Diagnosis and treatment of urolithiasis in a Toy Poodle dog

Background

Urolithiasis in dogs is a disorder of the urinary tract caused by the development of crystals. These crystals are composed of minerals such as phosphates, oxalates, urates, cystine, carbonates, and silica. It can be fatal if the diagnosis and treatment are inaccurate. This report aims to report a case of urolithiasis in a Toy Poodle dog.

Case Description

A 2-year-old male Toy Poodle dog weighing 4.2 kg with black hair, and having trouble urinating was presented to Prof. Soeparwi Animal Hospital, Universitas Gadjah Mada, Indonesia. The dog is examined physically and, in the laboratory, diagnosed and continued with operative therapy. The history and physical examination revealed that the dog had been experiencing hematuria, stranguria, and oliguria for 2 months, with the last few days accompanied by decreased appetite. The dog exhibited decreased skin turgor, a capillary refill time (CRT) of less than 2 seconds, signs of pain and distress during urination, and palpation of distended urinary vesicles. Ultrasound scans revealed uroliths in the urinary vesica, which were identified by an acoustic shadow. Blood tests indicated a decrease in hematocrit and erythrocytes along with an increase in leukocytes. Urolithiasis was diagnosed in the case dog based on anamnesis, physical examination, hematological examination, and ultrasonography. Subsequently, a cystotomy was performed, and uroliths located in urinary vesicles were removed. The dog received ceftriaxone injections at 15 mg/kg body weight and vitamin B-complex injections at a concentration of 10 mg/kg body weight for 5 days. Four days post-surgery, the case dog was able to successfully urinate and pass clean urine.

Conclusion

The Toy Poodle dog was diagnosed with silica urolithiasis in the urinary vesicles and the urolith is quite large. Cystotomy was performed to remove the urolith. Postoperative care were included the administration of antibiotics and vitamins to facilitate the healing process. The condition of the Poodle toy dog improved.

Bangle pessary: An unusual cause of vesicovaginal fistula

Vaginal pessaries are commonly used for uterine prolapse. Long forgotten pessaries get incarcerated in the vagina and may erode in the bladder and rectum. We present a unique case of a 60-year-old female patient who presented with dysuria and urge incontinence. In remote areas, bangles are still used as a pessary, which may present with atypical symptoms due to bladder perforation, encrustation, and Vesicovaginal fistula (VVF). VVF with a long curved tract can heal with prolonged catheterization. To our knowledge, this is the first case of glass bangle pessary being reported.

Incidental urinary tract injury and the formation of vesicovaginal fistula at the time of hysterectomy for benign indications

INTRODUCTION AND HYPOTHESIS

The association between hysterectomy type, laparoscopy use and vesicovaginal fistula (VVF) is currently unclear and would be useful to determine route of surgery and provide adequate patient counseling. The objective of this study was to evaluate the magnitude of association between the use of laparoscopic assistance, recognized intraoperative urinary tract injury and subsequent VVF repair and to quantify any differences in fistula repair and injury detection by hysterectomy type. Lastly, we sought to determine whether the type of hysterectomy is a risk factor for VVF repair independent of injury identification.

METHODS

We performed a retrospective cohort study utilizing the Healthcare Cost and Utilization Project database examining benign hysterectomies performed in California, New York and Florida from 2005-2011. Multivariable logistic regression models were used to evaluate associations among hysterectomy type, reported injury and VVF.

RESULTS

Of 581,395 eligible hysterectomies, urinary tract injuries occurred in 6702 patients (1.15%) and 640 patients developed VVF (0.11%). Patients with reported injury were 20-fold more likely to develop VVF than those without (OR = 20.6; 1.96% vs. 0.089% respectively). The association between reported injury and VVF development was stronger if laparoscopy was involved (OR = 30) than if it was not (OR = 17). Patients undergoing laparoscopic procedures were less likely to have injury reported (OR = 0.6) but more likely to undergo VVF repair (OR = 1.5). This association with VVF repair was independent of injury identification. Patients developing VVF were more likely to have undergone total abdominal hysterectomy compared to other hysterectomy types.

CONCLUSIONS

Laparoscopy is an independent risk factor for the need for subsequent VVF repair, independent of hysterectomy type and presence of intraoperatively recognized urinary tract injury.

Successful management of severe refractory haemorrhagic cystitis secondary to cyclophosphamide and BK virus with cystotomy and alum infusion

A 36-year-old male patient is referred for urology review for haematuria following cyclophosphamide and mesna administration for allogeneic stem cell transplant for treatment of acute lymphoblastic leukaemia. Severe haematuria continued despite multiple interventions including continuous bladder irrigation and cystoscopic fulguration, with formation of consolidated clot in the bladder. A successful cystotomy for removal of clot and initiation of alum was performed, leading to resolution of haematuria.

