Placement of an artificial urethral sphincter in 8 male dogs with urethral diverticulum.

BACKGROUND: Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs. HYPOTHESIS/OBJECTIVES: Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS). ANIMALS: Eight client-owned dogs with UD treated with an AUS. METHODS: Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed. INCLUSION CRITERIA:  diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively. RESULTS: Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs). CONCLUSION: Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs.

Management of obstructive urethroliths, urethral pseudodiverticulum, and stricture by diverticulectomy, urethroplasty, and urethral stenting placement in a male goat.

A 5-year-old wether was presented for an acute onset of loss of appetite and inability to urinate. Urethral urolithiasis causing urethral obstruction was diagnosed and a cystostomy catheter was placed. The wether continued to be unable to urinate through the urethra and further developed a perineal pseudodiverticulum. Diverticulectomy followed by a urethroplasty using porcine small intestinal submucosa was performed to relieve the obstruction. The wether developed a urethral stricture following urethroplasty and the owners refused a perineal urethroplasty. Cystourethrography, fluoroscopic-guided balloon dilations, and urethral stent placement were done to establish urethral patency. The wether developed tissue ingrowth through the stent, resulting in recurrent obstruction that necessitated placement of covered urethral stents. Key clinical message: Although obstructive uroliths usually carry a guarded prognosis in small ruminants, the use of novel interventional radiology techniques along with urethroplasty using a xenograft allowed a wether to achieve urethral patency and normal urinations.

Prise en charge d'un bouc présentant des urétrolithes osbtructifs, un pseudodiverticule urétral et une stricture par diverticulectomie, urétroplastie et placement d'un stent urétral. Un bouc castré de 5 ans a été présenté pour une perte aigüe d'appétit et une incapacité à uriner. Un calcul urétral provoquant une obstruction urinaire a été diagnostiquée et une sonde de cystotomie placée. Le bouc a continué d'être incapable d'uriner pas son urètre et a développé un pseudodiverticule périnéal. Une diverticulectomie suivie d'une urétroplastie utilisant de la sous-muqueuse d'intestin grêle de porc a été réalisée pour soulager l'obstruction. Le bouc a développé une stricture urétrale à la suite de l'urétroplastie et les propriétaires ont refusé une urétroplastie périnéale. Une cystourétrographie, des dilatations par ballonnets guidées par fluoroscopie ainsi que le placement d'un stent urétral ont été réalisés afin de résoudre l'obstruction urétrale. Le bouc a développé une réaction tissulaire envahissant la lumière du stent, entrainant ainsi une nouvelle obstruction et nécessitant la mise en place de stents urétraux couverts.Message clinique clé :Bien que les urolithes obstructifs aient généralement un pronostic réservé chez les petits ruminants, l'utilisation de nouvelles procédures provenant de la médecine interventionnelle associées à une urétroplastie utilisant une xénogreffe a permis d'obtenir une perméabilité de son urètre et des mictions normales chez ce bouc.(Traduit par les auteurs).

Pseudomembranous cystitis in cats with presumed or confirmed mineralization: A retrospective study of 26 cases (2016-2021).

BACKGROUND: Pseudomembranous cystitis (PMC) in cats is a recognized disease, but concurrent mineralization is reported rarely and its outcome is poorly described. HYPOTHESIS AND OBJECTIVES: Describe a population of cats with PMC and the prevalence of concurrent mineralization. ANIMALS: Twenty-six cats with PMC. METHODS: Medical records were retrospectively reviewed (January 2016 to December 2021). Cats with an ultrasound diagnosis of PMC were included. Clinicopathologic results, imaging, treatment, and outcome were reviewed. RESULTS: All cats were male and 21 (80%) were diagnosed with urethral obstruction (UO). Five cats (23.8%) had positive urine culture (Staphylococcus felis, 3/5; Proteus mirabilis, 2/5) with a median urine pH of 8 (range, 6-9). All cats had ultrasonographic changes suggestive of mineralization. On ultrasound examination, 10 cats (38.5%) had pseudomembranes with acoustic shadowing suggestive of mineralization, 15 (57.7%) had changes indicative of ulceration, and 8 (31%) had changes compatible with of a urachal anomaly. Twenty-two cats received medical treatment, 4 underwent surgery (3 percutaneous cystolithotomy, 1 cystotomy). Twenty cats (77%) survived to discharge. Follow-up ultrasound examination indicated resolution of PMC in 6/7 cats, 4 had persistent hyperechoic bladder lining. Five of 12 cats with follow-up had a relapse of lower urinary tract signs. CONCLUSIONS AND CLINICAL IMPORTANCE: Pseudomembranous cystitis was diagnosed mainly in male cats with UO and imaging findings suggestive of mineralization were present in all cases. Frequent negative urine culture suggests a different etiology than encrusting cystitis related to urease-positive bacteria. Good outcomes can be achieved with medical management.

