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- Author or Editor: Kenneth Lamb x
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Abstract
OBJECTIVE To determine outcomes of subcutaneous ureteral bypass (SUB) device placement for treatment of benign ureteral obstruction in cats.
DESIGN Retrospective case series.
ANIMALS 134 cats with SUB devices placed in 174 obstructed ureters during 144 hospitalizations.
PROCEDURES Medical records of cats that underwent SUB device placement for treatment of benign ureteral obstruction between 2009 and 2015 were reviewed. The SUB device was placed by use of fluoroscopic and surgical methods. Signalment, history, diagnostic imaging results, postprocedural results, duration of hospitalization, complications, and short- and long-term outcomes were recorded.
RESULTS Ureteral obstructions were caused by ureterolithiasis (114/174 [65.5%]), stricture (28/174 [16.1%]), both ureterolithiasis and stricture (29/174 [16.7%]), or pyonephrosis (1/174 [0.6%]); in 2 (1.1%) cats, the cause was not recorded. Fifty-two of the 134 (39%) cats had bilateral ureteral obstruction. At admission, 127 (95%) cats were azotemic. Median serum creatinine concentrations at admission and 3 months after SUB device placement were 6.6 and 2.6 mg/dL, respectively. Median renal pelvis diameters before and after the procedure were 9.2 and 1.5 mm, respectively. Postsurgical complications included device occlusion with blood clots (14/172 [8.1%]), device leakage (6/172 [3.5%]), and kinking of the device tubing (8/174 [4.6%]). Cats survived to hospital discharge after 135 of the 144 (94%) hospital admissions. The most common long-term complication was catheter mineralization (40/165 [24.2%]), which was documented a median of 463 days after device placement. A high postoperative serum ionized calcium concentration was significantly associated with SUB device occlusion.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that SUB device placement may be a viable option for treatment of cats with benign ureteral obstruction.
Abstract
OBJECTIVE To compare improvements in values for periodontal disease indices in dogs following treatment with closed root planing (CRP) alone, CRP with concurrent 8.5% doxycycline hyclate gel application, and CRP with concurrent 2% clindamycin hydrochloride reverse-polymer hydrogel application.
DESIGN Randomized, blinded, controlled clinical trial.
ANIMALS 34 client-owned dogs with periodontal pockets measuring 3.5 to 5.5 mm deep.
PROCEDURES Dogs were randomly assigned to receive 1 of 3 treatments: CRP alone (n = 10) or CRP plus 8.5% doxycycline hyclate (12) or 2% clindamycin hydrochloride (12) gel applied within the periodontal pockets. Indices of periodontal disease severity were recorded before and 12 weeks after treatment, and outcomes were compared among treatment groups.
RESULTS Except for gingivitis index, no significant differences were identified among the 3 treatment groups in the amount of improvement observed in values for periodontal disease indices following treatment. A minor but clinically unimportant improvement in mean gingivitis index values was identified for dogs treated with CRP plus doxycycline gel, which differed significantly from improvements in the other 2 groups. Teeth that were initially more severely affected (pocket depths, 5.0 to 5.5 mm) had the greatest amount of improvement, whereas teeth with only mildly high initial pocket depths (3.5 to 4.0 mm) had less improvement.
CONCLUSIONS AND CLINICAL RELEVANCE Overall, addition of doxycycline or clindamycin gel application to CRP for the treatment of periodontal disease in dogs yielded no clinically relevant benefit over CRP during the 12-week follow-up period.
Abstract
OBJECTIVE
To better understand spatial relationships between principal bronchi and other intrathoracic structures by use of CT images of dogs of various somatotypes.
ANIMALS
93 dogs that underwent thoracic CT.
PROCEDURES
Information was collected from medical records regarding signalment and physical examination and echocardiographic findings. Two investigators recorded multiple measurements on a thoracic axial CT image from each dog.
RESULTS
Thoracic height-to-width ratio (H:W) was associated with left principal bronchus (LPB) and right principal bronchus (RPB) H:W, aortic-LPB separation, focal LPB narrowing, and aortic-vertebral overlap. Thoracic H:W was not associated with dog age, weight, sex, or brachycephalic breed. Twenty-five (27%) dogs had focal LPB narrowing, compared with 5 (5%) dogs with focal RPB narrowing (P < 0.001). Ten of 25 dogs had overlap or contact between vertebrae, aorta, LPB, and heart, suggesting a cumulative compressive effect on the LPB, while 15 had LPB-aorta contact and lack of contact between the aorta and thoracic vertebrae, suggesting an aortic constrictive effect on the LPB. None had LPB narrowing without contact from surrounding structures. Inter-rater agreement was high.
CLINICAL RELEVANCE
In dogs that underwent CT and were not selected for clinical suspicion of bronchial disease, principal bronchial morphology was associated with thoracic conformation. Focal LPB narrowing occurred more often than RPB narrowing. Focal LPB narrowing occurred with evidence of extraluminal compression, with or without contact between aorta and vertebrae. Brachycephalic breed could not be used for predicting thoracic H:W.
