Minimally invasive removal of obstructive ureteral stones by intracorporeal lithotripsy in horses: 3 patients.

Three client-owned horses diagnosed with obstructive ureteral stones were referred and treated in a minimally invasive manner by retrograde ureteroscopy in conjunction with electrohydraulic lithotripsy (EHL) or laser Holmium:YAG lithotripsy (HYL). For all 3 horses, additional tests revealed variable degrees of azotemia and ureteral obstruction. Ultrasound examination (2 horses) revealed a loss of cortico-medullary distinction consistent with a chronic nephropathy. Ultrasound-guided biopsy of the right kidney in 1 horse revealed moderate glomerulosclerosis and lymphoplasmacytic nephritis. A standing anesthesia with a coccygeal epidural was done for each horse. A perineal urethrotomy was performed in 2 horses before the urethrocystoscopy. One horse was treated with Holmium:YAG laser lithotripsy and 2 others were treated using a electrohydraulic lithotripsy probe. Each procedure was successful. The ureteroscopy was successfully performed and visualization was excellent. Fragmentation of stones seemed easier with the electrohydraulic lithotripsy probe. No complications, pain, or signs of discomfort after the procedure were noticed. All 3 horses were discharged from the hospital. Key clinical message: Obstructive ureteral stones in horses can be successfully treated in a minimally invasive manner by retrograde ureteroscopy accompanied by lithotripsy. This technique is safe, not painful and did not require general anesthesia. Electrohydraulic lithotripsy appeared superior for stone fragmentation.

Exérèse minimalement invasive de calculs urétéraux obstructifs par lithotritie intracorporelle chez le cheval : trois patients. Trois chevaux appartenant à des clients diagnostiqués avec des calculs urétéraux obstructifs ont été référés et traités de manière peu invasive par urétéroscopie rétrograde en conjonction avec une lithotripsie électrohydraulique (EHL) ou une lithotripsie au laser Holmium:YAG (HYL). Pour les trois chevaux, des tests supplémentaires ont révélé des degrés variables d'azotémie et d'obstruction urétérale. L'échographie (deux chevaux) a révélé une perte de distinction cortico-médullaire compatible avec une néphropathie chronique. La biopsie échoguidée du rein droit chez un cheval a révélé une glomérulosclérose modérée et une néphrite lymphoplasmocytaire. Une anesthésie debout avec une péridurale coccygienne était effectuée pour chaque cheval. Une urétrotomie périnéale a été réalisée chez deux chevaux avant l'urétrocystoscopie. Un cheval a été traité par lithotripsie au laser Holmium:YAG et deux autres ont été traités à l'aide d'une sonde de lithotripsie électrohydraulique. Chaque procédure a réussi. L'urétéroscopie a été réalisée avec succès et la visualisation était excellente. La fragmentation des calculs semblait plus facile avec la sonde de lithotripsie électrohydraulique. Aucune complication, douleur ou signe d'inconfort après la procédure n'a été remarqué. Les trois chevaux ont obtenu leur congé de l'hôpital.Message clinique clé :Les calculs urétéraux obstructifs chez les chevaux peuvent être traités avec succès de manière peu invasive par urétéroscopie rétrograde accompagnée de lithotripsie. Cette technique est sûre, non douloureuse et ne nécessite pas d'anesthésie générale. La lithotritie électrohydraulique est apparue supérieure pour la fragmentation des calculs.(Traduit par Dr Serge Messier).

Passive ureteral dilation and ureteroscopy after ureteral stent placement in five healthy Beagles.

OBJECTIVE To determine whether passive ureteral dilation (PUD) would occur after an indwelling ureteral stent was left in place in healthy dogs for 2 or 6 weeks, ureteroscopy would be possible at the time of stent removal, and PUD would be reversible after stent removal. ANIMALS 5 healthy adult female Beagles. PROCEDURES A ureteral stent was cystoscopically placed in each ureter of each dog with fluoroscopic guidance (week 0). One stent was removed from 1 ureter in each dog after 2 weeks (ureter group 1), and the other was removed after 6 weeks (ureter group 2); removal timing was randomized. Computed tomographic excretory urography was performed every 2 weeks from weeks 0 through 10 to measure ureteral diameters. Ureteroscopy was attempted at the time of ureteral stent removal in each group. Ureteral diameters were compared among measurement points. RESULTS The degree of PUD was significant after 2 and 6 weeks of stent placement in both ureter groups. Mean diameter of the midportion of the ureter in both groups prior to stent placement was 1.70 mm (range, 1.3 to 2.7 mm). At stent removal, mean diameter of the midportion of the ureter was 2.86 mm (range, 2.4 to 3.1 mm) in group 1 and 2.80 mm (range, 2.1 to 3.4 mm) in group 2. Ureteroscopy was successfully performed in all dogs up to the renal pelvis. Compared with week 0 values for diameter of the midportion of the ureter, the degree of PUD induced by stent placement had reversed by week 8 in group 1 (mean diameter, 2.00 mm [range, 1.5 to 2.3 mm]). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that ureteral stent placement for 2 weeks would result in sufficient PUD in healthy dogs to allow ureteroscopy at the time of stent removal and that the original ureteral diameter would eventually be restored. Additional research is needed to determine whether findings would be similar for dogs with urinary tract disease.

Advances in Urinary Tract Endoscopy.