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).

Comparison of percutaneous cystolithotomy and open cystotomy for removal of urethral and bladder uroliths in dogs: Retrospective study of 81 cases (2014-2018).

OBJECTIVE: Compare percutaneous cystolithotomy (PCCL) and open cystotomy (OC) for removal of bladder and urethral uroliths. DESIGN: Retrospective study. ANIMALS: Client-owned dogs and cats that underwent PCCL (n = 41) or OC (n = 40) between January 1, 2014 and February 28, 2018 at a referral center. METHODS: Medical records of dogs and cats that underwent a PCCL or an OC were reviewed. History, signalment, physical examination, diagnostic tests, length of the procedure and anesthesia, complications, and duration of hospitalization were recorded. RESULTS: A total 17 cats (PCCL = 10; OC = 7) and 64 dogs (PCCL = 31; OC = 33) were included. There was no significant difference, regardless of species, in the mean surgical time (45 min [24-160 min] and 48.5 min [15-122 min] with P = .54 in dogs, P = .65 in cats) nor mean duration of anesthesia (90 min [50-120 min] and 98 min [54-223 min] with P = .87 in dogs, P = .08 in cats) in the PCCL and OC groups respectively. Number of uroliths did not affect duration of surgery in either group. Complete urolith removal was achieved in 98% of dogs and cats in both groups. The median hospitalization time was significantly shorter in the PCCL group for dogs (11.3 hours [range 4 to 51.3] in the PCCL vs 56.6 hours [range 7.3 to 96] in the OC group; P < .001) but did not differ for cats (24.5 hours [range 8.3 to 30] in the PCCL vs 56.6 hours [range 10.1 to 193.2] in the OC group; P = .08). CONCLUSION AND CLINICAL RELEVANCE: Bladder urolith removal by PCCL procedure is no longer than OC. Further studies are needed to compare the pain related to procedure between PCCL and OC.

Multicenter retrospective evaluation of transmural migration of subcutaneous ureteral bypass devices within the digestive tract in cats.

BACKGROUND: Placement of a subcutaneous ureteral bypass (SUB) device is an effective method to relieve all causes of ureteral obstruction in cats. Complications involving migration within the gastrointestinal tract have been seldomly described. OBJECTIVES: To characterize transmural migration of SUB devices within the digestive tract in cats. ANIMALS: Eleven migrated SUB catheters identified in 8 cats between 2017 and 2021. METHODS: Retrospective review of medical records of cats with a SUB device in which migration into the gastrointestinal tract was identified. RESULTS: The median time from SUB device placement to implant migration was 928 days (201-2298 days). Seven cats had obstruction of the SUB device and a positive urine culture at diagnosis. The migration was identified by ultrasound in 6/11, pre-operative contrast radiography in 2/2, and only at time of surgery in 3 SUB devices. All cats underwent surgical correction. Four nephrostomy and 7 cystotomy catheters migrated. Migration occurred into the duodenum (3/11), jejunum (7/11), and colon (1/11). SUB devices were removed in 7 cats and replaced in 2 cats, with 1 cat diagnosed with 2 migration events. Gastrointestinal resection and anastomosis were performed in 7/8 cats and an enterotomy in 2 cats. Six cats survived to discharge. The median follow-up time after migration diagnosis was 365 days (range, 0-1114 days) and 2 cats are still alive. CONCLUSIONS AND CLINICAL IMPORTANCE: Although a rare complication, migration of SUB device should be considered in cats with SUB device obstruction and a positive urine culture.

Use of tetrasodium EDTA acid for the treatment of intraluminal obstruction of subcutaneous ureteral bypass devices.

