The use of a low-profile cystostomy tube to relieve urethral obstruction in a dog

Single-step, non-surgical placement of permanent low-profile cystostomy tubes in dogs: 10 cases (2018-2023)

OBJECTIVES

Low-profile cystostomy tubes provide an alternative to conventional cystostomy tubes with external tubing. Previously, these have been placed surgically involving coeliotomy, cystotomy and cystopexy, or have been used as replacement tubes in existing stoma sites. The purpose of this study is to describe a technique for, and the outcomes of, single-step, non-surgical low-profile cystostomy tube placement.

MATERIALS AND METHODS

All cases that had single-step, non-surgical placement of low-profile cystotomy tube attempted at the authors' institutions were included in this study. Data, including success rates, outcomes and complications, were extracted from the medical records.

RESULTS

Ten client-owned dogs were inclided. Single-step, non-surgical placement was successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low-profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement of their cystostomy tube. Mean time until first tube replacement was 103 days (range 13 to 363 days).

CLINICAL SIGNIFICANCE

Single-step, non-surgical placement of a low-profile cystostomy tube is a viable alternative to surgical placement. Lack of cystopexy does not appear to result in complications. Conversion to coeliotomy might be required if tube placement is not successful with this technique. Complications seen with non-surgical tube placement such as inadvertent tube removal were similar to those previously reported for surgically placed tubes.

Buccal mucosal graft urethroplasty in five male dogs with penile urethral stricture at the bulbus glandis

OBJECTIVES

To evaluate the feasibility of correcting penile urethral strictures at the bulbus glandis using buccal mucosal graft (BMG) urethroplasty in dogs.

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Five male dogs with urethral strictures located at the bulbus glandis.

METHODS

Urethrotomy was performed throughout the entire length of the urethral stricture including ~0.5 cm healthy urethra proximal and distal. The scarred tissue and unhealthy mucosa of the strictured urethra were completely excised. The graft was harvested from the buccal mucosa and tubularized at the stricture site using a urethral catheter as the skeleton. The catheter was maintained for 14 days after surgery and removed when no urethral leakage was identified on a positive-contrast retrograde urethrogram. The dogs were discharged after spontaneous urination was confirmed. Six months postoperative follow-up was completed for all dogs with repeated positive contrast urethrogram and an owner questionnaire to score urinary function and quality of life.

RESULTS

The five dogs recovered well following surgery and only one dog experienced a minor complication. All dogs were able to urinate normally after catheter removal. No evidence of leakage was identified on a 14 day postoperative retrograde positive contrast urethrogram and clinically at a median follow-up time of 182 days (range, 182-186). All owners scored the urinary function as excellent and ranked their satisfaction very high 6 months after the procedure.

CONCLUSION

Buccal mucosal graft urethroplasty has positive outcomes for dogs with penile urethral strictures.

Case report: Utility, complications, and short-term outcomes in three dogs managed with percutaneous pigtail cystostomy catheters for urethral obstruction

Objective

This study aimed to describe the utility, complications, and short-term outcomes of three dogs managed with percutaneous pigtail cystostomy catheters placed in the emergency room (ER).

Case summary

Three dogs were presented separately to the ER for unalleviated mechanical urethral obstruction secondary to urolithiasis and urethral neoplasia. Retrograde urinary catheterization and urohydropulsion were not successful after multiple attempts. Percutaneous pigtail cystostomy catheters were placed under sedation to achieve temporary urinary diversion, and were successful in two of the three dogs. Complications encountered include mild abdominal effusion, unsuccessful placement resulting in hemorrhagic abdominal effusion, steatitis, abdominal pain, and kinking of the catheter. The two dogs diagnosed with urolithiasis were discharged from the hospital, and the dog diagnosed with urethral neoplasia was humanely euthanized due to poor prognosis.

New or unique information provided

When successful, the placement of pigtail cystostomy catheters allowed for temporary urinary diversion until definitive treatment could be performed and were well tolerated. Short-term outcomes were good. Complications arising from this procedure were common and increased morbidity. The risk of unsuccessful catheter placement may be increased when the procedure is performed in an over conditioned patient or by an inexperienced operator. Careful case selection and risk-benefit analysis should be considered before attempting this procedure. Further studies are necessary to evaluate the ideal technique, incidence of complications, and outcomes of this procedure.

