Diagnostic Imaging of the Urinary Tract

Positive and Negative Retrograde Computed Tomographic Vaginography Studies Offer Similar Visibility of the Anatomy of the Lower Urogenital Tract in Female Dogs with Urogenital Signs

Computed tomography is commonly used to investigate pathologies of the lower urogenital tract in female dogs. Even though a positive contrast medium is commonly used, negative contrast has proven to be a valuable tool in the assessment of urinary pathologies. This study aims to compare the use of negative with positive retrograde CT vaginography in the assessment of the lower urogenital tract in female dogs. This retrospective method comparison study gathered 30 cases retrieved from the database of three referral hospitals and equally divided them into two groups: positive CT vaginography group and negative CT vaginography group. Criteria for inclusion were CT images of the entire urogenital tract before and after intravenous contrast agent injection, followed by retrograde vaginography. The degree of visibility of seven anatomical structures from the fossa clitoridis to the cervix was blindly scored from 0 (nonvisible) to 2 (well visible) by two board-certified radiologists. The agreement between the two readers was assessed using Cohen's kappa statistics. Positive and negative vaginographies were compared using Wilcoxon tests. The agreement between readers varied between structures. A significant difference in grading was observed for the cervix, which was better visualized with positive vaginography (p-value = .0006), and the ostium of the urethra, which was more conspicuous on negative vaginography (p-value = .02). Both techniques offer similar visualization on most of the structures analyzed. Negative retrograde computed tomographic vaginography is a valuable and alternative technique to positive CT vaginography to assess the lower urogenital tract in female dogs.

Urinary Tract Trauma in Cats: Stabilisation, Diagnosis and Management

PRACTICAL RELEVANCE

Traumatic injury of the urinary tract may be caused by external accidental trauma or due to iatrogenic injury (typically as a result of catheterisation procedures). Thorough patient assessment and careful attention to patient stabilisation are essential, with diagnosis and surgical repair delayed until the patient is stable, if necessary. Treatment depends on the location and severity of the trauma. If diagnosed and treated promptly, the chance of survival of a patient without other concurrent injuries is good.

CLINICAL CHALLENGES

Following accidental trauma, at the initial presentation urinary tract injury can be overshadowed by other injuries, but if left undiagnosed or untreated it can lead to serious morbidity and potentially mortality. Many of the surgical techniques described for management of urinary tract trauma can be associated with complications, and so comprehensive communication with the owners is necessary.

PATIENT GROUP

The main population affected by urinary tract trauma is young, adult male cats, owing to their roaming behaviour, as well as their anatomy and the resulting increased risk of urethral obstruction and its associated management.

AIMS

This article aims to serve as a guide to all veterinarians who treat cats for the diagnosis and management of urinary tract trauma in cats.

EVIDENCE BASE

This review summarises the current knowledge available from a number of original articles and textbook chapters in the literature that cover all aspects of feline urinary tract trauma, and is supported by the authors' own clinical experience.

Comparison of static-fluid or excretory magnetic resonance urography with computed tomography urography for visualization of nondilated renal pelvises and ureters in healthy Beagles

OBJECTIVE

To assess the usefulness of magnetic resonance urography (MRU) for the visualization of nondilated renal pelvises and ureters in dogs and to compare our findings for MRU versus CT urography (CTU).

ANIMALS

9 healthy Beagles.

PROCEDURES

Dogs underwent CTU, static-fluid MRU, and excretory MRU, with ≥ 7 days between procedures. Contrast medium was administered IV during CTU and excretory MRU, whereas urine in the urinary tract was an intrinsic contrast medium for static-fluid MRU. For each procedure, furosemide (1 mg/kg, IV) was administered, and reconstructed dorsal plane images were acquired 3 minutes (n = 2) and 7 minutes (2) later. Images were scored for visualization of those structures and for image quality, diameters of renal pelvises and ureters were measured, and results were compared across imaging techniques.

RESULTS

Excretory MRU and CTU allowed good visualization of the renal pelvises and ureters, whereas static-fluid MRU provided lower visualization of the ureters. Distention of the renal pelvises and ureters was good in excretory MRU and CTU. Distention of the ureters in static-fluid MRU was insufficient compared with that in CTU and excretory MRU. Distinct artifacts were not observed in CTU and excretory MRU images. Static-fluid MRU images had several mild motion artifacts.

CLINICAL RELEVANCE

Our findings indicated that excretory MRU with furosemide administration was useful for visualizing nondilated renal pelvises and ureters of dogs in the present study. When performing MRU for the evaluation of dogs without urinary tract dilation, excretory MRU may be more suitable than static-fluid MRU.

The urethra of healthy female dogs can be normally narrowed due to the urethral flexure in retrograde CT urethrography

Quantitative analysis of urethral size in male dogs by retrograde CT urethrography using a power injector is a recently reported technique. The aim of the current, prospective, analytical study was to apply the same method to six, healthy, intact female Beagle dogs. The proximal (P < .0001) and middle (P = .0010) urethral volumes significantly differed between the empty and distended bladder states, although no significant difference was observed in the distal volume (P = .0971). Unlike male dogs, female dogs showed two patterns of the urethral course: a straight urethra and urethral flexure. The urethral flexure was always related to intrapelvic position of the urinary bladder, and the more caudal the location of the vesicourethral junction beyond the pecten of the pubic bone, the more marked the appearance of the urethral flexure. Analysis of the urethral diameter at five sites (adopted from the previous radiographic study) was performed, and the urethral diameter showed a significant difference between the empty and the distended bladder states at sites 1 (vesicourethral junction, P < .0001), 2 (P < .0001), and 3 (P = .0244). However, there were no significant differences at sites 4 (P = .2516) and 5 (inflatable retention bulb, P = .1260). The urinary bladder may be in part intrapelvically located in clinically healthy female dogs, and urethral flexure and urethral narrowing can result from the intrapelvic location of the bladder. Narrowing of the urethra should be interpreted with caution when the pelvic bladder is identified.