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Purpose: Ureteral access sheaths (UAS) are widely used in ureteroscopy. UAS are believed to pose a significant risk for ureteral stenosis due to ureteral mucosal compression, but little evidence supports this claim. Our systematic review aimed to investigate the relationship between different UAS diameters and stenosis risk. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Scopus, and Cochrane, from its inception to May 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines were followed. χ2 test was performed to compare the prevalence within the groups. Results: Six nonrandomized trials and one randomized, with a total of 962 patients, were included. The overall incidence of ureteral stenosis of 0.9%. UAS sizes were: 9.5/11.5Fr, 10/12Fr, 11/13Fr, 12/14Fr, and 14/16Fr. Within each subgroup, the incidence of ureteral stenosis was: 0.4, 8, 0, 1, and 1% (p = 0.099). No trend for stenosis was observed among larger UAS. Conclusions: In this systematic review, no relationship between UAS diameter and incidence of ureteral stenosis was observed. Nonetheless, additional randomized controlled trials are required to support this finding.

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Um caso de dioctofimatose é relatado em um cão macho, não castrado, criado em zona rural de Campos do Jordão, estado de São Paulo, Brasil. O tutor relatou o aumento de volume peniano e dificuldade de seu cão para urinar alguns dias antes da consulta. À ultrassonografia, observou-se dilatação e cálculo em uretra peniana (0,56 cm de comprimento) e alterações do parênquima renal direito, sugestivas da infecção por Dioctophyme renale, a qual foi confirmada na urinálise. Por fim, o paciente foi submetido à orquiectomia, penectomia e nefrectomia direita, com a presença de um exemplar de D.renale com 35 cm de comprimento, que havia consumido, totalmente, o parênquima do rim. Este é o primeiro relato de dioctofimatose em Campos do Jordão, com o agravante da necrose peniana.(AU)

We report a case of dioctophymatosis in a male, non-castrated dog raised in a rural area of Campos do Jordão Municipality, State of São Paulo, Brazil. The tutor reported a penile enlargement and the difficulty of the dog in urinating few days before admission. Ultrasonography showed an urethral dilatation with a penile urethral calculus (0.56 cm length) and altered right kidney parenchyma suggestive of Dioctophyme renale infection, which was confirmed by urinalysis. Finally, the patient underwent orchiectomy, penectomy and right nephrectomy, with the presence of a specimen of D. renale measuring 35 cm in length that had completely consumed the kidney's parenchyma. This is the first report of dioctophymatosis in Campos do Jordão, with penile necrosis as an aggravating factor.(AU)

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Background: Obstructive urolithiasis is a rare but potentially serious condition in equids. In the reviewed literature, there are several case reports of urolithiasis in horses and donkeys, but the only mention of this condition in mules occurred as incidental findings at a slaughterhouse. Therefore, this work aims to describe the first report and successful treatment of obstructive urethrolithiasis in a mule (Equus asinus x Equus caballus). Case: A 10-year-old castrated male mule weighing 380 kg was referred for hospital care. Tachycardia (64 beats per min), mild dehydration (7%), increased capillary filling time (3 s), slightly congested mucous membranes, and dysuria were observed. During its attempts to urinate, the mule was able to expose the penis, resulting in only dribbling of urine with reddish coloration. Urethral catheterization failed to reach the urinary bladder and revealed an obstruction at the ischial arch (7 x 4 cm), as confirmed by palpation and ultrasonography. Additionally, rectal ultrasound examination showed urine sedimentation and a single 2.36 mm vesical calculus. After sedation, local anesthesia, and surgical preparation, urethrotomy in the standing position was performed over the urethral obstruction at the ischial arch, reaching the urethrolith that fragmented during removal. Urethral catheterization from the urethrotomy site to flush the urinary bladder and urethra were performed, but the remaining vesical calculus was not retrieved. Considering the presence of a vesical calculus, severe urethral damage caused by the spiculated calculus and catheterization attempts, permanent perineal urethrostomy was performed. Laboratory tests revealed unremarkable hematological parameters, while serum biochemistry showed increased creatinine level. Urinalysis revealed cloudiness, amber appearance, countless red blood cells and bacteria, and calcium carbonate crystals. The urethrolith composition included ammonia, carbonate, and oxalate. Twelve months after surgery, the mule was healthy, the urethrostomy was viable, and no complications were recorded during this period. Discussion: Although uncommon, there are reports describing calculi of different sizes and weighing up to 803 g, causing mild to severe clinical signs according to the degree of obstruction in horses and donkeys. In the mule described here, the urethrolith did not completely obstruct the urethra, but the spiculated calculus caused dysuria and hematuria. In fact, most animals are usually referred for acute abdominal signs or hematuria and pollakiuria, but other unusual signs, such as rectal prolapse, may also be present. In the present report, the diagnosis of obstructive urethrolithiasis was established based on clinical signs and transcutaneous ultrasound of the subischial area, allowing visualization of the urethrolith. To the best of our knowledge, this is the first report of obstructive urethrolithiasis affecting a mule in Brazil. We reiterate that this condition must be included in the differential diagnosis of mules and hinnies with hematuria and dysuria, especially when associated with abdominal pain. Additionally, urethrostomy associated with urethrotomy performed on this mule in the standing position was a low-cost procedure with good results. Due to the lack of specificity regarding the food management of the mule on the previous farm, an assessment cannot be made regarding the effects of its food on urolith composition.(AU)

