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in Journal of the American Veterinary Medical Association

Abstract

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.

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in Journal of the American Veterinary Medical Association

Abstract

Case Description—An 8-year-old castrated male German Shepherd Dog was evaluated because of abdominal distension, retching, and vomiting.

Clinical Findings—Gastric dilatation-volvulus was suspected on the basis of the dog's signalment, history, clinical signs, and results of clinicopathologic analyses and abdominal radiography. Celiotomy was performed, and gastric dilatation-volvulus was confirmed along with splenomegaly. Gastric invagination was performed over an area of gastric necrosis. The dog was reevaluated 21 days later after an episode of collapse. Findings of physical examination and clinicopathologic analyses were suggestive of internal hemorrhage. Abdominal ultrasonography and subsequent celiotomy revealed severe gastric ulceration at the gastric invagination site, splenic torsion, and a focal splenic infarct.

Treatment and Outcome—Splenectomy and gastrectomy of the necrotic tissue were performed. The dog was discharged from the hospital, and the owner was instructed to administer gastroprotectants and feed the dog a bland diet. The dog was reported to be healthy 3.25 years after surgery.

Clinical Relevance—Findings suggest that complications associated with the gastric invagination procedure include severe gastric ulceration that may require subsequent surgery. Prolonged treatment with gastroprotectants following gastric invagination surgery may be necessary to avoid gastric ulceration in dogs.

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in Journal of the American Veterinary Medical Association

Abstract

CASE DESCRIPTION

A 5-year-old spayed female Maltese mixed-breed dog was referred for evaluation because of severe urinary incontinence refractory to medical management.

CLINICAL FINDINGS

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.

CLINICAL RELEVANCE

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.

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in Journal of the American Veterinary Medical Association

Abstract

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.

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in Journal of the American Veterinary Medical Association

Abstract

Case Description—Two adult male castrated cats were evaluated because of a history of constipation, tenesmus, or intermittent vomiting.

Clinical Findings—Radiography and ultrasonography revealed luminal narrowing in the colon of 1 cat and a colonic mass in the other. A histopathologic diagnosis of colonic adenocarcinoma was made in both cats.

Treatment and Outcome—Under fluoroscopic guidance, a self-expanding metallic stent was advanced over a wire and across the area of colonic stenosis and deployed. One cat had progressive weight loss but maintained a normal appetite, energy, and a high quality of life. Fecal continence was maintained, and tenesmus was rarely observed. The cat was euthanized because of tumor metastasis 274 days after the colonic stent was placed. The other cat retained fecal continence, and the owners reported subjective improvement in the severity of tenesmus, compared with that prior to stent placement. The cat was euthanized 19 days after stent placement because of perceived decreased quality of life.

Clinical Relevance—The use of self-expanding metallic stents for alleviation of colonic obstruction secondary to adenocarcinoma in cats appears to be effective. This technique provides a simple, quick, nonsurgical option for palliation in cats with advanced metastatic or systemic disease in which surgical resection may not be possible or warranted.

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in Journal of the American Veterinary Medical Association

Abstract

CASE DESCRIPTION 4 cats were examined because of ureteral obstruction.

CLINICAL FINDINGS Clinical and clinicopathologic abnormalities were nonspecific and included anorexia, lethargy, weight loss, anemia, leukocytosis, neutrophilia, lymphopenia, and azotemia. A diagnosis of pyonephrosis was made in all cats. The presence of bacteriuria was confirmed by means of urinalysis in 2 cats, bacterial culture of a urine sample obtained by means of preoperative cystocentesis in 2 cats, and bacterial culture of samples obtained from the renal pelvis intraoperatively in 3 cats. Ureteral obstruction was caused by a urolith in 3 cats; ureteral stricture associated with a circumcaval ureter was identified in 1 cat.

TREATMENT AND OUTCOME All 4 cats underwent renal pelvis lavage and placement of a subcutaneous ureteral bypass (SUB) device for treatment of obstructive pyonephrosis. Postoperatively, the cystostomy tube became occluded with purulent material in 1 cat, requiring exchange. The procedure was successful in relieving the obstruction and pyonephrosis in all cats. Three of 4 cats had documented resolution of urinary tract infection. One cat had persistent bacteriuria without clinical signs 1 month after SUB device placement.

CLINICAL RELEVANCE Results of this small series suggested that renal pelvis lavage with placement of an SUB device may be a treatment option for cats with obstructive pyonephrosis.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe the technical aspects and clinical outcome of endoscopic- and fluoroscopic-guided ureteropelvic lavage and ureteral stent placement for treatment of obstructive pyonephrosis in dogs.

Design—Retrospective case series.

Animals—13 client-owned dogs (14 obstructed ureters).

Procedures—All patients with obstructive pyonephrosis were treated with a ureteral stent. Medical records were reviewed for history, clinical signs, pre- and postprocedural clinical and imaging data, and short- and long-term outcomes.

Results—13 dogs (14 ureters) had unilateral or bilateral ureteral obstructions and pyonephrosis due to ureterolithiasis (n = 13) or a suspected ureteral stricture (1). Eleven dogs had positive results of bacteriologic culture of urine obtained from the bladder, renal pelvis, or both. Ten were thrombocytopenic, and 8 were azotemic. Stents were placed fluoroscopically with endoscopic (n = 11) or surgical (3) assistance. Median hospitalization time was 48 hours (range, 6 to 260 hours). Median follow-up time was 480 days (range, 2 to 1,460 days). Intraoperative complications occurred in 2 patients (stent occlusion from shearing of a guide wire, and wire penetration of the ureter at the location of a stone). Short-term complications included a bladder hematoma (n = 1) and transient dysuria (1). Long-term complications included stent encrustation (n = 1), stent migration (1), and tissue proliferation at the ureterovesicular junction (5), which had no clinical implications. Recurrent urinary tract infections were documented in 7 dogs.

Conclusions and Clinical Relevance—Ureteral stenting was a successful renal-sparing treatment for obstructive pyonephrosis in dogs and could often be performed in a minimally invasive manner. There were few major complications. This technique may be considered as an effective treatment option for this condition in dogs.

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in Journal of the American Veterinary Medical Association
in Journal of the American Veterinary Medical Association

Abstract

CASE DESCRIPTION

An 8-year-old spayed female Yorkshire Terrier–Poodle dog was evaluated for persistent pollakiuria and stranguria following routine cystotomy for calcium oxalate cystoliths.

CLINICAL FINDINGS

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.

CLINICAL RELEVANCE

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.

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in Journal of the American Veterinary Medical Association