OBJECTIVES: The aim of this study was to evaluate the efficacy and tolerability of a 4% tetrasodium EDTA (tEDTA) infusion protocol in the subcutaneous ureteral bypass (SUB) devices of cats with intraluminal obstruction at a veterinary teaching hospital between July 2017 and April 2020. METHODS: This was a retrospective controlled study. Cats with an obstructed SUB device underwent a 4% tEDTA infusion protocol. Obstruction of the device was diagnosed based on renal pelvic dilation, dilatation of the ureter, mineralized material within the device (cystostomy or nephrostomy catheters) seen on ultrasound, the absence of visible bubbles within the renal pelvis and/or urinary bladder following ultrasound-guided flushing of the device with saline. RESULTS: A total of 16 tEDTA infusion protocols were performed in 14 cats. The infusion protocol was considered successful in 11/16 SUB devices (68.8%). Six devices (n = 6/11; 54.5%) had recurrence of obstruction with a median time of 87 days. One or more episodes of self-limiting pollakiuria and/or hematuria following infusion was seen in eight patients (n = 8/14; 57.1%). CONCLUSIONS AND RELEVANCE: Infusions of 4% tEDTA successfully relieved intraluminal obstruction in patients with occluded SUB devices; however, the recurrence of obstruction was common. Additional studies evaluating case selection and optimal protocols are warranted.

Feline urinary incontinence: a retrospective case series (2009-2019).

OBJECTIVES: The objective of this retrospective study was to describe the feline population presented for urinary incontinence at a veterinary teaching hospital between 2009 and 2019, with a particular focus on cats with a non-neurologic underlying cause. METHODS: The medical records of cats diagnosed with urinary incontinence were retrospectively evaluated. Signalment, clinical presentation, results of diagnostic tests, diagnosis of the underlying cause and treatments were recorded. When information was available, outcome was recorded and follow-ups divided into three time frames (0-1 week, 1 week to 3 months and >3 months). RESULTS: Thirty-five cats were presented with urinary incontinence. Of these, 18 cats with complete medical records presented urinary incontinence of non-neurologic origin. The most common clinical signs at presentation were urine leakage while resting (12/18), urine-soiled perineum (8/18), urine dribbling (8/18) and no spontaneous micturition (5/18). The most common underlying cause was urethral obstruction (67%; 12/18), with a majority due to urethral strictures (58%; 7/12). Other causes were suspected inflammation (2/12), neoplasia (1/12), urolithiasis (1/12) and foreign body (1/12). In 8/10 cats in which it was performed, cystoscopy and contrast cystourethrography were the methods that led to the diagnosis. Twelve cats with urethral obstruction underwent interventional procedures, resulting in complete resolution of incontinence in 7/12 and improvement in 1/12. Urinary tract infection was a common complication after 3 months (4/18). CONCLUSIONS AND RELEVANCE: When incontinence of non-neurologic origin is suspected in a cat, urethral obstruction should be considered. Advanced imaging studies (cystoscopy and contrast studies) are useful for diagnosis. A good prognosis was reported in cats undergoing interventional procedures with no long-term treatment.

Retrospective evaluation of cystoscopic-guided laser ablation of intramural ectopic ureters in female dogs.

BACKGROUND: Cytoscopic-guided laser ablation (CLA) is a technique that can be used to correct intramural ectopic ureters (EUs) in dogs. HYPOTHESIS/OBJECTIVES: To describe clinicopathologic, imaging, and cystoscopic findings in dogs undergoing CLA for intramural EU correction, and whether any of these findings are associated with continence outcomes. ANIMALS: Thirty-one client-owned dogs undergoing CLA between 2009 and 2019. METHODS: Retrospective cohort study. Data collected from medical records included signalment, clinical findings (including continence score at presentation), clinicopathologic findings (serum biochemistry profile, urinalysis, and urine culture results before CLA), ultrasonography, and cystoscopy findings. Follow-up information was collected at 1 day to 1 week, 1 week to 1 month, and at >1 month time points after CLA. Final continence score was determined based on this follow-up information. Multiple logistic regression was used to determine factors that were associated with final continence score. RESULTS: Median continence score of dogs at initial evaluation was 2 (range, 2-4). Median continence score after CLA alone was 3 (range, 1-5). Seventeen of 31 (54.8%) dogs received adjunctive medical management after CLA. Median continence score after CLA with or without adjunctive medical management was 5 (range, 1-5). Overall, 67.7% of dogs were considered continent after CLA with or without adjunctive medical management. No preoperative or perioperative factors were found to be associated with final continence score. CONCLUSIONS: Cystoscopic-guided laser ablation for intramural EU in female dogs provides improvement in incontinence. Dogs remaining incontinent after CLA may improve with adjunctive medical management. Surgical management is required to manage incontinence in dogs with extramural EU.