Evaluation of urethral thickness using ultrasonography in healthy small-breed dogs

Introduction

Urethral thickness measurements can be indicative of the pathological state of a patient; however to the best of our knowledge, no measurement reference range has been established in small-breed dogs. This study aimed to establish reference ranges for total urethral thickness and urethral wall thickness in healthy small-breed dogs; "urethral wall thickness" was assumed to be 1/2 of the "total urethral thickness."

Methods

Total urethral thickness was measured by ultrasonography in 240 healthy small-breed dogs. In both female and male dogs, the thickness was measured in the mid-sagittal plane. In female dogs, it was measured immediately before the pelvic bone. In male dogs, it was measured caudal to the prostate and cranial to the pelvic bone. The total urethral thickness we measured is the total thickness of the collapsed urethra, which is the sum of the thicknesses of the dorsal and ventral urethral wall.

Results

The mean value of total urethral thickness was 3.15 ± 0.83 mm (urethral wall thickness, 1.58 ± 0.41 mm) in 240 small-breed dogs. The total urethral thickness was significantly greater in male dogs than in female dogs (p < 0.001), even when compared among the same breeds (p < 0.05). The mean value of the total urethral thickness in females was 2.78 ± 0.60 mm (urethral wall thickness, 1.39 ± 0.30 mm), and 3.53 ± 0.86 mm (urethral wall thickness, 1.76 ± 0.43 mm) in males. There was very weak positive correlation between body weight (BW) and total urethral thickness (R2 = 0.109; β = 0.330; p < 0.001). Intraobserver reliability measured by intraclass correlation coefficient (ICC) was 0.986 (p < 0.001) and interobserver reliability measured by ICC was 0.966 (p < 0.001).

Discussion

This study described the differences in total urethral thickness between breeds, sexes, and sterilization status, and the correlation between BW and total urethral thickness. Furthermore, this is the first study to provide reference ranges of total urethral thickness and urethral wall thickness in small-breed dogs using ultrasonography, and is expected to be useful for urethral evaluation in veterinary diagnostic imaging.

Retrospective study of proliferative urethritis in dogs: Clinical presentation and outcome using various treatment modalities in 11 dogs

BACKGROUND

Proliferative urethritis (PU) is an uncommon inflammatory and infiltrative disease of the urethra in female dogs, often associated with urinary tract infection (UTI). It typically presents with evidence of urethral obstruction (UO).

OBJECTIVES

Identify clinical features in dogs with PU and determine outcome after different treatment modalities.

ANIMALS

Eleven client-owned dogs.

METHODS

Medical records of dogs with histopathologic diagnosis of PU from 2011 to 2020 were retrospectively evaluated, including information on clinical pathology, imaging, and histopathology. Outcomes of various treatment modalities were recorded and compared. Long-term urethral patency (>6 months) was considered treatment success.

RESULTS

All dogs were female and presented with UO. Eight (73%) had a history of UTI. Ten of 11 survived to discharge and were used for long-term data collection. Seven of 10 (70%) were treated using an effacement procedure (balloon dilatation [BD], stent, or both) and 6/7 (86%) achieved long-term urethral patency (>6 months). Seven of 10 had UO recurrence after their first procedure, including 3/3 (100%) that did not have effacement and 4/7 that did (57%), at a median of 101 days and 687 days, respectively. After effacement, the duration of patency was longer for those treated using a stent than BD alone (median, 843 days and 452 days, respectively).

CONCLUSIONS AND CLINICAL IMPORTANCE

Proliferative urethritis is a recurrent disease often associated with UTI. The best outcome of long-term urethral patency occurred after lesion effacement, either by BD or stenting. Future prospective studies should determine the impact of immunosuppressive treatment.

Permanent Implantable Medical Devices in Exotic Pet Medicine

Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.

Interventional Therapies of the Urinary Tract

Minimally invasive interventional therapies are the new standard of care in veterinary medicine. In comparison with standard surgical procedures, they are associated with minimal tissue injury, leading to shorter, smoother recovery and decreasing the perioperative morbidity and mortality. A thorough understanding of the therapeutic options available is essential to properly educate and inform clients. Proper equipment, technical expertise, and experience are essential prerequisites to many of these procedures.

