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CASE DESCRIPTION A 7-year-old female domestic shorthair cat was referred for evaluation of azotemia and unilateral hydronephrosis.
CLINICAL FINDINGS Abdominal ultrasonography revealed right-sided hydronephrosis and dilation of the proximal aspect of the ureter; the left kidney was small with irregular margins. A highly vascular, irregular retroperitoneal mass, not clearly associated with the ureteral obstruction, was also visualized. Surgical exploration confirmed a retroperitoneal mass involving the caudal mesenteric artery and both ureters, with hydroureter on the right side.
TREATMENT AND OUTCOME A subcutaneous ureteral bypass (SUB) device was surgically implanted to treat right ureteral obstruction, and the mass was biopsied. Shortly after surgery, progressive azotemia and hyperkalemia were detected; ultrasonographic examination revealed left-sided hydronephrosis and hydroureter, which was suspected secondary to inflammation of the mass causing a left-sided ureteral obstruction. A second surgery was performed to place an SUB device for the left kidney and remove the retroperitoneal mass; both ureters were ligated at the mid- and distal aspects and then transected and removed with the mass. A neuroendocrine paraganglioma was identified by histopathologic evaluation of the mass. Hydronephrosis improved (right kidney) or resolved (left kidney) after surgery, and azotemia improved. Chemotherapeutic intervention was declined. Markers of renal function were static during the 14-month follow-up period. At the last follow-up evaluation, the patient was reportedly doing well, and both SUB devices were patent.
CLINICAL RELEVANCE This was the first report of retroperitoneal paraganglioma in a domestic cat causing bilateral ureteral obstruction. Bilateral SUB device placement enabled en bloc mass resection and provided long-term relief of ureteral obstruction.
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.
CASE DESCRIPTION A 15-month-old male Newfoundland was examined because of an inability to urinate, lethargy, inappetence, and intermittent vomiting that first became evident after bilateral cryptorchidectomy 2 days previously. The patient was referred for further evaluation and treatment.
CLINICAL FINDINGS Results of physical examination, serum biochemical analysis, and abdominocentesis led to a diagnosis of uroperitoneum. Retrograde cystography indicated urinary tract obstruction. In view of the history of recent elective cryptorchidectomy, a diagnosis of uroperitoneum with urethral obstruction secondary to iatrogenic prostatectomy and urethrectomy was made.
TREATMENT AND OUTCOME During a ventral midline celiotomy, the inadvertent prostatectomy and urethrectomy were found to have resulted in insufficient urethral length for primary repair. Surgical repair of the urethral defect was achieved by means of a novel technique of bladder retroversion and neourethrocystostomy at the apex of the bladder. A urethral stricture evident 1.5 months after surgery was initially treated with balloon dilatation, followed by temporary and then permanent placement of a self-expanding metallic stent. At the last follow-up 6.6 years after stent placement, the dog remained continent while receiving phenylpropanolamine and the owner was highly satisfied with the outcome.
CLINICAL RELEVANCE Caudal intraabdominal bladder retroversion with apex neourethrocystostomy may be a viable alternative to more complex urethral lengthening procedures in dogs and can potentially preserve lower urinary tract function. This treatment might be considered for patients with urethral trauma or malignant neoplasia necessitating extensive urethral resection. Urethral strictures may be effectively managed with stenting.
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.
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.