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- Author or Editor: Allyson C. Berent x
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Objective—To describe the technique and evaluate short- and long-term outcomes in female dogs after endoscopic-guided laser ablation (ELA) of various vestibulovaginal septal remnants (VVSRs).
Design—Retrospective case series.
Procedures—Medical records of dogs with VVSRs that underwent ELA were retrospectively reviewed. All patients underwent complete cystourethrovaginoscopy for diagnosis and treatment. Endoscopic-guided laser ablation (with a holmium:yttrium-aluminum-garnet or diode laser) was used to transect the vaginal membrane. Patients with intramural ectopic ureters were concurrently treated with ELA of their ectopic ureters. Endoscopy was repeated 6 to 8 weeks after ELA of vaginal remnants in some patients, and the procedure sites were reassessed.
Results—36 female dogs with persistent paramesonephric septal remnants (n = 19), vaginal septa (11), or dual vaginas (6) were included. Twenty-six dogs had urinary incontinence, 2 had recurrent UTIs, and 8 had both. Thirty of 36 (83%) dogs had concurrent ectopic ureters. Endoscopic-guided laser ablation was performed with holmium:yttrium-aluminum-garnet and diode lasers in 8 and 28 dogs, respectively. Five dogs had mild postoperative dysuria for < 24 hours. One patient developed a complication involving inadvertent laser perforation of the vaginal wall. There were no negative effects from this event, and the perforation was fully healed within 8 weeks. At the time of follow-up, all defects were fully healed with no sign of recurrence in the 18 (50%) patients reevaluated. There was a significant improvement in continence scores and a significantly decreased incidence of UTIs after ELA. The median follow-up time was 34 months (range, 8 to 57 months).
Conclusions and Clinical Relevence—The results of the present study indicated that ELA provided an effective, safe, and minimally invasive treatment option for various VVSRs in dogs, avoiding the need for more invasive surgery.
Case Description—An 11-year-old castrated male mixed-breed dog was examined for a 3-month history of hematochezia and tenesmus. Abdominal ultrasonography and rectal examination prior to referral had revealed a colorectal polyp, diagnosed as a benign colorectal polypoid adenoma after histologic examination of tissue samples. The patient was referred for treatment.
Clinical Findings—A 2-cm-diameter sessile polypoid mass was located approximately 6 cm orad to the anus in the right dorsolateral region of the descending colon just caudal to the pubis. There was no evidence of metastasis on thoracic radiography or abdominal ultrasonography. Results of a CBC and serum biochemical analysis were within reference limits.
Treatment and Outcome—Endoscopic mucosal resection (EMR) and snare electrocautery were used to resect the mass and a definitive histopathologic diagnosis of a sessile colorectal polypoid adenoma was made. A 9.9-mm gastroduodenoscope was used during colonoscopy to inspect the mass. To aid in EMR, a 25-gauge endoscopic injection needle was used to infuse sterile saline (0.9% NaCl) solution under the base of the polyp, into the submucosa to elevate the mucosa from the muscularis layer beneath the polyp prior to polypectomy. This was necessary because of the sessile, rather than pedunculated, base of the mass. The entire polyp was successfully removed with endoscopic guidance. The clinical signs of hematochezia and tenesmus resolved immediately, and serial rectal examinations were performed over the following 36 months with no palpable evidence of recurrence.
Clinical Relevance—The patient described in the present report underwent successful colonic EMR and snare polypectomy with no known evidence of mass recurrence during the following 36 months, suggesting that this minimally invasive procedure may be a valuable treatment option for sessile polyps. The advantage of this technique was that elevation of the mucosa via injection of saline solution improved visibility of the polyp and helped to separate the polyp base from the deeper submucosal colorectal tissue, making complete resection possible.
CASE DESCRIPTION 3 cats were referred for evaluation of chronic urinary incontinence.