The use of endoscopy in veterinary medicine has become the mainstay of diagnosis and treatment in the subspecialty of small animal urology over the past decade. This subspecialty is termed endourology. With the common incidence of urinary tract obstructions, stones disease, renal disease, and urothelial malignancies, combined with the recognized invasiveness and morbidity associated with traditional surgical techniques, the use of endoscopic-assisted alternatives using interventional endoscopic techniques has become appealing to both owners and clinicians. This article provides a brief overview of some of the most common urologic procedures being performed in veterinary medicine.

New alternatives for minimally invasive management of uroliths: nephroliths.

Urolithiasis is a common clinical problem in small animal veterinary patients. Management of upper urinary tract calculi can be particularly challenging in small animals, as traditional surgical removal can be associated with significant morbidity. In humans, minimally invasive treatment options have replaced traditional surgical removal in many cases. This article reviews the current literature on the various types of lithotripsy and some of the newer minimally invasive options available for management of nephrolithiasis in small animal veterinary patients. An article in the January 2013 issue addressed management of lower urinary tract uroliths; a future article will discuss current management strategies for ureteroliths.

New alternatives for minimally invasive management of uroliths: ureteroliths.

Ureterolithiasis is a serious clinical problem in small animal veterinary medicine, and management can be challenging and frustrating. Various traditional surgical treatment options exist but are associated with significant morbidity and mortality. In humans, minimally invasive treatment options have overtaken traditional surgical removal. This article reviews the current literature on the management of ureteral stone disease, including various types of lithotripsy, and discusses some of the newer minimally invasive options available for small animal veterinary patients. It is important to realize that much of the data in this article is only published in abstract form and is largely one institution's experience with these novel techniques. Articles on minimally invasive management of lower urinary tract uroliths and nephroliths were published in the January 2013 and February 2013 issues, respectively.

Ectopia ureteral unilateral congênita em uma cadela Teckel Dachshund com pelagem arlequim: relato de caso / Single congenital ureteral ectopy in a female dog Teckel Dachshund with merle colour pattern: case report

O presente relato apresenta a primeira descrição de ectopia ureteral congênita na raça Teckel Dachshund, diagnosticada em uma cadela com pelagem arlequim. O animal, aos dois meses de idade, apresentava sinais de incontinência urinária e cistite bacteriana, sendo submetido a um plano diagnóstico para confirmação de ureter ectópico. A urografia excretora revelou hidroureter direito com desembocadura caudal ao trígono da bexiga. O exame físico do animal evidenciou ainda hérnia inguinal bilateral, o que reforçou a caracterização da origem congênita das alterações. Aspectos de bem-estar animal são também discutidos.

The present work reports the first description of congenital ureteral ectopy in the canine breed Teckel Dachshund, diagnosed in a female dog with merle colour pattern. The two month old animal, presented with continuous dribbling of urine and bacterial cystitis, was subjected to a diagnostic plan for ectopic ureter. The excretory urography showed a right hidroureter, which had an orifice located caudally to the trigone of the bladder. The animal also presented a bilateral inguinal hernia, which confirmed the case description as a multiple congenital anomaly condition. Animal welfare aspects are also discussed.

Bilateral hydronephrosis secondary to endometriosis managed by endoscopic ureteral stent placement in a captive Guinea baboon (Papio papio).

Spontaneous endometriosis is an estrogen-dependent, progressive and painful disease that affects a variety of nonhuman primates, including several species of baboons (Papio sp.). This case documents multimodal management of severe endometriosis in a captive female baboon within a zoological institution. An 18-yr-old, intact female Guinea baboon (Papio papio) was found to have an enlarged uterus. Fifteen months post ovariohysterctomy, scarring associated with endometrial tissue resulted in ureteral strictures, bilateral hydronephrosis, and azotemia. Cystoscopic placement of bilateral ureteral stents with fluoroscopy was performed and resulted in short-term clinical improvement. The animal's condition declined and euthanasia was elected 4 mo after ureteral stent placement. Severe endometriosis with secondary inflammation resulting in bilateral hydroureter and hydronephrosis, as well as concurrent cystitis, ureteritis, and pyelonephritis were confirmed at necropsy. Despite possible complications, ureteral stents can be considered a useful therapeutic option in patients with ureteral disease.

Canine ureteral ectopia: an analysis of 175 cases and comparison of surgical treatments.

The case histories of 175 dogs with ureteral ectopia were reviewed; there were 156 females and 19 males. Golden retrievers, labrador retrievers and Skye terriers appeared to be over-represented. Their median age when examined was 10 months, and the males were significantly older than the females. Fifty-six animals were affected bilaterally, 50 were affected on the left side alone and 69 on the right side alone. One hundred and twenty-two cases had other abnormalities and 67 had more than one; they included hydro-ureter, hydronephrosis, pyelonephritis, bladder hypoplasia and congenital incompetence of the urethral sphincter mechanism. Forty-one cases were not treated, and the other 134 were treated by ureteronephrectomy, extravesicular ureteric transplantation or intravesicular ureteric transplantation. One hundred and twelve cases were available for follow-up for a median period of over two years (range one month to 15 years). The response to surgery and the incidence of complications was similar after each method of treatment. Sixty-five of the 112 cases were cured of incontinence and 26 were improved. The complication rate (14 per cent overall) was similar for each procedure although different types of complications occurred. Hydronephrosis occurred most commonly after extravesicular transplantation and dysuria occurred most commonly after intravesicular transplantation.