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Background: Obstructive urinary tract disease in horses is a rare and low prevalence pathology in the species, but potentially severe. It is an emergency condition that presents variable clinical signs and depends on the anatomical locationof the obstruction. The bladder calculus are the most common followed by the urethra and less commonly seen are thekidney or ureteral. The main crystalloid component of uroliths in horses is calcium carbonate. The higher prevalence ofurolithiasis in male horses is justified by some anatomical differences between genders. The urethra of males is narrowerand longer than that of females. The tissue injury is the most important factor for the development of uroliths in horses.Desquamation of epithelial cells, presence of leukocyte and necrotic cell debris are relevant contributors to crystal growth.Urinary stasis favors nucleation by increasing the chance of contact between crystalloid material and urinary epithelium.Once crystal growth has begun, the urine alkalinity of the equines favors the crystallization and further deposition of othercomponents, especially calcium carbonate. Typical clinical signs of urolithiasis include tenesmus, dysuria, strangury andpolaquiuria. Hematuria is often present, mainly observed after exercise and at the end of urination. In addition signs ofcolic are quite frequent in the acute bladder and urethral urolithiasis due to bladder distension. Upper urinary tract surgerymay be technically challenging due to limited structural exposure, especially in adult horses The prognosis for horses withurolithiasis depends on the location of the urolith and the degree of renal injury that occurred.Case: This report aims to describe a rare case of obstructive urolithiasis in a 8-year-old castrated male horse with 24 hevolution. The horse was expressing signs of abdominal pain and during the transretal examination through palpation...

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Background: This work reports a case of urethral obstruction by urolith in a female cat. The patient had a history of hematuria beginning approximately 2 months before visiting the clinic, with anorexia, apathy, emesis, tenesmus and absence of urination. Following physical and ultrasonic examinations, urethral obstruction by urolith was diagnosed. Although feline lower urinary tract disease (FLUTD) is common in both males and females, a urethral obstruction in female cats is extremely rare. This report aims to alert veterinarians to such an occurrence, highlighting the importance of early diagnosis and treatment in view of the severity of the consequences of a urethral obstruction.Case: An undefined, female cat of indefinite age, with a history of hematuria, emaciation, anorexia, apathy, emesis, tenesmus and anuria, presented at our clinic. Physical examination revealed dehydration, discrete rectal prolapse and dysuria. During abdominal palpation, a rigid spherical-shaped structure was observed in the hypogastric region, and complementary examinations were subsequently performed. Hematological examination revealed leukocytosis and increased serum urea and creatinine levels. Abdominal ultrasound examination showed that the urinary vesicle was full, with heterogeneous anechoic content with discrete sedimentation, as well as the presence of a hyperechogenic structure that formed an acoustic shadow at the transition between the bladder trigone and the urethra. In addition, both renal pelves presented dilatation by anechoic content, and measured about 0.5 cm. Treatment with amoxicillin and potassium clavulanate (20 mg/kg administered intravenously) was initiated, and the patient was referred to undergo a surgical procedure to remove the calculus. When exploring the abdominal cavity, the urinary vesicle was identified, which appeared to be rigid.[...]

