Cystotomy, partial cystectomy, and tube cystostomy

Feasibility of laparoscopic stapled partial cystectomy in canine cadavers

OBJECTIVE

To describe a technique for laparoscopic partial cystectomy and evaluate sealing of canine urinary bladder tissue with an endoscopic stapler.

STUDY DESIGN

Prospective, cadaveric study.

SAMPLE POPULATION

Eleven canine cadavers.

METHODS

Laparoscopic partial cystectomy was performed with an endoscopic gastrointestinal anastomosis (GIA) stapler. Leak testing and urodynamic evaluation was performed to measure intravesical pressure at initial leakage and catastrophic failure or the maximum pressure at which intravesical pressure plateaued. Surgical time, complications, and site of leakage were also recorded.

RESULTS

Laparoscopic partial cystectomy was successfully performed in 10 of 11 cadavers. Median procedure time was 13.6 min (10.1-15.2 min). Median intravesical pressure at initial leakage was 31 mmHg (28-56 mmHg) with a median increase from initial pressure of 15 mmHg (11-37 mmHg). No catastrophic failure of the cystectomy site was observed during leak testing. Intravesical pressure plateaued at a median of 52 mmHg (39-73 mmHg), which was a median of 13 mmHg (8-23 mmHg) higher than intravesical pressure at initial leakage. The median total volume infused at the time of plateau of intravesical pressure was 89 mL (58-133 mL).

CONCLUSION

Laparoscopic stapled partial cystectomy was feasible in canine cadavers. Endoscopic GIA staplers appear to seal the canine urinary bladder with minimal leakage.

CLINICAL SIGNIFICANCE

Use of an endoscopic GIA stapler may provide a minimally invasive option for partial cystectomy in dogs. Further evaluation for application to clinical cases is warranted.

Reason for euthanasia in dogs with urothelial carcinoma treated with chemotherapy or radiation therapy or both: A retrospective observational study

BACKGROUND

Clients want to know the ultimate cause of death in their pet after cancer treatment. The cause of euthanasia and investigation of urinary obstruction in treated dogs with urothelial carcinoma (UC) has not been specifically reported in veterinary literature.

HYPOTHESIS/OBJECTIVES

Our hypothesis was that the majority of treated dogs with UC are euthanized secondary to primary tumor factors, such as urinary obstruction.

ANIMALS

Fifty-nine client-owned dogs diagnosed with UC.

METHODS

Retrospective observational study on clinical signs and disease at euthanasia of dogs with UC treated by radiation therapy or chemotherapy or both.

RESULTS

The median overall survival time (OST) of all dogs was 339 days (range, 17-1996; 95% confidence interval [CI], 185-392; interquartile range [IQR], 112-505). Of dogs deemed to have been euthanized because of UC (50/59, 85%), the primary cause was considered to be local progression in 31/50 (62%), most often because of perceived complete or partial urinary obstruction (24/31, 77%). No variables were found to be predictive of urinary obstruction. The overall documented metastatic rate was 56%. In dogs euthanized because of UC, metastasis was deemed to be the cause in 19/50 (38%) dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

Regardless of the type of treatment, UC in dogs has a poor prognosis and there is a continuing need to improve treatments that focus on local control of the primary tumor, given its high contribution to the decision for euthanasia. Proactive management to avoid the high frequency of urinary obstruction may be worthy of future investigation.

A Systematic Review of Canine Cystectomy: Indications, Techniques, and Outcomes

This review provides a summary of the literature encompassing partial and total cystectomy procedures in dogs and subsequent conclusions that can be drawn. Surgical excision as a component of treatment for lower urinary tract neoplasia in dogs may enhance survival time and result in acceptable quality of life, though risk for surgical complications is substantial, particularly following total cystectomy procedures. However, for dogs with urothelial carcinoma, cystectomy is generally not considered curative and disease progression is common. Appropriate case selection and thorough preoperative discussion with owners regarding potential risks and benefits of cystectomy are imperative for successful outcomes.

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.

Präpubische Urethrostomie bei einem Wiesenauer Minischwein mit Urolithiasis

Ein 10-jähriges kastriertes, männliches Minischwein wurde aufgrund eines Tenesmus vesicae mit Anurie vorgestellt. Begleitsymptom war eine Tachypnoe. Röntgenologisch waren zahlreiche Harnsteine in Blase und Urethra nachweisbar. Über die Harnröhre konnte nicht katheterisiert werden, sodass eine Notfallzystostomie mit Einlegen eines Ballonkatheters durchgeführt wurde. Trotz Blasenspülung gelang es nicht die Harnröhrensteine so auszuspülen. Deswegen wurde ein präpubisches Urethrostoma angelegt. Das Tier erholte sich vollständig und setzt seither problemlos Urin über die urethrale Fistel ab. Prophylaktische Maßnahmen der Urolithiasis beinhalten unter anderem eine ausreichende Wasseraufnahme, eine ausgewogene Fütterung und balancierte Futterzusammensetzung sowie die Gewährleistung eines physiologischen Urin-pH-Werts.