Vesicovaginal fistula repair at the time of colpocleisis

INTRODUCTION AND HYPOTHESIS

The objectives of this video are to discuss the presentation, evaluation, and surgical management of a patient with a vesicovaginal fistula at the time of colpocleisis.

METHOD

We present the case of an 83-year-old woman with a history of stage IV prolapse who had had a pessary device removed. Urine had been noted to be in the vaginal vault, leading to suspicion of a vesicovaginal fistula. Following evaluation, the patient decided to proceed with surgical management. The patient underwent a vesicovaginal fistula repair with concomitant colpocleisis. A cystoscopy was performed at the conclusion of the case where the bilateral ureteral stents were removed and a strong efflux was noted at both ureteral orifices.

RESULTS

At the patient's 1-month follow-up, she had no complaints of prolapse or vaginal leaking.

CONCLUSION

Neglect of a vaginal pessary can lead to serious complications, indicating the importance of patient education and careful follow-up. Surgical planning is a key component in effectively managing a vesicovaginal fistula with ureteral presentation in order to preserve ureteral integrity. Concomitant vesicovaginal repair and colpocleisis can be performed safely with effective cure of a vesicovaginal fistula and stage IV prolapse.

A report of a retained bullet in the bladder which migrated from an extraperitoneal injury

Genitourinary trauma secondary to a gunshot wound is uncommon as it only occurs in about 10% of cases. We present a case of a gentleman who suffered a gunshot wound to the pelvis. The bullet was originally extraluminal to the bladder; however, upon repeat CT scan eight days later, the bullet had migrated intra-luminally. We hope to show through this case that uncomplicated extraperitoneal injuries with an adjacent missile might benefit from early surgical exploration.

Surgical Treatment of Childhood Pulmonary Hydatidosis: An Analysis of 25 Cases

BACKGROUND

Hydatid cyst disease is caused by the parasite Echinococcus granulosus and it is an important health problem in the childhood period. In the present study, we aimed to report our experience in 25 surgically managed pediatric hydatid cyst cases under the light of the relevant literature.

MATERIALS AND METHODS

We retrospectively analyzed 25 patients below 15 years of age who were treated for pulmonary hydatid cyst at our clinic between 2005 and 2016. The patients were analyzed for age, sex, signs and symptoms, diagnostic methods, cyst localization, diameter, number, treatment modalities, mortality, morbidity, and recurrences.

RESULTS

Of the 25 patients included in this clinical study, 16 were male and their mean age was 10.5 (range 5-15) years. The most common presenting symptom was paroxysmal cough which affected 18 patients. The cysts were located in lungs in 23 patients and lungs and liver in 2 patients. Nineteen pulmonary cysts were solitary, and 21 (66%) were in the lower lobe. Thirteen (52%) patients had perforated cysts. Fourteen (56%) patients were operated with cystotomy and capitonnage, 9 (36%) with cystotomy, and 2 (8%) with enucleation. No case of recurrence was observed during an average 12 (range 8-18) months of follow-up.

CONCLUSION

Surgery is the primary treatment of pediatric pulmonary hydatid cyst disease. Cystotomy and capitonnage is the most commonly used parenchyma sparing technique.

["De optima lithotomiam administrandi ratione" : A dissertation from 1713 about the various possibilities of the cystotomy by Johann Michael Eisenbarth, the son of the well-known travelling physician Johann Andreas Eisenbarth (1663-1727)]

The present dissertation was submitted in 1713 at the University of Halle as part of the requirements to obtain the "licentiat". The author was Johann Michael Eisenbarth, the oldest son of the well-known physician Johann Andreas Eisenbarth. The dissertation delivers an overview over the history of the cystotomy, leading back to antiquity. In sixty paragraphs, the author dealt with different issues, such as diagnosis, preparation, and aftercare of patients with urinary bladder stones. However, the center of the thesis is the critical evaluation of all surgical methods known three hundred years ago.