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Background: The presence of macroscopic concretions in the urinary system is called urolithiasis. In horses the occurrence is rare. The calculi are generally large and unique spicule concretions, composed of calcium carbonate crystals. Less commonly, the concretions are of mixed crystals of calcium carbonate and of calcium phosphate. The aim of the this work was to report a case of obstructive urethrolithiasis in a horse.Case: A 1-year-and-5-month-old, undefined breed, uncastrated male presented tenesmus, strangury, and dysuria. The horse died seven days after the onset of clinical signs and was referred for necropsy. At necropsy, samples were collected from organs of the abdominal cavity, thoracic cavity, central nervous system and integumentary system. The fragments were fixed in 10% formaldehyde, cleaved, routinely processed for histology and stained with hematoxylin and eosin. A urinary calculus collected during necropsy was sent for chemical analysis. In the abdominal cavity, a large quantity of citrus liquid of uremic odor was observed. Deposition of fibrin filaments in the peritoneum was observed, as well as in diaphragm and abdominal organs. Serosa of the small and large intestine was red with evidence of the capillaries. Kidneys presented multiple slightly protrusive white areas with a maximum diameter of 3 mm. When cutting, these areas were limited to the cortical region. There was rupture of the urinary bladder, diffuse loss of the mucosa with capillary exposure and evidence, as well as the deposition of fibrin and crude blood clots. The opening of the penile urethra presented a urolith of approximately 3.5 x 3 cm in size, with a rough and porous surface, light brown and of a stony consistency. Necrosis of the mucosa and hemorrhage were also observed in the urethra....

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A urolitíase é uma doença de elevada ocorrência nas criações de ovinos. Os urólitos são formados a partir de fatores predisponentes, tais como, dieta excessivamente proteica, com alto teor de fósforo, magnésio ou cálcio ou ainda por ingestão de plantas com grande quantidade de oxalato ou sílica. Ocorre na maioria dos casos nos machos jovens devido à anatomia da uretra peniana. Geralmente, a obstrução uretral é completa, embora em alguns casos possa ser parcial. Após o aparecimento dos sinais clínicos há poucas chances de reversão do quadro clínico e se for necessário tratamento cirúrgico a grande maioria dos animais torna-se inapto para a reprodução. A prevenção constitui a melhor medida para controlar o surgimento da enfermidade, por meio do balanceamento adequado da alimentação e acidificação da urina com a suplementação na dieta empregando o cloreto de amônio, que se mostraram bem eficazes.

Urolithiasis is a disease of high occurrence in sheep creations. Uroliths are formed from predisposing factors such as excessive protein diet with high content of phosphorus, magnesium or calcium or by ingestion of plants with large amount of oxalate or silica. In most cases occurs in young male due to the anatomy of penile urethra. Generally the urethral obstruction is complete, although in some cases it may be partial. After the onset of clinical signs there is a little chance of reversing the clinical picture and if is necessary surgical treatment the vast majority of animals becomes unfit for reproduction. The prevention is the best measure to control the onset of disease, by the proper balancing of the power and acidification of the urine with dietary supplementation employing ammonium chloride, which proved effective as well.