Abstract
OBJECTIVE To describe the technique and short- and long-term outcomes for dogs undergoing double-pigtail ureteral stent placement for treatment of benign ureteral obstruction.
DESIGN Retrospective case series.
ANIMALS 44 dogs (57 ureters).
PROCEDURES Medical records of dogs that underwent ureteral stenting for treatment of benign ureteral obstruction between 2010 and 2013 were reviewed. Signal-ment, history, pertinent diagnostic imaging results, endourologic and post-procedural details, duration of hospitalization, complications, and outcome (short term, 7 to 30 days; long term, > 30 days) were recorded. Ureteral stent placement was performed endoscopically, surgically, or both, with fluoroscopic guidance.
RESULTS 57 ureters (44 dogs) underwent stenting because of obstructive ureterolithiasis (n = 48 [84%]), stricture (5 [9%]), or both (4 [7%]). Endoscopic or surgical techniques were successful for stent placement in 45 of 55 and 12 of 12 ureters (34/42 and 10/10 dogs), respectively. Median hospitalization time was 1 day. Median creatinine concentration was 2 mg/dL prior to stenting and 1.3 mg/dL 3 months after the procedure. Urinary tract infections were present in 26 of 44 (59%) dogs prior to stenting and in 11 of 43 dogs (26%) after stenting. One of the 44 (2%) dogs died after undergoing stenting, but the cause of death was not related to the procedure. Median follow-up time was 1,158 days (range, 3 to > 1,555 days), with 30 of 44 dogs alive at the time of last follow-up.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that ureteral stenting may be a viable option for first-line treatment of dogs with benign ureteral obstruction. However, patients should be monitored for urinary tract infection following stenting.
Abstract
OBJECTIVE To determine outcome for dogs and cats with benign nasopharyngeal stenosis or an imperforate nasopharynx that underwent balloon dilatation or metallic stent placement.
DESIGN Retrospective case series.
ANIMALS 15 dogs and 31 cats.
PROCEDURES Medical records were retrospectively reviewed, and data on signalment, history, clinical signs, lesion location, treatment, and outcome were obtained. Patients were excluded if < 6 months of follow-up information was available.
RESULTS 5 dogs and 22 cats underwent balloon dilatation, and results were successful in 11 (0 dogs and 11 cats) of the 27 (41%). Stents were placed in 34 patients (including 15 in which balloon dilatation had been unsuccessful). Uncovered stents were placed in 30 patients, and results were successful in 20 (67%). Covered stents were placed in 11 patients (including 7 in which uncovered stent placement was unsuccessful), and results were successful in all 11. Twenty-three of the 34 (68%) patients in which stents were placed developed complications. The most common complications were tissue ingrowth (n = 10), chronic infection (7), and stent fracture (5) for the 30 patients with uncovered stents and chronic infection (8) and oronasal fistula (3) for the 11 patients with covered stents. Overall, outcome was successful in 36 of the 46 (78%) patients (median follow-up time, 24 months; range, 2 to 109 months).
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in dogs and cats, nasopharyngeal stenosis and imperforate nasopharynx can be successfully treated with balloon dilatation or stent placement, but that there was a high risk of failure with balloon dilatation alone and a high risk of complications regardless of procedure.
Abstract
OBJECTIVE
To describe techniques and outcomes for dogs and cats undergoing endoscopic nephrolithotomy (ENL) for the removal of complicated nephroliths.
ANIMALS
11 dogs and 1 cat (n = 16 renal units) with complicated nephroliths that underwent ENL via a surgically assisted ENL approach (12 renal units) or a percutaneous nephrolithotomy approach (4 renal units) between December 2005 and June 2017.
PROCEDURES
Data were obtained from the medical records regarding preoperative, operative, and postoperative findings. Follow-up information on complications and outcomes was also collected.
RESULTS
Indications for nephrolith removal included massive calculi displacing parenchyma (n = 7), recurrent urinary tract infections (5), and ureteral outflow obstruction (4). Median nephrolith diameter was 2.5 cm (range, 0.5 to 5.7 cm). Nephrolith composition differed among patients; calcium oxalate was the most common type (n = 7 [including 2 mixed nephroliths containing ≥ 60% calcium oxalate]). Following ENL (median duration, 180 minutes), 15 of 16 renal units were completely nephrolith free. Procedure-related complications included renal puncture-associated hemorrhage requiring a blood transfusion (n = 1), renal capsule tear (1), and ureteral puncture (1); all were managed without adverse consequence. Five of 12 patients remained alive at the final follow-up (median, 557 days after ENL), and none died from the procedure.
CONCLUSIONS AND CLINICAL RELEVANCE
ENL as performed was safe and effective in removing complicated nephroliths in a renal-sparing manner for the patients in this study. This procedure requires technical training and could be considered for the treatment of complicated nephrolithiasis in dogs and possibly cats.
