Ventral approach to the pelvic canal in the female dog

Surgical management of urethral obstruction secondary to perineal liposarcoma in a dog: a case report

BACKGROUND

Swelling of the perineal region in male dogs is most commonly caused by a perineal hernia. Clinical signs associated with perineal hernia are constipation, tenesmus or stranguria. This case report documents a rare cause of perineal swelling created by the growth of a malignant tumour leading to urethral obstruction and subsequent stranguria.

CASE PRESENTATION

An 11-year-old neutered male German Shepherd was presented for swelling in the perineal region and stranguria for three days. Complete blood count and serum biochemistry were unremarkable. Ultrasound revealed a heterogeneous mass in the perineal region. Retrograde urethrography showed a severe narrowing of the urethra caudal to the pelvis. A fine-needle aspirate of the mass was highly suspicious for liposarcoma. Staging was performed by computed tomography (CT) of the thorax and abdomen. Total penile amputation in combination with pubic-ischial pelvic osteotomy, transposition of the remaining urethra through the inguinal canal, V-Y-plasty cranial to the prepuce and preputial urethrostomy were performed to remove the tumour. Histopathology confirmed a well-differentiated liposarcoma with complete histological margins. Six months after the surgery the dog was doing well and there were no signs indicating local tumour recurrence.

CONCLUSIONS

Wide surgical excision is generally recommended for soft tissue sarcomas, however this is sometimes not feasible for large tumours. In the case reported here, tumour resection was achieved by a combination of several surgical techniques with a good clinical outcome.

Submucosal resection via a transanal approach for treatment of epithelial rectal tumors - a multicenter study

Objective

To report complications and long‐term outcomes after submucosal resections of benign and malignant epithelial rectal masses.

Study design

Retrospective multicentric study.

Sample population

Medical records of 93 dogs at 7 referral hospitals.

Methods

Records were reviewed for surgical time, diagnosis, margins, complications, and recurrences. Survival of dogs was evaluated based on tumor types, categorized as benign, carcinoma in situ, and carcinoma. The Kaplan‐Meier survival curve and Cox proportional hazards analysis were used to determine the association of a range of variables with recurrence and survival time.

Results

Duration of follow up was 708 days (range, 25‐4383). Twenty‐seven dogs (29%) developed complications. Recurrence was identified in 20/93 (21%), with 12/20 recurrent masses treated with repeat submucosal resection. Median survival was not reached in any group. The 1‐,2‐, 5‐year survival rates for carcinomas were 95%, 89%, and 73% respectively. However, overall survival was longer for benign tumors than carcinomas (P = .001). Recurrence was more likely when complications (P = .032) or incomplete margins (P = .023) were present. Recurrence was associated with an increased risk of death (P = .046).

Conclusion

Submucosal resection of both benign and malignant rectal masses was associated with a low rate of severe complications and prolonged survival in the 93 dogs described here.

Clinical significance

Submucosal resection is a suitable technique for resection of selected rectal masses.

Novel surgical approach to neoplastic lesions in the distal part of the urethra: A pilot cadaver study comparing open and hybrid techniques

Tumours of the distal urethra in female dogs are often difficult to treat, and the surgical methods described thus far have technical limitations. This study aimed to present a novel approach to the surgical treatment of distal urethral tumours. This study used dog cadavers to evaluate the technical feasibility of surgically removing neoplastic lesions in the distal urethra and compared surgical outcomes of open surgery with those of hybrid surgery (combination of laparoscopy and open surgery). Open intact, open spayed, hybrid intact, and hybrid spayed dog cadaver groups underwent surgery (n = 6 per group). The novel surgical method was based on vulvovaginectomy (ovariohysterectomy in intact dogs), resection of the distal part of the urethra, and pre-pubic urethrostomy. Outcomes of interest included technical feasibility of each procedure, using both surgical techniques, wound length, time required to complete the procedure, and the incidence of intraoperative ureter and rectum injuries. Surgical technique and reproductive status affected operating time. Technique choice affected wound length; the surgical wound was longer in the open group than in the hybrid group. Macroscopic evaluation of the rectum did not reveal any damage to the wall. There was no evidence of ureter leakage or obstruction in any case. The present findings suggest that both open and hybrid surgery can be used to treat distal urethral tumours.

Case report laparoscopy-assisted pre-pubic urethrostomy as a palliative procedure for resection of distal urethral tumor in a female dog

Background

This paper presents the first described case of laparoscopy-assisted prepubic urethrostomy and laparoscopic resection of a tumor of the distal part of the urethra in a female dog as a palliative treatment.

Case presentation

An intact, 11 -year-old, mixed breed female dog, weighing 15 kg, was admitted with signs of urinary obstruction and difficulty with catheterization. Vaginal, rectal, and endoscopic examinations revealed a firm mass in the pelvic cavity at the level of the pelvic urethra. Ultrasound and computed tomography examination showed enlargement of the urethral wall (5.5 cm width and 3 cm thick), which was significantly restricting the patency of the urethra. The lesion affected only the distal part of the urethra without the presence of local or distant metastatic changes.