La urolitiasis es una alta incidencia de la enfermedad en las creaciones de ovejas. Urolitos se forman a partir de factores predisponentes tales como la dieta excesiva de proteínas con alto contenido de fósforo, magnesio o calcio o por ingestión de plantas con gran cantidad de oxalato o sílica. En la mayoría de los casos ocurre en la anatomía masculina joven debido a la uretra peneana. Generalmente, la obstrucción uretral es completa, aunque en algunos casos puede ser parcial. Después de la aparición de los signos clínicos hay pocas posibilidades de revertir el cuadro clínico y si el tratamiento quirúrgico necesario, la gran mayoría de los animales se convierte en no aptos para la reproducción. La prevención es la mejor medida para controlar la aparición de la enfermedad, por el equilibrio adecuado de la alimentación y la acidificación de la orina con la suplementación dietética empleando cloruro de amonio, que resultó ser eficaz también.

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A estrutura dessa dissertação é composta por dois capítulos sobre o uso de stent metálico nas vias urinárias em gatos e coelhos. Os capítulos são artigos científicos distintos compostos por estudos sobre a técnica cirúrgica, análise histopatológica e complicações relacionadas ao uso de stent metálico em ureter e uretra peniana. O primeiro artigo refere-se a um estudo cadavérico realizado em parceria com a Pontifícia Universidade Católica do Paraná tendo como objetivo avaliar a padronização da técnica cirúrgica para inserção do stent metálico na uretra peniana de gatos. A avaliação do diâmetro uretral com radiografia digital mostrou que a uretra distal varia de 1 a 3mm e o método de implantação do stent de forma retrograda com auxílio do fio guia hidrofílico foi possível em todos os animais. Concluímos que a sondagem retrógrada para implantação do stent foi um método rápido, pouco invasivo e viável em todos os animais deste estudo. O segundo artigo um estudo in vivo realizado com coelhos onde foi inserido o stent metálico em um dos ureteres, divididos em dois grupos e acompanhado por 15 e 30 dias, sendo realizada a eutanásia após esse período. Macroscopicamente foi observado de moderada a intensa reação inflamatória, acúmulo de sedimento e cálculo no interior e ao redor do stent, sinais de dilatação ureteral anterior ao stent e formação de mega ureter em dois animais. Conforme os achados encontrados nesse estudo a utilização de stents metálicos BEMS no ureter de coelhos não é indicada, pois as características da urina destes animais, não os tornam um bom modelo experimental.

The structure of this thesis is composed by two chapters about the use of metallic stent in the urinary tract in cat and rabbit. The chapters are distinct scientific articles composed by studies about the surgical technique, histopathological analysis and complications related by the use of the metallic stent at the ureter and urethra penile. The first article was a cadaveric study realized in partnership between the Pontifícia Universidade Católica do Paraná, with the aim to evaluate the standardization of the surgical technique for the insertion of the metallic stent at the penile urethra. The evaluation of the urethral diameter with digital radiography showed that the distal urethra varied from 1 to 3mm, and the retrograde access stent implantation method by using hydrophilic guide wire was possible in all animals. Conclusion the retrograde access for implantation of stent was a fast method, little invasive and effective in all animals of this study. The second article was an in vivo study, realized with rabbits,were it was inserted a metallic stent in one ureter, divided in two groups and followed for 15 and 30 days, with the euthanasia realized after this period. Macroscopically it was observed in the animals quite an with mild to moderate inflammatory reaction, sediment accumulation and calculus in the interior and around to the stent, sings of urethral dilatation anterior to the stent and generation of mega ureter in two animals. According to the findings in this study, the use of metal stents BEMS in the ureter rabbits is not indicated, due the characteristics of the urine from this animals dont turning then a good experimental model.

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Entre janeiro de 1990 e dezembro de 2010 foram necropsiados 4.872 cães no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM). Destes, 76 (1,6%) apresentaram urólitos em algum local do sistema urinário. O perfil epidemiológico dos cães afetados demonstrou o predomínio de machos (64,5%), adultos (52,6%) e com raça definida (56,6%). Sinais clínicos indicativos de urolitíase foram reportados em 30,3% dos casos e consistiram principalmente de hematúria, anúria, disúria e incontinência urinária. Os urólitos tiveram localização única ou múltipla e os locais anatômicos mais frequentemente acometimentos, em ordem decrescente de frequência, foram: bexiga, rim e uretra. Urolitíase ureteral não foi observada. Lesões secundárias à urolitíase foram observadas em aproximadamente 40% dos cães afetados; as mais prevalentes, em ordem decrescente de frequência, foram: cistite, obstrução uretral, hidroureter, hidronefrose, ruptura vesical (com uroperitônio) e pielonefrite. Em 25% dos cães afetados ocorreu morte espontânea ou eutanásia decorrente das lesões secundárias à urolitíase. Lesões extra-renais de uremia foram observadas em 11,8% dos casos.