Subcutaneous ureteral bypass device placement in 81 cats with benign ureteral obstruction (2013-2018).

BACKGROUND: Benign ureteral obstructions (BUOs) present a therapeutic challenge in cats. HYPOTHESIS/OBJECTIVES: The purpose of this study was to determine the outcome and complications associated with placement of subcutaneous ureteral bypass (SUB) device in cats. ANIMALS: Eighty-one client-owned cats (117 kidneys) with BUO treated by placement of a SUB. METHODS: Retrospective study. Medical records of cats with BUO and treated by SUB device placement between 2013 and 2018 were reviewed. Outcome and complications were documented. RESULTS: Hospital discharge rate was 94% (76/81). Serum creatinine on admission and at the time of discharge was 5.3 mg/dL (range, 1.2 to >15 mg/dL) and 2.1 mg/dL (range, 1.1-12.5 mg/dL), respectively. Luminal obstructions were documented in 17% (18/109) of the SUB devices of 16 cats discharged from the hospital. Infection was documented in 26% (20/76) of discharged cats. Kink of the device was documented in 10% (12/117) of devices. Time to luminal obstruction and kink were 204 days (range, 21-1678 days) and 58 days (range, 2-601 days), respectively. Fourteen of 81 (17%) cats required a revision surgery in order to restore patency of the device. At the time of writing, 53% (43/81) of cats were alive, with a mean survival time of 821 days (range, 1-2170 days) after surgery. Of those that died, 52% (20/38) died of urinary related causes. CONCLUSION AND CLINICAL IMPORTANCE: This study suggests that SUB device placement is associated with good outcomes and could be considered for the treatment of BUO in cats.

Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012-2018).

OBJECTIVES: The aim of the study was to describe renal pelvis (RP) and ureteral ultrasonographic measurements in a population of cats with confirmed benign ureteral obstruction (UO) by antegrade pyelography. The secondary objective was to further describe clinical findings associated with minimally dilated obstructed kidneys in an attempt to better understand its occurrence. METHODS: Retrospective case series of cats diagnosed with benign UO were confirmed by antegrade pyelography. Medical records were reviewed and signalment, diagnostic imaging results, serum creatinine (SCr) concentration and urine culture results were recorded. Each obstructed kidney was categorized into two groups: group 1 included all RP measurements ⩽4 mm and group 2 included all RP measurements >4 mm. RESULTS: A total of 82 cats with 114 obstructed ureters met the inclusion criteria. Fifty (61%) cats had a unilateral UO and 32 (39%) had a bilateral UO. Thirty (26%) kidneys were included in group 1 while 84 (74%) were included in group 2. Nine (8%) kidneys had an RP dilation ⩽2 mm. Median RP and ureteral diameters were 6.6 mm (range 1.1-37.0 mm) and 3.2 mm (range 0.0-11.0 mm), respectively. RP size correlated positively with ureteral diameter in the study population (P <0.0001), but not in group 1 when analyzed separately (P = 0.47). UO was secondary to stones in 80 (70%) ureters. Seventeen (21%) cats had a positive urine culture. At admission, 79 (96%) cats were azotemic with a median preoperative SCr concentration of 444 µmol/l (range 108-1326 µmol/l). The mean (95% confidence interval [CI]) preoperative SCr concentration was significantly higher in group 1 (762 µmol/l [498-1165 µmol/l]) than in group 2 (409 µmol/l [333-502 µmol/l]). RP size in the two groups correlated negatively with preoperative SCr concentration (P = 0.0002). CONCLUSIONS AND RELEVANCE: Feline UO may be associated with minimal RP dilation and the severity of RP and ureteral dilation can be highly variable. Absence of significant RP dilation does not rule out UO in cats.

Vulvar calcinosis cutis in a female dog with urinary incontinence secondary to an ectopic ureter.