Radiographic features of suspected suture-associated cystic calculi in dogs

This retrospective case series describes the radiographic features of suspected suture-associated cystic calculi in six dogs with a history of at least one or multiple prior cystotomies. One of the dogs presented twice. Suspected suture-associated cystic calculi were multifocal, short, predominantly linear mineral opacities localized in the center of the urinary bladder on abdominal radiographs. One patient (n = 1) presented with multifocal round, pin point, and linear radiopaque calculi. The calculi were all calcium oxalate in composition. On gross examination, the calculi had a hollow center. Six cystotomies used monofilament absorbable suture material (polydioxanone [n = 4] or poliglecaprone 25 [n = 1]) in prior cystotomies. Suture material in two of the cases was unknown. Suspected suture-associated cystic calculi are a rare occurrence in veterinary medicine but should be considered in dogs that have a history of prior cystotomy, hollow core on gross analysis, and radiographic evidence of mineral opaque, predominantly linear, cystic calculi.

Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases

OBJECTIVE

To compare perioperative opioid consumption and duration of hospitalization (DOH) in anesthetized dogs receiving opioid-based analgesia (OBA) vs those receiving bupivacaine epidural-based analgesia (EPID) during cystotomy.

STUDY DESIGN

Retrospective cross-sectional study.

ANIMALS

Fifty-six client-owned dogs undergoing cystotomy.

METHODS

Clinical records of dogs undergoing cystotomy between January 2015 and December 2017 were reviewed. Demographic data, duration of anesthesia and surgery, anesthetic management, perioperative opioid consumption expressed in morphine equivalents (ME), perioperative use of adjuvant analgesics, time to first micturition, time to eat, time to ambulate, and DOH were recorded. Opioid consumption and DOH were compared with a Wilcoxon rank-sum test, followed by linear regression analysis as appropriate. Time to first micturition, time to eat, and time to walk unassisted were modeled with Cox-proportional hazard models.

RESULTS

Dogs treated with EPID during surgery required 1.5 mg/kg ME less compared with those treated with OBA (P = .04) during surgery. Three of 19 dogs treated with EPID vs 15 of 37 dogs receiving OBA required intraoperative adjuvant analgesics (P = .06). Dogs treated with EPID regained motor function slower than dogs treated with OBA (P = .01); however, there was no difference in time to urinate, time to eat, or DOH between treatments.

CONCLUSION

Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy.

CLINICAL SIGNIFICANCE

The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.

Clinical evaluation of the multifunctional suprapubic catheter in patients requiring permanent suprapubic cystostomy: A prospective randomised trial in a single centre

AIMS AND OBJECTIVES

To assess the clinical effect of the multifunctional suprapubic catheter (MSC) on occurrence of cystospasm, catheter occlusion, the catheter-related urinary tract infection and remission of overactivity bladder, by comparing with the conventional suprapubic catheter (CSC) in patients with permanent suprapubic cystostomy.

BACKGROUND

The conventional suprapubic catheter usually presents with high incidence of catheter-associated complications.

DESIGN

A prospective randomised clinical trial in a single centre.

METHODS

Between January 2014 and January 2015, a total of 91 consecutive patients with permanent suprapubic cystostomy were prospectively randomised into two groups: the MSC group (n = 43) and CSC group (n = 48).

RESULTS

Our results showed that the total times of cystospasm in the MSC group were significantly less than that in the CSC group during the follow-up time (p < .001). In addition, the mean spasmodic duration per time in the MSC group was significantly shorter than that in the CSC group (p < .001). Besides, catheter occlusions were observed in 23 (25.27%) patients, including 5 (11.63%) in the MSC group and 18 (37.50%) in the CSC group (p = .005). The lower rate of positive urine culture was also found in the MSC group but with no significant difference (p = .540). Furthermore, the urodynamic measurement data demonstrated that the patients in the MSC group had a greater remission rate of overactivity bladder after catheter change (p < .001).

CONCLUSIONS

The present data showed that the multifunctional suprapubic catheter could significantly reduce the incidence of catheter occlusion, ameliorate the symptom of cystospasm and relieve the overactivity bladder, but have no influence on the catheter-related urinary tract infection.

RELEVANCE TO CLINICAL PRACTICE

The application of our self-devised multifunctional suprapubic catheter may result in better management of the patients with permanent suprapubic cystostomy.

Evaluation of intraluminal pressure in cystorrhaphies with and without intestinal serosal patch supplementation from canine cadavers

PURPOSE

To evaluate the maximal intraluminal pressure (MIP) supported by canine cadaveric urinary bladders that underwent cystotomy followed by cystorraphy, with and without serosal patching-supplementation.

METHODS

Two groups (n=8 each) were formed, and in one (conventional) the cystotomy was closed with cushing pattern. In the other group (serosal), the same procedure was performed, and a piece of jejunum was used for the construction of the serosal patching over the cystorraphy. MIP was measured by means of an invasive blood pressure transducer with closed stopcock attached to a multiparameter monitor. At the end of each measurement, the bladder body circumference was assessed.

RESULTS

Mean ± SD MIP sustained for the conventional and serosal groups were 28.88 ± 5.08 and 65.38 ± 10.99 mmHg, respectively (p < 0.0001). Bladder circumference did not change significantly between groups (p = 0.35) and did not correlate with MIP assessed in conventional (p = 0.27; r = 0.4379) and serosal groups (p = 0.37; r = -0.3637).