Clinical, histopathologic, cystoscopic, and fluorescence in situ hybridization analysis of proliferative urethritis in 22 dogs

Background

Proliferative urethritis (PU) is a lower urinary tract disease of dogs characterized by frond‐like lesions in the urethra. The etiology of PU is unknown, although an association with bacterial cystitis is reported.

Objectives

Deep‐seated bacterial cystitis is associated with PU, particularly in dogs with neutrophilic or granulomatous inflammation.

Animals

Twenty‐two client‐owned dogs with PU and 5 control dogs euthanized for non‐urinary disease.

Methods

In retrospective analysis, medical records of dogs with PU from 1986 to 2016 were reviewed. Signalment, clinical signs, cystoscopic findings, antimicrobial use, and results of urine, bladder, or urethral tissue cultures, if available, were recorded. Histopathology was reviewed and classified as lymphocytic‐plasmacytic (LP), neutrophilic, LP‐neutrophilic (LPN), granulomatous, or pleocellular. Eubacterial fluorescence in situ hybridization (FISH) was performed on 18 tissue samples (13 cases, 5 controls), with subsequent evaluation of bacterial species.

Results

Of the 22 dogs, 9 had LP urethritis, 6 had LPN, 4 had pleocellular, and 3 had neutrophilic urethritis. Of note, 7 of 13 PU samples were FISH+ for adherent or invasive bacteria; 1 of 5 controls were FISH+ for adherent bacteria. Five dogs had negative urine and tissue cultures when FISH was positive. There was no association detected between the type of urethral inflammation and the results of urine and tissue culture or FISH.

Conclusions and Clinical Importance

The type of inflammation varied widely in these 22 PU cases. Deep‐seated bacterial urethritis could be contributing to the inflammatory process in some dogs, regardless of the inflammation type. Urine and tissue cultures likely underestimate bacterial colonization of the urethra in dogs.

Urinary bladder retroversion and neourethrocystostomy for treatment of inadvertent prostatectomy and urethrectomy in a dog

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.

Management of transitional cell carcinoma of the urinary bladder in dogs: a review

Transitional cell carcinoma (TCC), also referred to as urothelial carcinoma, is the most common form of urinary bladder cancer in dogs, affecting tens of thousands of dogs worldwide each year. Canine TCC is usually a high grade invasive cancer. Problems associated with TCC include urinary tract obstruction, distant metastases in >50% of affected dogs, and clinical signs that are troubling both to the dogs and to their owners. Risk factors for TCC include exposure to older types of flea control products and lawn chemicals, obesity, female sex, and a very strong breed-associated risk. This knowledge is allowing pet owners to take steps to reduce the risk of TCC in their dog. The diagnosis of TCC is made by histopathology of tissue biopsies obtained by cystoscopy, surgery, or catheter. Percutaneous aspirates and biopsies should be avoided due to the risk of tumor seeding. TCC is most commonly located in the trigone region of the bladder precluding complete surgical resection. Medical treatment is the mainstay for TCC therapy in dogs. Although TCC is not usually curable in dogs, multiple drugs have activity against it. Approximately 75% of dogs respond favorably to TCC treatment and can enjoy several months to a year or more of good quality life. Many promising new therapies for TCC are emerging and with the close similarity between TCC in dogs and high grade invasive bladder cancer in humans, new treatment strategies found to be successful in canine studies are expected to help dogs and to be subsequently translated to humans.

Evaluation of urethral stent placement for benign urethral obstructions in dogs

Background

Benign urethral obstructions (BUO) in dogs result in substantial morbidity because of challenges with conventional therapies. Treatment of malignant urethral obstructions with intraluminal urethral stents is reported to successfully relieve obstructions.

Hypothesis/Objectives

To evaluate the efficacy and outcome of urethral stent placement for treatment of BUO in dogs.

Animals

Eleven client‐owned animals with urethral stents placed for treatment of BUO.

Methods

Retrospective study in which medical records were reviewed in dogs diagnosed with BUO and treated with a metallic urethral stent. Data collected included signalment, cause of benign obstruction, procedure time, size and type of stent, complications, and short‐ and long‐term outcome.