The affected portion of the urethra was laparoscopically removed while performing pre-pubic urethrostomy with laparoscopy. The patient regained full consciousness immediately after the end of anesthesia, without signs of urinary incontinence. Histopathological examination of the removed urethra revealed an oncological margin only from the side of the bladder. In the period of 2.5 months after the procedure, the owner did not notice any symptoms that could indicate a postoperative recurrence, which was diagnosed three months after the procedure.

Conclusions

Pre-pubic urethrostomy can be successfully performed with the assistance of laparoscopy. The use of minimally invasive surgery will allow, in selected cases, removal of the urethral tumor, and in inoperable cases, to perform a minimally invasive palliative pre-pubic urethrostomy.

Laparoscopic gonadectomy in dogs with ovotesticular disorder of sexual development

Disorders of sexual development (DSD) in dogs involve most commonly an XX sex reversal syndrome, treated conventionally by gonadohysterectomy. The objective of the present case series is to describe the surgical treatment and long-term follow-up of dogs undergoing laparoscopic gonadectomy without hysterectomy for treatment of ovotesticular DSD. Six female dogs clinically diagnosed with DSD were retrospectively included in the study when laparoscopic gonadectomy was performed and histology confirmed the presence of abnormal gonads. The dogs were evaluated by ultrasound after 6 months, and owners were contacted by phone for the long-term reevaluation. Laparoscopic gonadectomy was performed using 2- or 3-portal midline techniques with 3- and/or 5-mm instruments. Additional procedures were performed in 5 dogs, including os clitoris removal in 4 dogs and vulvoplasty in 1 dog. Histological analysis of the gonads reported 11 ovotestes and 1 testis. No major or minor complications occurred perioperatively. Ultrasonographic reevaluation was performed in 5/6 dogs and the remaining abdominal genital system was considered normal. Median long-term follow-up was 617 days (range, 265-1597) with none of the dogs having any symptom related to DSD. Therefore, laparoscopic gonadectomy is a valid alternative for dogs with ovotesticular DSD and is less invasive than conventional open techniques. Removal of the gonads avoids future development of hormone-related diseases of the remaining genital tract.

Complications and outcomes following rectal pull-through surgery in dogs with rectal masses: 74 cases (2000-2013)

OBJECTIVE

To evaluate the incidence of and factors associated with complications following rectal pull-through (RPT) surgery and the outcome for dogs with rectal tumors.

DESIGN

Retrospective case series.

ANIMALS

74 dogs with rectal masses.

PROCEDURES

Information regarding signalment, history, diagnostic testing, type of rectal disease, surgical details, and postoperative complications, treatments, and outcomes was obtained from medical records and follow-up communications. Survival times were calculated. Descriptive statistics were generated. Regression analyses were used to evaluate the effect of various variables on the development of postsurgical complications and survival time.

RESULTS

58 (78.4%) dogs developed postsurgical complications, the most common of which was fecal incontinence with 42 (56.8%) dogs affected, of which 23 (54.8%) developed permanent incontinence. Other complications included diarrhea (n = 32), tenesmus (23), stricture formation (16), rectal bleeding (8), constipation (7), dehiscence (6), and infection (4). The rectal tumor recurred in 10 dogs. The median survival time was 1,150 days for all dogs and 726 days for dogs with malignant tumors. The 2 most common rectal masses were rectal carcinoma and rectal carcinoma in situ, and the dogs with these tumors had median survival times of 696 and 1,006 days, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Dogs with rectal diseases that underwent RPT surgery had a high incidence of complications; however, those dogs had good local tumor control and survival times. The risk and impact of postsurgical complications on the quality of life and oncological outcomes should be discussed with owners before RPT surgery is performed in dogs with rectal masses.

The effect of abaxial retraction on pelvic geometry after pelvic symphysiotomy

OBJECTIVE

To describe the effect abaxial retraction after pelvic symphysiotomy has on the geometry of the sacroiliac joints (SIs) in dogs.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Canine cadavers (n = 9).

METHODS

Canine cadavers free of sacroiliac disease had pelvic symphysiotomy and retraction to 25%, 50%, 75%, and 100% of transverse sacral width, followed by axial reduction of the symphysis. Before symphysiotomy, after each abaxial retraction value, and after reduction of the symphysis each SI joint had a computed tomographic scan to evaluate the effect on the SI joints.

RESULTS

There was no luxation at 25% abaxial retraction, unilateral SI luxation in three cadavers after 50% abaxial retraction and in all cadavers after 75% abaxial retraction. Axial reduction of the symphysis resolved all luxations.