A 2-year-old, spayed female standard schnauzer dog was presented with a history of urinary incontinence and painful whitish lesions localized to the vulvar region. An ectopic ureter was diagnosed by cystoscopy. Histopathology of the biopsy specimens from the vulvar lesions was compatible with calcinosis cutis. Seven weeks following the cystoscopic laser ablation of the ectopic ureter and resolution of the urinary incontinence, the calcinosis cutis lesions completely resolved without any specific treatment. To the authors' knowledge, vulvar calcinosis cutis secondary to urinary incontinence has not been previously reported in a dog. Key clinical message: This is the first case report in the veterinary literature of vulvar calcinosis cutis in a female dog due to urinary incontinence.

Calcinose cutanée au niveau de la région vulvaire chez une chienne présentant une incontinence urinaire secondaire à un uretère ectopique. Une femelle stérilisée Schnauzer standard âgée de 2 ans a été présentée pour une histoire d'incontinence urinaire et des lésions blanchâtres douloureuses localisées en région vulvaire. Un uretère ectopique a été diagnostiqué par cystoscopie. L'analyse histopathologique des biopsies des lésions de la vulve était compatible avec une calcinose cutanée. Lors de la réévaluation 7 semaines après la résection cystoscopique de l'uretère ectopique par ablation au laser, les lésions de calcinose cutanée étaient complètement résolues sans traitement spécifique. D'après les auteurs, une calcinose cutanée secondaire à une incontinence urinaire et affectant la région vulvaire chez une chienne n'a pas été rapportée à ce jour.Message clinique clé:Ceci constitue le premier rapport dans la littérature vétérinaire d'un cas de calcinose cutanée vulvaire chez une chienne due à de l'incontinence urinaire.(Traduit par les auteurs).

Removal of lower urinary tract stones by percutaneous cystolithotomy: 68 cases (2012-2017).

OBJECTIVE: To describe the use and outcome of percutaneous cystolithotomy (PCCL) for removal of urethral and bladder stones in dogs and cats. STUDY DESIGN: Retrospective case series. ANIMALS: Sixty-eight client-owned dogs and cats. METHODS: Records were reviewed and analyzed for dogs and cats that underwent PCCL between January 2012 and December 2017. Signalment, clinical presentation, laboratory and imaging data, procedure time, use of lithotripsy, biopsy, perioperative and immediate postoperative complications, hospitalization times, stone composition, and urine culture results were recorded. Owners were contacted by phone or email 3 weeks after the procedure. Follow-up communications with the owner and referring veterinarian were also recorded. RESULTS: Seventy percutaneous cystolithotomies were performed in 59 dogs and nine cats. The median duration of the procedure was 95 minutes (45-420), and lithotripsy was required in 3% (2/70) of PCCL. Complications during the procedure were reported in one case. In eighty-three percent of procedures (58/70), animals were discharged within 24 hours postoperative. Twenty-four percent (16/68) of animals had minor complications (lower urinary tract signs), and one dog had a major complication (surgical wound dehiscence) during the 3 weeks after the operation. Long-term follow-up revealed stone recurrence in 21% of cases followed more than a year after the procedure (7/33). CONCLUSION: Percutaneous cystolithotomy allowed removal of bladder and urethral stones with rapid postoperative recovery and few major perioperative or short-term postoperative complications. CLINICAL SIGNIFICANCE: Percutaneous cystolithotomy provides an attractive minimally invasive surgical alternative for removal of lower urinary tract stones in small animals.

Transurethral cystoscopy in dogs with recurrent urinary tract infections: Retrospective study (2011-2018).