CLINICAL FINDINGS A presumptive diagnosis of urethral sphincter mechanism incompetence (USMI) was made in all 3 cats. Preoperatively, incontinence was mild in 1 cat (incontinence during sleep) and moderate to severe (incontinence while awake and at rest) in 2. Structural abnormalities noted during cystoscopy included urethrovestibular junction stenosis (n = 1), vaginal stenosis (1), short urethra (1), and intrapelvic bladder (1).
TREATMENT AND OUTCOME All 3 cats were treated by means of implantation of an inflatable silicone hydraulic occluder (HO) via a ventral midline celiotomy. Immediately prior to HO implantation, patients underwent cystoscopy to detect any anatomic abnormalities and confirm the absence of ureteral ectopia. Following surgery, all 3 patients attained complete continence, needing 0 or 1 inflation of the device. Complications included cystoscopy-associated urethral tear (n = 1), constipation (1), stranguria (1), hematuria (2), and urinary tract infection (2). Device explantation was performed 14 weeks after surgery in 1 cat because of postoperative constipation. Constipation persisted and urinary incontinence recurred but was markedly improved following device removal in this cat (leakage of urine only when sleeping at follow-up 29 months after surgery [26 months after device explantation]). At the time of last follow-up, 2 of the 3 cats remained fully continent approximately 3 and 6 years after device implantation.
CLINICAL RELEVANCE Findings suggested that implantation of an HO may be a safe and effective long-term treatment for some cats with USMI. Further studies are necessary to evaluate the potential for treatment-related complications and the long-term outcome.
OBJECTIVE To describe the technique and outcome for male dogs undergoing rigid urethrocystoscopy via a novel percutaneous, fluoroscopic-assisted perineal approach.
DESIGN Retrospective case series.
ANIMALS 19 client-owned male dogs.
PROCEDURES Medical records of male dogs that underwent urethrocystoscopy via a percutaneous perineal approach for treatment of a variety of conditions from 2005 through 2014 were reviewed. Signalment, history, pertinent diagnostic imaging results, endourologic and postprocedure details, duration of hospitalization, complications, and outcome (short-term, < 1 month; long-term, ≥ 1 month) were recorded. After flexible urethrocystoscopy, direct percutaneous perineal needle puncture and guidewire placement by means of fluoroscopic guidance (with or without ultrasonography) allowed access to the urethral lumen. The perineal tract was subsequently serially dilated to accommodate a peel-away sheath and rigid endoscope. Rigid urethrocystoscopy was performed, and on completion of endourologic procedures, the access site was left to heal by second intention.
RESULTS 19 male dogs successfully underwent 20 procedures. No intraoperative complications were reported. Short-term outcome was good (ie, mild perineal urine leakage) for 3 dogs and excellent (ie, no abnormalities with urination) for 16. Long-term outcome was excellent for the 17 dogs for which follow-up information was available.
CONCLUSIONS AND CLINICAL RELEVANCE A percutaneous fluoroscopic-assisted perineal approach (with or without ultrasonography) allowed access to the pelvic urethra with no major complications in the present series of patients. This minimally invasive approach may be a valuable tool for endourologic procedures in male dogs.
Case Description—A dog was examined because of a 6-month history of upper airway stridor that began after postoperative regurgitation of gastric contents.
Clinical Findings—Constant stridor was evident during inspiration and expiration, although it was worse during inspiration. The stridor was no longer evident when the dog's mouth was manually held open. Computed tomography, rhinoscopy, and fluoroscopy were used to confirm a diagnosis of nasopharyngeal stenosis.
Treatment and Outcome—The dog was anesthetized, and balloon dilatation of the stenosis was performed. Prednisone was prescribed for 4 weeks after the procedure to decrease fibrous tissue formation. Although the dog was initially improved, signs recurred 3.5 weeks later, and balloon dilatation was repeated. This time, however, triamcinolone was injected into the area of stenosis at the end of the dilatation procedure. Two months later, although the dog did not have clinical signs of stridor, a third dilatation procedure was performed because mild stenosis was seen on follow-up computed tomographic images; again, triamcinolone was injected into the area of stenosis at the end of the dilatation procedure. Three and 6 months after the third dilatation procedure, the dog reportedly was clinically normal.
