Retrospective comparison of modified percutaneous cystolithotomy (PCCLm) and traditional open cystotomy (OC) in dogs: 218 cases (2010-2019).

OBJECTIVE: To compare short- and long-term clinical variables between dogs undergoing a modified percutaneous cystolithotomy (PCCLm) and open cystotomy (OC) and evaluate for risk factors associated with complications and outcomes within the groups. STUDY DESIGN: Retrospective study. ANIMALS: A total of 218 dogs. METHODS: Records were reviewed for dogs that underwent PCCLm or OC between January 2010 and December 2019. Signalment; history and diagnostic findings; procedural, anesthetic, and hospitalized care data; complications; urolith recurrence; and follow-up were recorded. Logistic regression analysis was used to evaluate effects of clinical variables on outcomes within PCCLm and OC groups and to identify significant categorical variables between PCCLm and OC groups. Two sample t-tests were used to identify significant numerical variables between PCCLm and OC groups. RESULTS: A total of 60.1% (131/218) of dogs underwent the PCCLm procedure and 39.9% (87/218) of dogs underwent the OC procedure. Anesthesia time (p < .001) was significantly longer in the OC group. No significant difference in incomplete urolith removal was noted between groups. Although surgical site infection and inflammation rates were not significantly different between OC and PCCLm groups, incisional infections were significantly associated with complications occurring during PCCLm (p = .027). Significantly reduced postoperative lower urinary tract signs (p = .022) were noted in the PCCLm group. CONCLUSION: The PCCLm may result in reduced lower urinary tract signs postoperatively compared to OC, but other clear advantages of the PCCLm were not identified in this study. CLINICAL SIGNIFICANCE: PCCLm procedures are an effective alternative to OC for urolith removal in dogs.

Successful conservative management in a dog with substantial urinary bladder ischemia.

A 7-year-old spayed female pug dog was brought to the veterinary college with a severely and diffusely ischemic urinary bladder secondary to obstructive uroliths in the lower urinary tract. Cystotomy was performed to remove the uroliths and the ischemic bladder was managed with conservative treatment. A recheck abdominal ultrasound 4.5 mo after surgery revealed an abdominal mass that was associated with the urinary bladder. An exploratory laparotomy and partial cystectomy were performed. Histopathology of the mass showed granulomatous inflammation centered on necrotic tissue. The dog recovered well, and long-term prognosis is good. To the best of our knowledge, this is the first veterinary case report describing conservative management of an ischemic urinary bladder. An uncommon complication following cystotomy and the relevant imaging findings is also described. The positive outcome for the dog demonstrated that conservative management may serve as an option for treatment of substantial ischemia of the urinary bladder.

Prise en charge conservatrice réussie chez un chien présentant une ischémie importante de la vessie. Une chienne carlin femelle stérilisée âgée de 7 ans a été amenée à l'école vétérinaire avec une vessie sévèrement et diffusément ischémique secondaire à des urolithes obstructifs dans les voies urinaires inférieures. Une cystotomie a été réalisée pour retirer les urolithes et la vessie ischémique a été prise en charge avec un traitement conservateur. Une échographie abdominale de contrôle 4,5 mois après la chirurgie a révélé une masse abdominale associée à la vessie. Une laparotomie exploratrice et une cystectomie partielle ont été réalisées. L'histopathologie de la masse a montré une inflammation granulomateuse centrée sur le tissu nécrotique. Le chien a bien récupéré et le pronostic à long terme est bon. À notre connaissance, il s'agit du premier rapport de cas vétérinaire décrivant la prise en charge conservatrice d'une vessie ischémique. Une complication peu fréquente après cystotomie et les résultats d'imagerie pertinents sont également décrits. Le résultat positif pour le chien a démontré qu'une gestion conservatrice peut servir d'option pour le traitement d'une ischémie importante de la vessie.(Traduit par Dr Serge Messier).

Hand-assisted laparoscopic cystotomy for cystic calculus removal in male horses (3 cases).

A technique for hand-assisted laparoscopic removal of cystic calculi in male horses is described. Three cystic calculi ranging from 5 to 10 cm in diameter were removed successfully using bilateral para-inguinal laparoscopic portals assisted by a human hand within the abdomen, effectively sealing the midline incision. Long-term follow-up information obtained from referring veterinarians and owners indicated that the patients returned to their previous activity level and had no recurrence of clinical signs in the following 6 to 12 months. Key clinical message: Hand-assisted recumbent laparoscopy is a satisfactory surgical technique for removal of cystic calculi in horses which cannot be operated on standing or whose body condition would make the parainguinal approach difficult.