BACKGROUND: Urinary tract infections (UTIs) are common in female dogs and recurrent infections often require investigation by transurethral cystoscopy. HYPOTHESIS/OBJECTIVES: Describe the findings of transurethral cystoscopy in dogs presented for recurrent urinary tract infections (RUTI). ANIMALS: Fifty-three client-owned dogs with RUTI were included in the study. METHODS: Retrospective study. Data collected from medical records included signalment, clinical findings, bladder wall culture, cystoscopic, and histopathologic findings. UTI was defined as: presence of compatible clinical signs and at least 2 out of 3 of the following criteria: (1) pyuria, (2) positive urine culture, (3) resolution of clinical signs with antibiotic treatment. Recurrence of UTI was defined as at least 2 episodes of UTI within 6 months or at least 3 or more in 1 year. RESULTS: The mean age at presentation was 3.8 years with a majority of female dogs (48/53), 40/48 of which were spayed. Main breeds were Labrador (10/53), Australian Shepherd (4/53), and Miniature Schnauzer (3/53). A hooded vulva was noted in 33/48 of females. Transurethral cystoscopy showed anomalies in 45/53 of cases: mucosal edema (19/53), vestibulovaginal septal remnant (15/48), lymphoid follicles (8/53), short urethra (6/53), and ectopic ureter (5/53). Urine culture at the time of cystoscopy was positive in 13/49. Bladder wall edema and ulceration were the most common findings on histopathology (25/39). CONCLUSION AND CLINICAL IMPORTANCE: RUTI occurred more frequently in spayed female dogs. Transurethral cystoscopy is useful in the diagnosis and treatment of anomalies in dogs with RUTIs.

Retained laser fiber in the nidus of a recurrent cystine urolith in an intact male English bulldog.

A lithotripsy and percutaneous cystolithotomy (PCCL) were performed on a 5-year-old intact male English bulldog. The composition of the uroliths was 100% cystine. When a second PCCL was performed 2 months later, the nidus of the largest urolith was a segment of an optical fiber broken off during laser lithotripsy.

Fibre laser formant le nidus d'une urolithiase à cystine récurrente chez un Bulldog Anglais mâle entier. Une lithotripsie et une cystolithotomie percutanée (PCCL) ont été réalisées sur un Bulldog Anglais mâle entier de 5 ans. L'urolithe était constitué à 100 % de cystine. Lors d'une seconde PCCL réalisée 2 mois plus tard, le nidus du plus grand calcul de cystine se révéla être un fragment de fibre optique brisée durant la lithotripsie au laser.(Traduit par Dre Emmanuelle Butty).

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.

Use of cystoscopic-guided laser ablation for treatment of unilateral ureterovesicular stenosis and secondary orthotopic ureterocele in a female dog.

CASE DESCRIPTION A 4-year-old spayed female Beagle was evaluated because of a 2-month history of intermittent pollakiuria, stranguria, dysuria, and abdominal pain. A diagnosis of bacterial cystitis was initially made, but clinical signs persisted despite appropriate antimicrobial treatment, so the dog was referred for further evaluation and treatment. CLINICAL FINDINGS Abdominal ultrasonography revealed a large, thin-walled, cystic structure in the urinary bladder at the level of the expected right ureterovesicular junction that communicated with the uniformly dilated right ureter. Severe right-sided pyelectasia was also detected. A presumptive diagnosis was made of a right-sided orthotopic ureterocele with secondary hydroureter and pyelectasia. TREATMENT AND OUTCOME Cystoscopy revealed a large cystic structure in the region of the right ureterovesicular junction without obvious communication between the ureter and urinary bladder. Portable C-arm fluoroscopy was used to confirm the presence of an intramural orthotopic tract and to measure the diameter of the ureter and renal pelvis via retrograde contrast ureteropyelography. Complete laser ablation of the ureterocele was performed by incising it circumferentially near its base. Clinical signs resolved immediately following the procedure. Six weeks later, the dog remained free of clinical signs and abdominal ultrasonography revealed resolution of hydroureter with persistence of mild right-sided pyelectasia. CLINICAL RELEVANCE Cystoscopic-guided laser ablation of an orthotopic ureterocele secondary to ureterovesicular stenosis was a safe and effective minimally invasive treatment for the dog of this report, resulting in immediate and continued improvement of clinical signs and ultrasonographic changes. Laser ablation should be considered as an alternative to surgery for the treatment of orthotopic ureteroceles in dogs.

Treatment of congenital distal ureteral orifice stenosis by endoscopic laser ablation in dogs: 16 cases (2010-2014).

