. DR Wizard 2.0..

Clitoridectomy and Urethrostomy in a Pseudohermaphrodite Dog Background : Hermaphroditism is a rare congenital disease that causes ambiguous sexual features. True hermaphrodites have testicular and ovarian tissue, whereas pseudohermaphrodites have only one type of gonadal tissue, genitalia, but secondary characteristics of the opposite sex FELINE PERINEAL URETHROSTOMY (DORSAL RECUMBENCY) Our preferred technique is a slight variation on the traditional PU described by Wilson and Harrison in 1971. 2 In this variation, the cat is placed in dorsal recumbency instead of the standard perineal approach. This positioning is more ergonomic for the surgeon, and allows access to the ventral.

my 7 yr old male chihuahua had a urethrostomy and was castrated and sent home with no aftercare instructions. he is bleeding alot- how do i clean him? will the urethrostomy close up? will he urinate only out of the hole the doctor made right under his anus? i am worried to death- this cost over $700 and the vet doesnt return my phone calls, etc. this has been a nightmare, i love my dog and i. Tips and tricks for improving the success rate of a urolith retropulsion in a male dog are detailed. Narrated slides are used to demonstrate how to do a urethrotomy and a urethrostomy. Once you register for this course you will receive a passcode via email. This passcode will give you access to all the course materials. There is no expiry date Apply sterile lubricant to a 10-french, male dog catheter and insert it into a foley catheter to act as a stylet for insertion to the catheter into the urethra. Select a foley catheter with a 30-ml cuff and of the largest diameter that will pass into the urethra, usually 20 to 28 french in adult bulls 2. If your dog is prone to urate stones, consider switching to a low-purine home-prepared diet. 3. Avoid low-protein prescription foods when they are unnecessary or ineffective at preventing stone formation. 4. For male dogs who continue to form stones, consider urethrostomy surgery to greatly reduce the risk of obstruction

One of these is known as perineal urethrostomy also referred to as PU. In medical terms, tomy means opening. Thus, this procedure means to create an opening in the urethra, with the incision located in the perineum, between the scrotum and rectum of the animal, more often in cats and dogs perineal urethrostomy. Deciding if or how to treat SBU in dogs and cats is often challenging. Treatment of SBU is not usually indicated (see below). Pyelonephritis is defined as an infection of the renal pelvis and surrounding renal parenchyma and is also referred to as upper UTI.7 Differentiation of pyelonephritis fro Welcome to Askmyvet.net! This site is dedicated to bringing pet owners and animal lovers the latest, FREE expert pet health information and pet advice for dog care, cat care and other pets. Find answers to all your pet questions with our extensive information section and enjoy access to our pet resources such as our pet diagnostic tool. Cat and Dog euthanasia (without owner present): $90* Cat and Dog euthanasia (owner present): $120* *euthanasias include communal cremations; the cremains are spread in the mountains near Idaho City. Clients may choose to purchase a private cremation for an additional fee, so they may have the cremains returned