Obstructive bacterial cystitis following cystotomy in a Persian cat

Feline lower urinary tract diseases are known to be life threatening conditions in cats, especially when they occur as obstructive diseases in males. Early diagnosis and treatment is necessary, otherwise it may lead to death. A 3-year-old male Persian cat was referred to the clinic with a history of anuria, lethargy, loss of appetite and exploratory cystotomy 6 months ago due to urethral obstruction following urolithiasis. Urinary bladder was enlarged and painful on palpation and urine accumulation was observed in ultrasonography. Biochemical and hematological analyses revealed hypocalcemia, hyperphosphatemia and hyperkalemia and increase in blood urea nitrogen, creatinine, white blood cell (WBC), red blood cell (RBC) and hematocrit. Urine analysis showed a turbid appearance, protein 1+, blood 3+, pH reduction, increased WBCs and RBCs and presence of bacteria, calcium oxalate crystals and epithelial cells. Urine culture reveled Staphylococcus saprophyticus. Postoperatively, microscopic examinations of the urinary bladder biopsy showed pathological lesions of bacterial cystitis. Based on these findings, bacterial cystitis and urethral obstruction due to post-operative urinary tract infections were diagnosed. For treatment, electrolyte imbalances were corrected firstly, cystotomy was performed and a catheter was conducted into the urethra; then, urethra was flushed and obstruction was resolved. Ampicillin was effective in reducing the bacterial count in urine. Despite the fact that cystotomy is a common procedure in veterinary medicine, clinicians should be aware of its complications such as post-operative urinary tract infections.

[Retrieval of a migrated plastic stent in a 51-year-old man]

BACKGROUND

Endosonographically guided transgastric drainage is the first-line interventional therapy of walled-off necrosis and symptomatic pancreatic pseudocysts in necrotizing pancreatitis. Plastic stents or lumen apposing metal stents are commonly used. A possible complication of endoscopic therapy is stent migration.

CASE REPORT

We report upon a 51-year-old man who presented with acute necrotizing pancreatitis. Transgastric necrosectomy was performed and 5 transmural double-pigtail stents (DPS) were left in situ to drain the residual retroperitoneal cavity. The patient recovered and 4 stents were endoscopically removed 5 weeks later on an outpatient basis, whereas the fifth stent was suspected to have passed spontaneously via the natural route. The asymptomatic patient presented 3 months later for follow-up computed tomography. The necrosis had healed but one DPS was seen beyond the gastric wall near the kidney. Transmural access to the stent could be achieved by an endosonographically guided puncture toward the proximal portion of the stent followed by placement of a hydrophilic guidewire alongside the stent. A new gastrostomy was created by using a 6F cystotome followed by wire-guided dilation with a 12 mm balloon. The stent could then be grasped with transmurally inserted rat-tooth forceps and repositioned across the gastrostomy site. The patient was given prophylactic antibiotics. After removal of the stent, the patient could be discharged.

CONCLUSION

Herein, we present the successful endosonographically guided transmural removal of a retroperitoneally migrated plastic stent. Of note, in our patient we had to rely completely on endosonography and radiography for localization and targeting of the stent, since the former necrotic cavity had meanwhile completely healed.

Murine model for the evaluation of candiduria caused by Candida tropicalis from biofilm

To evaluate the pathophysiology of catheter-associated candiduria, the bladders of female mice were infected with Candida tropicalis. One group was implanted with a catheter fragment with preformed biofilm by cystotomy technique, while another group received, in separate, a sterile catheter fragment and a correspondent yeast suspension. The bladder tissues were examined by histopathology and the quantity of colony forming units was evaluated. All the animals presented inflammation and the presence of C. tropicalis was observed in the tissue within 72 h of the introduction of biofilm, while 75% of the mice remained infected after 144 h. However, only 50% of animals from the group infected with C. tropicalis in suspension (planktonic yeasts), exhibited such signs of infection over time. The cystotomy technique is therefore viable in mice, and is an effective model for evaluating the pathogenesis of candiduria from catheter biofilms. The model revealed the potential of C. tropicalis infectivity and demonstrated more effective evasion of the host response in biofilm form than the planktonic yeast.

Robotic Cystotomy for Pessary Extraction With Vesicovaginal Fistula Repair

STUDY OBJECTIVE

To demonstrate a robotic approach to foreign body extraction and vesicovaginal fistula repair.

DESIGN

Video case presentation with narration discussing the step-by-step robotic surgical approach to the removal of a pessary, via cystotomy, followed by vesicovaginal fistula and cystotomy repair.

SETTING

University of Louisville Hospital. The local Institutional Review Board deemed the video exempt from formal approval (Canadian Task Force Classification III).

PATIENT

A 77-year-old woman presented with complaints of vaginal leakage of urine, dysuria, and pelvic pain. She had a Gellhorn pessary placed 12 years prior without further evaluation or removal. The patient had a leukocytosis with a pseudomonal urinary tract infection. Imaging confirmed a Gellhorn pessary free floating within the urinary bladder.