Clinical Relevance—Findings suggest that balloon dilatation may be an effective treatment for nasopharyngeal stenosis in dogs.
Objective—To describe the technique and determine outcome for male cats with urethral obstruction treated with fluoroscopically guided percutaneous antegrade urethral catheterization (PAUC).
Design—Retrospective case series.
Animals—9 client-owned neutered male cats with urethral obstruction and inability to pass a retrograde urinary catheter.
Procedures—Information regarding the procedure and hospitalization was obtained from medical records. Long-term follow-up was obtained via medical record review or telephone interview.
Results—Diagnoses included iatrogenic urethral tear (n = 6), obstructive urethral calculi (1), urethral ulceration (1), and urethral stricture (1). Seven of the 9 procedures were successful. The 2 patients in which PAUC failed had mechanical obstructions preventing guide wire access across the urethral obstruction. Procedure times ranged from 25 to 120 minutes. No complications were noted in any patients during the procedure. One patient was euthanized because of unrelated disease. Follow-up information was available for 6 of 8 surviving patients. No complications that could be directly attributed to the procedure were noted. All 6 patients had a perineal urethrostomy performed 0 days to 6 weeks following the procedure because of reobstruction of the lower urinary tract. None of these patients had documented urethral strictures and none had recurrence of clinical signs following perineal urethrostomy.
Conclusions and Clinical Relevance—Results suggested that PAUC can be a simple, rapid, minimally invasive, and safe technique to facilitate transurethral catheterization in select cases. Patients with iatrogenic urethral tears may be good candidates. Patients with impacted urethral calculi, severe strictures or ulcerations, or a nondistended urinary bladder may be less amenable to PAUC.
A 5-year-old spayed female Maltese mixed-breed dog was referred for evaluation because of severe urinary incontinence refractory to medical management.
Physical examination revealed constant dribbling of urine and urine scalding. Culture of a urine sample yielded methicillin-resistant Staphylococcus pseudintermedius and Proteus mirabilis. Abdominal ultrasonographic examination revealed absence of the left kidney, a small, nondistended urinary bladder, and diffuse hepatopathy. Urinary incontinence persisted despite appropriate antimicrobial treatment. Cystourethroscopy and vaginoscopy were subsequently performed and revealed a hypoplastic bladder and a vesicovaginal fistula with urinary leakage through the vaginal diverticulum; no left ureterovesicular junction was identified, consistent with suspected left renal aplasia.
TREATMENT AND OUTCOME
Exploratory laparotomy was performed, and the cranial aspect of the vagina was circumferentially ligated immediately caudal to the fistula. The urinary incontinence resolved immediately after surgery, and lower urinary tract signs improved over the next 2 weeks. Moderate urinary incontinence recurred approximately 6 months later, and a urinary tract infection with Escherichia coli was subsequently identified and treated; clinical signs resolved ≤ 48 hours after treatment was initiated.
To the author's knowledge, vesicovaginal fistulas in dogs have not been previously described and should be considered a differential diagnosis for persistent urinary incontinence and recurrent urinary tract infections in female dogs. Vaginoscopy in addition to cystourethroscopy was required to identify the abnormality in this patient. Because multiple concurrent anomalies can be present, both procedures should be performed in female dogs with these clinical signs, even if an abnormality is identified cystoscopically.
To compare short-, intermediate-, and long-term results between dogs with tracheal collapse (TC) that received multimodal medical management only and those that underwent tracheal endoluminal stent placement.
159 dogs with TC that underwent medical management only (MM group; n = 84) or were surgically managed by stent placement (SM group; 75).
Medical records of dogs with TC that underwent medical management only or stent placement at a referral hospital between September 1, 2009, and August 1, 2018, were reviewed. Data regarding signalment, information relevant to TC, and outcome were extracted from the records and aggregated into short-, intermediate-, and long-term follow-up periods for analysis. Descriptive data and median survival times (MSTs) were compared between the MM and SM groups.