CONCLUSION

Serosal patch-supplemented cystorraphies were able to sustain intraluminal pressures 55.8% higher, than nonsupplemented cystorraphies in specimens from canine cadavers.

Comparison of short-term complication rates between dogs and cats undergoing appositional single-layer or inverting double-layer cystotomy closure: 144 cases (1993-2010)

OBJECTIVE

To compare short-term complication rates in dogs and cats undergoing cystotomy closure by use of an inverting double-layer pattern (group I) versus cystotomy closure by use of an appositional single-layer pattern (group A).

DESIGN

Retrospective case series.

ANIMALS

144 client-owned dogs and cats that underwent cystotomy between 1993 and 2010.

PROCEDURES

Information on signalment, reason for cystotomy, method of cystotomy closure, complications that developed during hospitalization, and duration of hospitalization were obtained from the medical record. The effect of closure technique on short-term complication rate and duration of hospitalization was examined.

RESULTS

2 of the 144 animals developed dehiscence and uroabdomen following cystotomy closure: 1 from group A and 1 from group I. Of group A animals, 29 of 79 (37%) developed minor complications such as hematuria and dysuria. Of group I animals, 33 of 65 (50%) developed the same complications. Group A and group I animals did not differ significantly with regard to prevalence of minor or major complications. The mean duration of hospitalization was 4.1 days and did not differ significantly between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

An appositional single-layer suture pattern for cystotomy closure was a safe and effective procedure with minimal risk of urine leakage and a short-term complication rate of 37%. The appositional single-layer suture pattern for cystotomy closure may be recommended for clinical use because the inverting double-layer suture pattern offered no clear advantage.

Laparoscopic repair in intraperitoneal rupture of urinary bladder in blunt trauma abdomen

OBJECTIVE

Intraperitoneal rupture of urinary bladder is a common condition associated with pelvic fractures. This is a true surgical emergency managed conventionally by open laparotomy with single layer or double layer repair. We performed total laparoscopic repair of an intraperitoneal rupture of bladder.

METHOD

A 25-year-old woman presented with fracture of both pubic rami and signs of bladder rupture after a road traffic accident. Ruptured urinary bladder and other visceral injuries were sutured laparoscopically.

CONCLUSIONS

Laparoscopic repair of intraperitoneal rupture of urinary bladder is an effective and minimally invasive technique.

Colonic seromuscular augmentation cystoplasty following subtotal cystectomy for treatment of bladder necrosis caused by bladder torsion in a dog

CASE DESCRIPTION

A 5-year-old Labrador Retriever was evaluated because of a 3-day history of lethargy, anorexia, vomiting, stranguria, and anuria after routine ovariohysterectomy.

CLINICAL FINDINGS

On initial examination, signs of abdominal pain and enlargement of the urinary bladder were detected. Clinicopathologic abnormalities included leukocytosis, azotemia, and hyperkalemia. Radiography and surgical exploration of the abdomen revealed urinary bladder torsion at the level of the trigone; histologically, there was necrosis of 90% of the organ.

TREATMENT AND OUTCOME

After excision of the necrotic wall of the urinary bladder (approx 0.5 cm cranial to the ureteral orifices), the remaining bladder stump was closed with a colonic seromuscular patch. Eleven weeks later, cystoscopy revealed an intramural ureteral stricture, for which treatment included a mucosal apposition neoureterocystostomy. Thirteen months after the first surgery, the dog developed pyelonephritis, which was successfully treated. By 3 months after subtotal cystectomy, the dog's urinary bladder was almost normal in size. Frequency of urination decreased from 3 to 4 urinations/h immediately after surgery to once every 3 hours after 2 months; approximately 4 months after the subtotal cystectomy, urination frequency was considered close to normal.

CLINICAL RELEVANCE

Urinary bladder torsion is a surgical emergency in dogs. Ischemia of the urinary bladder wall may result from strangulation of the arterial and venous blood supply and from overdistension. Subtotal resection of the urinary bladder, preserving only the trigone area and the ureteral openings, and colonic seromuscular augmentation can be used to successfully treat urinary bladder torsion in dogs.

Clinical use of low-profile cystostomy tubes in four dogs and a cat

Traditional cystostomy tubes (used for temporary or permanent diversion of urine in dogs and cats) are long (> or = 22 cm) and cumbersome to stabilize, requiring sutures or bandages to hold the tube against the body. Use of a low-profile gastrostomy port system as a low-profile cystostomy tube (LPCT) in 4 dogs and a cat was investigated; owner satisfaction with the device was assessed. Technical difficulty associated with placement and management of LPCTs was similar to that for traditional cystostomy tubes; with LPCTs, activity and mobility of pets was not compromised, and bandaging was not required. Complications included lower urinary tract infection, mild peristomal leakage of urine and leakage from components of the system, and subcutaneous peristomal infection. Four of 5 owners considered the tube to be easy to use; all owners said they would be comfortable repeating their decision to use the LPCT in their pet.