INTERVENTIONS

The patient was taken to the operating room for an exam under anesthesia where a copious amount of urine was found coming from the vagina. A small vesicovaginal fistula was appreciated but could not be thoroughly explored. Cystoscopy revealed the foreign object in the urinary bladder. A robotic approach to the foreign body extraction was then performed with the davinci Xi robot (da Vinci Xi Intuitive Surgical, Sunnyvale, CA). The pessary was evident in the bladder on abdominal entry. Cystotomy was performed with the monopolar curved scissors. A vaginal EEA sizer was found to be advanced through the vesicovaginal fistula. The pessary was then grasped and removed from the bladder. Bilateral ureteral orifices were visualized. The fistula was then closed in 2 layers with 3-0 vicryl V-loc sutures (Covidien Medtronic, St. Paul, MN). The bladder was then closed in 2 layers with 3-0 vicryl V-loc sutures. A no. 15 Jackson-Pratt drain was then inserted through the right lower quadrant port and placed in the pelvis under direct visualization. The pessary was then removed via mini-laparotomy. A Foley catheter was left in place for prolonged drainage for a total of 6 weeks because of the multiple bladder repairs on the inflamed tissue. The patient denied any leakage of urine at her following postoperative appointment.

CONCLUSION

A robotic surgical approach, as an alternative to vaginal surgery, improves ease of dissection, provides a method for thorough anatomy surveillance, and can be used for successful repairs in complicated urogynecologic cases.

Surgery in Amphibians

Amphibian surgery has been especially described in research. Since the last decade, interest for captive amphibians has increased, so have the indications for surgical intervention. Clinicians should not hesitate to advocate such manipulations. Amphibian surgeries have no overwhelming obstacles. These patients heal well and tolerate blood loss more than higher vertebrates. Most procedures described in reptiles (mostly lizards) can be undertaken in most amphibians if equipment can be matched to the patients' size. In general, the most difficult aspect would be the provision of adequate anesthesia.

Laparoscopic-Assisted Surgical Procedures

Laparoscopic-assisted procedures allow a balance between the improved patient recoveries often associated with smaller incisions and the need for appropriate visualization of visceral organs/identification of lesions. The organ systems of small animal veterinary patients that are highly amenable to laparoscopic-assisted procedures include the urinary bladder, the gastrointestinal tract, and the reproductive tracts. Laparoscopic-assisted procedures are especially beneficial in the approach to luminal organs, allowing the organ incision to be exteriorized through the body wall, protecting the peritoneal cavity from contamination from luminal contents. Procedure-specific morbidities and patient selection should be considered when choosing between assisted laparoscopic and open approaches.

[Mid-uretral retropubic TVT sling procedure complicated by intraoperative cystotomy (bladder injury): Is it possible to avoid postoperative indwelling catheter?]

OBJECTIVE

Retropubic mid-uretral sling (MUS) procedure may be complicated by bladder injury (intraoperative cystotomy). There is no scientific consensus on the length of catheter drainage following bladder injury during MUS procedure: it varies from hours to days. We have made it our policy to immediately remove the catheter. The objective of the current study was to assess the results associated with immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure.

METHODS

Retrospective case-control study. Group 1 (cases): 8 women who have experienced bladder injury during retropubic MUS procedure and group 2 (controls): 32 women (ratio of controls to cases: 4:1).

RESULTS

Mean (sd) age, BMI and MUCP were 62(13) vs. 59(10), 25(4) vs. 26(4) and 42(18) vs. 43(16), in group 1 and group 2, respectively (P=0.55, 0.56 and 0.92). Minimum follow-up duration was 12 months. None patient was lost to follow-up in group 1 (cases) and 2 patients were lost to follow-up in group 2 (controls) at 12 months follow-up. No rehospitalization or postoperative complication was noted in both groups. Immediate suprapubic postoperative pain exceeding 30/100 on VAS occurred in 1/8 (12%) and 3/32 (10%), in group 1 and group 2, respectively (P=1.00). Urinary stress incontinence cure rates were not significantly different between the two groups: 8/8 (100%) vs. 28/32 (87%), in group 1 and group 2, respectively (P=0.56). The level of satisfaction was comparable in both groups: PGI-I score was equal to 1(very satisfied) in 6/8 women (75%) and in 24/32 women (75%), in group 1 and group 2, respectively (P=1.00). De novo urgency was observed in 0/8 (0%) vs. 3/32 (10%), in group 1 and group 2, respectively (P=1.00).

CONCLUSION

In the current short retrospective series, immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure was not associated with an increased prevalence of complications.

LEVEL OF EVIDENCE

4.