Clinical signs of dogs in the MM group generally improved during the short term but regressed and worsened over time. The proportion of dogs with malformation-type TC that underwent stent placement (38/43 [88%]) was significantly greater than the proportion of dogs with traditional-type TC that underwent stent placement (37/107 [35%]). The MST from TC diagnosis was 3.7 years for the MM group and 5.2 years for the SM group. For dogs with severe disease, the MST was 12 days for medically managed dogs and 1,338 days for dogs that underwent stent placement.
CONCLUSIONS AND CLINICAL RELEVANCE
Multimodal medical management alleviated clinical signs for months to years in dogs with mild to moderate TC disease, but stent placement should be considered for dogs with severe disease.
An 8-year-old spayed female Yorkshire Terrier–Poodle dog was evaluated for persistent pollakiuria and stranguria following routine cystotomy for calcium oxalate cystoliths.
The dog presented for a cystotomy with intermittent hematuria. Postoperative radiographs revealed no remaining cystoliths. Urine, cystolith, and bladder mucosal aerobic cultures were negative. Pollakiuria, stranguria, and hematuria developed immediately after surgery and persisted despite antibiotics. Ultrasound revealed suspected fibrous adhesions within the urinary bladder lumen connecting the dorsal and ventral bladder wall creating a septum. This was confirmed cystoscopically 4 weeks after surgery.
TREATMENT AND OUTCOME
Cystoscopic-guided laser ablation was performed to incise abnormal tissue connecting the ventral and dorsal bladder wall using a holmium:yttrium-aluminum-garnet laser. Three weeks later, ultrasound revealed adhesion resolution though mild pollakiuria and stranguria persisted. Oxybutynin was prescribed and clinical signs resolved. At 27 months after ablation, hematuria occurred with recurrent cystoliths. These cystoliths were removed by percutaneous cystolithotomy, documenting a cystoscopically normal bladder wall. The patient had normal urination for 55.5 months after ablation, with normal bladder wall thickness on ultrasound repeated at 27 and 36 months after ablation.
To the authors’ knowledge, an adhesion creating a septum between the dorsal and ventral bladder wall has not been previously reported as a complication after cystotomy in any species and should be considered as a cause of persistent lower urinary signs after surgery. Ultrasound identified the lesion in this dog. Because bladder abnormalities can develop quickly after surgery, ultrasound might be considered if urine testing is not supportive of infection. Cystoscopic-guided laser ablation was a successful minimally invasive treatment in this case.
Objective—To evaluate the outcome following urethral stent placement for the palliative treatment of obstructive carcinoma of the urethra in dogs.
Design—Retrospective case series.
Animals—42 dogs with obstructive carcinoma of the urethra.
Procedures—Medical records for dogs in which a self-expanding metallic stent (SEMS) was used for the treatment of obstructive carcinoma of the urethra were reviewed. Signalment, diagnostic findings, clinical signs before and after SEMS placement, and patient outcome were analyzed. Fluoroscopic images were evaluated to determine the effects of stent size, obstruction length, tumor length, and urethral length and width on the incidence of incontinence or stranguria.
Results—Resolution of urinary tract obstruction was achieved in 41 of 42 (97.6%) dogs. After SEMS placement, 6 of 23 male and 5 of 19 female dogs developed severe incontinence, and 1 of 23 male and 1 of 17 female dogs developed stranguria. Stent length, diameter, and location were not associated with incidence of incontinence or stranguria. Median survival time after SEMS placement was 78 days (range, 7 to 536 days). Treatment with NSAIDs before and chemotherapeutics after SEMS placement increased median survival time to 251 days (range, 8 to 536 days).
Conclusions and Clinical Relevance—Urethral SEMS placement was an effective palliative treatment for dogs with obstructive carcinoma of the urethra; however, severe incontinence subsequently developed in 11 of 42 (26%) treated dogs. Adjunctive treatment of affected dogs with NSAIDs and chemotherapeutics significantly increased the median survival time.