CONCLUSIONS

Pelvic symphysiotomy and abaxial retraction between 50% and 75% of transverse sacral width leads to unilateral SI luxation, which is resolved by axial reduction. While not likely requiring ancillary stabilization, SI joint luxation may be a cause for additional postoperative pain, reluctance to ambulate, and prolonged hospitalization/recovery.

Subtotal vaginectomy for management of extensive vaginal disease in 11 dogs

OBJECTIVE

To report (1) a surgical technique for subtotal vaginectomy using a combined abdominal and vestibular approach; (2) intra- and postoperative complications; and (3) long-term outcome.

STUDY DESIGN

Retrospective case series.

ANIMALS

Female dogs (n = 11) with extensive intramural vaginal disease.

METHODS

Through a ventral median celiotomy, the cranial aspect of the vagina was freed and ovariohysterectomy (OVH) was performed in intact females. After episiotomy, the vaginal wall was incised at the vestibulovaginal junction cranial to the urethral orifice, and the vagina freed from any remaining pelvic attachments. Dogs were reexamined at 4 weeks and 6 months. Long-term outcome was evaluated by contacting the primary veterinarian by phone.

RESULTS

Five dogs had benign vaginal disease and 6 had malignant vaginal neoplasia. A combined abdominal and vestibular approach permitted subtotal vaginectomy in all dogs; 6 dogs also had OVH. No major complications occurred and clinical signs had resolved by 4 weeks. One dog with malignant neoplasia was euthanatized 3 months later for metastatic disease and 1 dog developed postoperative urinary incontinence. Local recurrence or metastases were not identified in the other dogs.

CONCLUSION

Combined abdominal and vestibular approach for subtotal vaginectomy allowed complete resection of extensive vaginal lesions, was not associated with major complications, and outcome was favorable.

Vaginectomy and urethroplasty as a treatment for non-pedunculated vaginal tumours in four bitches

Vaginal tumours are uncommon in dogs. Previous reports have shown that 73 to 94 per cent of documented vaginal tumours are benign and pedunculated, often on narrow stalks. Some vaginal tumours are non-pedunculated. They grow in a concentric way either towards the vestibular area or towards the cervix. Their growth can locally affect the function of other organs. Urethral and rectal compression as well as local neurological disturbances have been described. This case series describes total and partial vaginectomy associated with urethroplasty as a treatment for non-pedunculated vaginal tumours in four dogs. These surgical procedures allowed complete resection of the tumour and were associated with low morbidity. Postoperative management and short term outcome are discussed. The final outcome was favourable; throughout the follow-up period, no local recurrence or metastasis was encountered in the animals.

Intrapelvic granuloma formation six years after total hip arthroplasty in a dog

A 9-year-old Golden Retriever that had undergone left total hip arthroplasty 6 years previously was evaluated because of constipation and tenesmus. Abdominal radiography and ultrasonography revealed a large intrapelvic mass that was contiguous with a mass of polymethyl methacrylate that had been extruded through a defect in the medial wall of the acetabulum at the time of total hip arthroplasty. Clinical signs resolved following resection of the mass and associated polymethyl methacrylate from the pelvic canal. Results of histologic examination of the mass were consistent with a diagnosis of foreign body granuloma, most likely secondary to particulate debris. There was no clinical or radiographic evidence of aseptic loosening of the acetabular or femoral components, and the mass may have represented a response to wear debris.

Surgery of the canine vagina and vulva

Accurate diagnosis of canine vaginal abnormalities often requires general anesthesia, vaginoscopy, and contrast radiography. Abdominal ultrasonography, thoracic radiography, computed tomography, and histopathology may also be advised for the workup of mass lesions before surgery. Many procedures such as episioplasty and resection of pedunculated vaginal masses or edematous tissue are easily performed with proper planning and equipment (e.g., electrocautery). Consideration should be given to referring more complicated procedures such as resection of large vaginal masses or vaginal stenoses to a board-certified surgeon. Finally, preoperative placement of a fentanyl patch and pre- or postoperative epidural analgesia are highly recommended for any vulvovaginal surgical procedure.

Vaginourethroplasty for treatment of urethral obstruction in the bitch

Vaginourethroplasty was performed in six bitches with infiltrative, obstructive urethral disease. The initial clinical signs included dysuria, hematuria, pollakiuria, and stranguria. Diagnosis was based on the clinical signs, plain radiography and contrast vagino-urethrogram examination, and urethral biopsy. Five dogs were diagnosed as having urethral neoplasia; the sixth dog had granulomatous urethritis. In all six dogs, up to 50% of the urethra and the urethral tubercle were resected to ensure adequate surgical margins. One dog was euthanatized 4 months after surgery for recurrence of a transitional cell carcinoma at the surgical site. Long-term resolution of the problem (minimum of 12 months) was achieved in the other five dogs. The frequency of serious complications, including urinary incontinence and ascending lower urinary tract infections, was low.