Management and complications following trigonal-colonic anastomosis in a dog: five-year evaluation

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.

Evaluation of palliative stenting for management of malignant urethral obstructions in dogs

OBJECTIVE

To evaluate use of balloon-expandable and self-expanding metallic stents in management of malignant urethral obstructions in dogs.

DESIGN

Original study.

ANIMALS

12 dogs with malignant urethral obstructions.

PROCEDURES

The extent and location of urethral obstructions and the diameter of adjacent unaffected luminal segments were determined by use of fluoroscopically guided wires and measuring catheters. Stents were chosen to extend approximately 1 cm proximal and distal to the obstruction. Stent diameters were chosen to be approximately 10% greater than the diameter of healthy portions of the urethra to prevent displacement. Stents were placed in the urethra under fluoroscopic guidance to restore luminal patency.

RESULTS

3 dogs received balloon-expandable metallic stents, and 9 dogs received self-expanding metallic stents. The placement procedures were rapid, safe, and effective at restoring luminal patency and were not associated with major complications. Complications included recurrent urethral obstruction secondary to blood clot formation and urethral edema in 1 dog and stent dislodgement into the urinary bladder in 1 dog. All dogs were able to urinate immediately after the procedure. Nine dogs (3/4 females and 6/8 males) were continent or mildly incontinent after stent placement. Of the remaining 3 dogs, 2 developed severe incontinence and 1 had an atonic bladder. Seven dogs were considered to have good to excellent outcome, 3 had fair outcome, and 2 had poor outcome.

CONCLUSIONS AND CLINICAL RELEVANCE

Transurethral placement of metallic stents was a safe and effective palliative treatment option for dogs with malignant urethral obstructions.

Transurethral Resection in the Management of Urethral and Prostatic Neoplasia in 6 Dogs

OBJECTIVE

To assess cystoscopic transurethral resection (TUR) for the palliative management of dogs with neoplastic infiltration of the urethra.

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Six client-owned dogs.

METHODS

Cystoscopic examination and electrosurgical TUR were performed in dogs with urination difficulties caused by prostatic or urethral neoplasia. TUR was performed in a retrograde manner in female dogs and antegrade in male dogs via exploratory celiotomy and ventral cystotomy. Cystoscopic examination was used to determine the extent of neoplastic involvement of the urethra. TUR involved piecemeal removal of neoplastic tissue from the urethral lumen using an electrocautery cutting loop. Hemorrhage was controlled with a cystoscopic cauterized roller-ball. In 2 male dogs, intraoperative radiation therapy (IORT) was used to treat both prostatic neoplasia and the sublumbar lymph node bed. Surgical technique, complications, adjuvant treatment, and outcome were recorded.

RESULTS

TUR was performed in 3 male dogs with prostatic carcinoma and 2 female dogs with urethral transitional cell carcinoma (TCC). In 1 female dog, TUR was attempted but not successful because of cystoscope diameter. Iatrogenic urethral perforation occurred during TUR in 3 dogs. In 2 dogs, prolonged exposure to lavage fluid resulted in clinical and biochemical abnormalities consistent with TUR syndrome. Dysuria resolved in 5 dogs within 10 days of TUR. Treatment-related complications included urinary tract infection and tumor seeding. Local tumor progression and metastasis occurred in all dogs.

CONCLUSIONS

TUR (in combination with chemotherapy+/-IORT) resulted in rapid palliation of urination difficulties in male dogs with prostatic carcinoma. In female dogs with urethral TCC, however, electrosurgical TUR cannot be recommended because of a high intra- and postoperative complication rate with no improvement in postoperative management compared with historical reports of tube cystostomy.

CLINICAL RELEVANCE

TUR is a novel alternative for the palliation of male dogs with prostatic carcinoma. In female dogs with urethral TCC, electrosurgical TUR does not provide any advantages compared with tube cystostomy.