OBJECTIVE To determine characteristics of and outcomes for dogs with congenital distal ureteral orifice stenosis (CDUOS) treated by cystoscopic-guided laser ablation (CLA). DESIGN Retrospective case series. ANIMALS 16 client-owned dogs with CDUOS treated by CLA at 2 veterinary hospitals between 2010 and 2014. PROCEDURES Medical records were reviewed and data collected regarding clinical findings, imaging results, surgery characteristics, treatment, and outcome. Follow-up information was collected from dog owners and referring veterinarians via standardized interview. RESULTS Dogs included 10 males and 6 females; median age was 11.5 months (range, 4 to 112 months). Labrador Retriever (n = 6; 3 males) was the most common breed. Intramural ectopic ureteral openings were identified at the site of stenosis in 15 dogs (18/20 stenotic ureteral openings). Treatment with CLA to enlarge and relocate the stenotic opening was successful in all dogs. Median duration of anesthesia and hospitalization was 105 minutes and 24 hours, respectively. No complications were noted. Fourteen dogs remained alive (2 lost to follow-up) during a median follow-up period of 14.5 months. Owners of 11 of 13 dogs reported improvement in their dog's quality of life after CLA. The treated ureteral orifice remained patent in the 2 dogs that were reimaged. CONCLUSIONS AND CLINICAL RELEVANCE CDUOS should be considered as a differential diagnosis for dogs with idiopathic distal ureteral obstruction, particularly young male Labrador Retrievers, and was most often associated with an intramural ectopic ureter in this study. Treatment with CLA was safe and effective for opening the ureteral orifice.

Use of percutaneous cystolithotomy for removal of urethral uroliths in a pot-bellied pig.

A 6-month-old neutered male pot-bellied pig was presented for an obstructive urethral stone which was successfully removed by percutaneous cystolithotomy (PCCL). The pig recovered well although suspected urethral spasms and pollakiuria persisted for 2 weeks after surgery. The owner reported a good urine stream 2 months after discharge. This novel minimally invasive approach provided excellent visualization and allowed complete evaluation of the lower urinary tract. Percutaneous cystolithotomy holds great promise for the future treatment of various lower urinary tract disorders in this species.

Utilisation de la technique de cystolithotomie transcutanée pour le retrait d'un calcul urétral chez un cochon vietnamien. Un cochon vietnamien mâle castré de 6 mois a été présenté suite à un calcul urétral obstructif qui a pu être retiré par cystolithotomie transcutanée. Le cochon s'est bien remis bien qu'une pollakiurie persistante possiblement secondaire à des spasmes urétraux fut observée pendant deux semaines après la procédure. Le propriétaire a rapporté la présence d'un bon jet urinaire deux mois après la procédure. Cette nouvelle technique minimalement invasive permet une excellente visualisation et évaluation de l'ensemble du système urinaire inférieur. C'est une option thérapeutique d'avenir dans la gestion des cas d'affection du système urinaire chez cette espèce.(Traduit par les auteurs).

Ultrasound evaluation of the renal pelvis in cats with ureteral obstruction treated with a subcutaneous ureteral bypass: a retrospective study of 27 cases (2010-2015).

Objectives The objective of the study was to measure the preoperative and postoperative renal pelvic size and describe the ultrasound findings following successful decompression of a ureteral obstruction using the subcutaneous ureteral bypass (SUB) device in cats. Methods This retrospective study assessed the measurement of the renal pelvis of 27 cats with unilateral (n = 21) or bilateral (n = 6) ureteral obstruction before (pre-t0) and after placement of a SUB during short- (before t0 + 3 months) and long-term (after t0 + 3 months) follow-up. Several qualitative ultrasound parameters were recorded for each cat. At both intervals, the last ultrasound examination was used for qualitative criteria and the mean pelvic size was recorded. The complications observed during follow-up were divided into obstructive and non-obstructive. Results No qualitative ultrasound parameter was statistically significant. The presence of retroperitoneal or peritoneal effusion was rarely seen (n = 4/25 during the short term and n = 1/14 during the long term). Hyperechogenicity of the perirenal adipose tissue decreased in the long term. A statistically significant decrease in the width of the renal pelvis was noted in the short- (2.4 mm, range 0-7.0 mm) and long-term (1.7 mm, range 0-3.5 mm) follow-ups compared with the preoperative value (11.7 mm, range 0.9-41 mm). Three months following SUB placement, each cat without an obstructive complication had a pelvic width ⩽3.5 mm. Conclusions and relevance Renal pelvic distension is at least partially reversible when ureteral obstruction is treated by placement of a SUB. Ultrasound monitoring is a useful tool to detect obstructive complications.