From January 1990 to December 2010, 4,872 dogs were necropsied at the Laboratório de Patologia Veterinária, Universidade Federal de Santa Maria. Seventy six dogs (1.6%) had uroliths along the urinary tract. The epidemiological profile of the affected dogs showed predominance of males (64.5%); adults (52.6%); and pure breeds (56.6%). Clinical signs suggestive of urolithiasis were reported in 30.3% of the dogs and consisted mainly of hematuria, anuria, dysuria and urinary incontinency. The uroliths were found in one or more anatomical sites, and the main affected ones (in descending order) were urinary bladder, kidney, and urethra. Ureteral urolithiasis was not observed. Secondary lesions to urolithiasis were found in about 40% of the cases. The most prevalent (in descending order) were cystitis, urethral obstruction, hydroureter, hydronephrosis, urinary bladder rupture (with uroperitoneum), and pyelonephritis. In 25% of the affected dogs, spontaneous death occurred or euthanasia was performed due to the secondary lesions of urolithiasis. Extra-renal lesions of uremia were found in 11.8% of the cases.

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A obstrução uretral em gatos machos enquadra-se na doença do trato urinário inferior dos felinos, constituindo em um quadro dramático de não emissão da urina, que dependendo de horas obstruído, pode levar o animal ao óbito. A obstrução é usualmente causada por mucoproteínas, mas também pode ser devida a urólitos, transtornos funcionais da musculatura e neoplasias. Assim, a presente revisão de literatura, teve como objetivo, descrever a patofisiologia, epidemiologia, recursos em diagnóstico, condutas e opções terapêuticas a serem adotadas com o paciente obstruído e provável prognóstico dos gatos acometidos por esta afecção.

The urethral obstruction in male cats is framed in the feline lower urinary tract disease, constituting a dramatic condition of non-issuance of urine which, depending on the hours of obstruction, it can take the animal to death. This obstruction is usually caused by mucoprotein, but it can also be due to uroliths, functional disorders of the muscles and neoplasms. Thus, the present literature review had the objective of describing the pathophysiology, epidemiology, resources in diagnosis, lines and treatment options to be adopted with the obstructed patient and probable prognostic of the cats suffering from this affection.

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The epidemiology, clinical picture and pathology of an outbreak of urolithiasis in cattle in southern Brazil are described. The disease occurred in August 1999 in a feedlot beef cattle herd. Five out of 1,100 castrated steers were affected. Clinical signs included colic and ventral abdominal distension. White, sand-grain-like mineral deposits precipitated on the preputial hairs. Affected cattle died spontaneously 24-48 hrs after the onset of the clinical signs. Only one animal recovered after perineal urethrostomy. Necropsy findings included calculi blocking the urethral lumen of the distal portion of the penile sigmoid flexure, urinary bladder rupture with leakage of urine into the abdominal cavity and secondary fibrinous peritonitis. Daily water intake was low since water sources were scarce and not readily available. The animals were fed rations high in grains and received limited amounts of roughage. Biochemical analysis revealed that the calculi were composed of ammonium phosphate. A calcium-phosphorus imbalance (0.4:0.6) was detected in the feedlot ration. For the outbreak, it is suggested that contributing factors to urolith formation include insufficient fiber ingestion, low water intake and high dietary levels of phosphorus. No additional cases were observed in that feedlot after preventive measures were established. Similar dietary mismanagement in fattening steers has been associated with obstructive urolithiasis in feedlot beef cattle in other countries