Results

Eleven dogs with 15 urethral stents were included. Intraluminal urethral stent(s) relieved the obstructions in all dogs. Four dogs had 2 stents placed in separate procedures because of incomplete patency after treatment (n = 1), inadvertent compression of the stent (n = 1), or tissue ingrowth through the stent (n = 2). The median continence score after stent placement was 10 of 10 (range 3–10) with 6 dogs being continent, 3 mildly incontinent, and 1 each moderately and severely incontinent. All owners considered their dog to have an excellent long‐term clinical outcome with long‐term urethral patency. The median follow‐up time was 24 months (range 4–48).

Conclusions and Clinical Importance

Urethral stents appear to be an effective treatment for benign urinary obstructions. Moderate to severe incontinence developed in a minority (12.5%) of dogs. Stents relieved obstructions in all dogs with an excellent long‐term outcome.

Complications of Stamey percutaneous loop cystostomy catheters in three cats

Complications associated with the Stamey percutaneous loop cystostomy catheter (Cook Medical), including exposure of the most proximal side-hole and leakage of urine from the bladder, were encountered following percutaneous placement in three cats. In all cats, surgical exploration for removal of the catheter was performed.

Delayed Urethral Obstruction After Uterine Torsion in a Pregnant Dog

A 4 yr old pregnant female shih tzu was presented with abdominal discomfort and bloody vulvar discharge. The nongravid uterine horn was reflected caudally over the trigone, obstructing urine outflow. A cesarian section and ovariohysterectomy were performed. Postoperatively, the hematuria and pollakiuria resolved. Seventeen days later, the pelvic urethra was completely obstructed by a soft tissue mass that was identified by rectal palpation, blocked catheterization attempts, contrast radiography, ultrasonography, and surgery. Management included temporary cystostomy tube and definitive prepubic urethrostomy. Histologic diagnosis was severe, multifocal, necrosuppurative urethritis with fibroplasia, fibrosis, and cellulitis, apparently secondary to ischemia. Delayed urethral obstruction is a potential complication of canine uterine torsion.

Porcine Small Intestinal Submucosa Augmentation Urethroplasty and Balloon Dilatation of a Urethral Stricture Secondary to Inadvertent Prostatectomy in a Dog

A 10-month-old, male German shepherd dog experienced inadvertent prostatectomy during cryptorchidectomy. Cystourethral anastomosis was performed 1 day later. The dog developed stranguria and incontinence. A proximal urethral stricture was diagnosed with a contrast urethrogram 5 weeks later. Urethral augmentation with an onlay graft of porcine small intestinal submucosa was performed. Urinary diversion was accomplished with a urethral catheter followed by a cystostomy tube. The stricture recurred over the next 6 weeks. Three urethral balloon dilatations were performed 3 days apart, with the third attempt resulting in expansion of the stricture. Twenty-two months postdilatation, the dog intermittently urinated with a steady stream and had mild to moderate urinary incontinence.

Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995–2006)

OBJECTIVE

To determine indications for cystostomy tube use in dogs and cats, complications associated with their use, and outcome of dogs and cats in which cystostomy tubes had been inserted.

DESIGN

Retrospective case series.

ANIMALS

37 dogs and 39 cats.

PROCEDURES

Information was obtained from medical records. Long-term follow-up information was obtained by use of a client questionnaire.

RESULTS

Indications for cystostomy tube placement were bladder dysfunction, urinary tract rupture, obstructive urinary tract neoplasia, urinary diversion following urogenital surgery, obstructive urolithiasis, and feline lower urinary tract disease. Median time tubes were in place was 11 days, but duration of tube use was significantly longer for animals with bladder dysfunction than for animals with urinary tract trauma, urinary diversion, or urinary tract obstruction. Thirty-seven (49%) animals had tube complications. Development of complications was not significantly associated with species, age, body weight, duration of tube use, or tube type, except that animals were significantly more likely to develop complications following long-rather than short-term use. In 42 animals, the underlying condition resolved and the tube was removed; 22 animals died or were euthanatized with the tube in place.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that cystostomy tubes may be used for animals with various conditions related to problems with urine outflow. Nearly half the animals in the study developed complications related to the cystostomy tube, suggesting that potential complications should be discussed with owners prior to tube placement. However, most complications were easily resolved.