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Evaluation of palliative stenting for management of malignant urethral obstructions in dogs

Chick WeisseSection of Small Animal Surgery, Department of Clinical Studies–Philadelphia, University of Pennsylvania, Philadelphia, PA 19104-6010

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 VMD, DACVS
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Allyson BerentSection of Small Animal Medicine, Department of Clinical Studies–Philadelphia, University of Pennsylvania, Philadelphia, PA 19104-6010

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Kim ToddSection of Small Animal Surgery, Department of Clinical Studies–Philadelphia, University of Pennsylvania, Philadelphia, PA 19104-6010

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Craig CliffordRed Bank Veterinary Hospital, 197 Hance Ave, Tinton Falls, NJ 07724

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Jeffrey SolomonSchool of Veterinary Medicine, and the Section of Vascular and Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA 19104-6010

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Abstract

Objective—To evaluate use of balloon-expandable and self-expanding metallic stents in management of malignant urethral obstructions in dogs.

Design—Original study.

Animals—12 dogs with malignant urethral obstructions.

Procedures—The extent and location of urethral obstructions and the diameter of adjacent unaffected luminal segments were determined by use of fluoroscopically guided wires and measuring catheters. Stents were chosen to extend approximately 1 cm proximal and distal to the obstruction. Stent diameters were chosen to be approximately 10% greater than the diameter of healthy portions of the urethra to prevent displacement. Stents were placed in the urethra under fluoroscopic guidance to restore luminal patency.

Results—3 dogs received balloon-expandable metallic stents, and 9 dogs received self-expanding metallic stents. The placement procedures were rapid, safe, and effective at restoring luminal patency and were not associated with major complications. Complications included recurrent urethral obstruction secondary to blood clot formation and urethral edema in 1 dog and stent dislodgement into the urinary bladder in 1 dog. All dogs were able to urinate immediately after the procedure. Nine dogs (3/4 females and 6/8 males) were continent or mildly incontinent after stent placement. Of the remaining 3 dogs, 2 developed severe incontinence and 1 had an atonic bladder. Seven dogs were considered to have good to excellent outcome, 3 had fair outcome, and 2 had poor outcome.

Conclusions and Clinical Relevance—Transurethral placement of metallic stents was a safe and effective palliative treatment option for dogs with malignant urethral obstructions.

Abstract

Objective—To evaluate use of balloon-expandable and self-expanding metallic stents in management of malignant urethral obstructions in dogs.

Design—Original study.

Animals—12 dogs with malignant urethral obstructions.

Procedures—The extent and location of urethral obstructions and the diameter of adjacent unaffected luminal segments were determined by use of fluoroscopically guided wires and measuring catheters. Stents were chosen to extend approximately 1 cm proximal and distal to the obstruction. Stent diameters were chosen to be approximately 10% greater than the diameter of healthy portions of the urethra to prevent displacement. Stents were placed in the urethra under fluoroscopic guidance to restore luminal patency.

Results—3 dogs received balloon-expandable metallic stents, and 9 dogs received self-expanding metallic stents. The placement procedures were rapid, safe, and effective at restoring luminal patency and were not associated with major complications. Complications included recurrent urethral obstruction secondary to blood clot formation and urethral edema in 1 dog and stent dislodgement into the urinary bladder in 1 dog. All dogs were able to urinate immediately after the procedure. Nine dogs (3/4 females and 6/8 males) were continent or mildly incontinent after stent placement. Of the remaining 3 dogs, 2 developed severe incontinence and 1 had an atonic bladder. Seven dogs were considered to have good to excellent outcome, 3 had fair outcome, and 2 had poor outcome.

Conclusions and Clinical Relevance—Transurethral placement of metallic stents was a safe and effective palliative treatment option for dogs with malignant urethral obstructions.

Contributor Notes

Address correspondence to Dr. Weisse.