Cystotomie laparoscopique aidée de mains pour le retrait de calculs cystiques chez des chevaux mâles (3 cas). Une technique pour le retrait de calculs cystiques par laparoscopie aidée de mains chez des chevaux mâles est décrite. Trois calculs cystiques variant de 5 à 10 cm de diamètre furent retirés avec succès en utilisant des entrées laparoscopiques bilatérales para-inguinales aidées d'une main humaine à l'intérieur de l'abdomen, scellant avec succès l'incision sur la ligne médiane. Les informations sur le suivi à long terme obtenues des vétérinaires référant et des propriétaires indiquaient que les patients étaient retournés à leur niveau d'activité antérieur et qu'aucune récurrence des signes cliniques ne fut notée dans les 6 à 12 mois suivants.Message clinique clé:La laparoscopie couchée aidée de mains est une technique chirurgicale satisfaisante pour le retrait de calculs cystiques chez des chevaux qui ne peuvent être opérés debout ou dont la condition corporelle rendrait l'approche parainguinale difficile.(Traduit par Dr Serge Messier).

NEOURETEROCYSTOSTOMY AND URETHRAL STENT PLACEMENT IN A BLACK-HANDED SPIDER MONKEY (ATELES GEOFFROYI).

A 27-y-old female black-handed spider monkey (Ateles geoffroyi) was evaluated 13 d after an ovariohysterectomy because of abdominal distension, anorexia, and absent urination. The animal was diagnosed with a uroabdomen and urethral obstruction from computed tomographic findings and fluid creatinine levels. During exploratory laparotomy, a defect in the right ureter was confirmed as the source of the uroabdomen. Utilizing intraoperative fluoroscopy, a urethral obstruction with an irregular luminal filling defect was evident. A self-expanding nitinol urethral stent was placed, and a ureteral transposition was performed. Two months after the procedure, the animal developed dysuria, a urinary tract infection, recurrent bladder distension and a partial urethral obstruction. Treatment with prazosin 1 mg/kg PO q12h improved urination. Reobstruction of the urethra occurred 17 mo postsurgery, and the animal was euthanatized. On postmortem examination, the animal had ingrowth into the stent with proliferative granulation tissue, detrusor muscle degeneration, pelvic adhesions, cystitis, pyelonephritis, and hydronephrosis.

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.

Radiographic features of suspected suture-associated cystic calculi in dogs.

This retrospective case series describes the radiographic features of suspected suture-associated cystic calculi in six dogs with a history of at least one or multiple prior cystotomies. One of the dogs presented twice. Suspected suture-associated cystic calculi were multifocal, short, predominantly linear mineral opacities localized in the center of the urinary bladder on abdominal radiographs. One patient (n = 1) presented with multifocal round, pin point, and linear radiopaque calculi. The calculi were all calcium oxalate in composition. On gross examination, the calculi had a hollow center. Six cystotomies used monofilament absorbable suture material (polydioxanone [n = 4] or poliglecaprone 25 [n = 1]) in prior cystotomies. Suture material in two of the cases was unknown. Suspected suture-associated cystic calculi are a rare occurrence in veterinary medicine but should be considered in dogs that have a history of prior cystotomy, hollow core on gross analysis, and radiographic evidence of mineral opaque, predominantly linear, cystic calculi.

Comparison of initial leak pressures after single- and double-layer cystotomy closure with barbed and nonbarbed monofilament suture material in an ex vivo ovine model.

OBJECTIVE: To compare initial leakage pressure after double-layer inverting and single-layer appositional closures with unidirectional barbed suture or an analogous monofilament absorbable suture in an ex vivo ovine model. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Ovine cadaveric bladders (n = 48). METHODS: A 4-cm ventral cystotomy was performed in each bladder. Bladders were randomly divided into 4 groups (n = 12 each group) and sutured in an open setting with a single-layer appositional or a double-layer inverting pattern of unidirectional 2-0 barbed or an analogous monofilament suture. Intraluminal pressure at initial leakage and leakage location were recorded. Analysis of variance was used to compare initial leak pressure between the 4 groups (P < .05). RESULTS: Ovine urinary bladders closed with double-layer inverting closures leaked at intraluminal pressures about twofold greater than bladders closed with single-layer appositional closures (P < .0001) whether barbed or nonbarbed suture was used (P ≥ .987). Bladders most commonly leaked at the suture hole after single-layer closure. Bladders that had been repaired with a double-layer closure leaked at the knot in nonbarbed closures or at the preconstructed end loop in barbed closures. CONCLUSION: Double-layer closure increased leakage pressures compared with single-layer closures, irrespective of the suture type used. CLINICAL SIGNIFICANCE: This study provides evidence to support double-layer rather than single-layer closure of cystotomies in clinical cases. The use of barbed suture may be suitable for cystorrhaphy in sheep.

Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases.

OBJECTIVE: To compare perioperative opioid consumption and duration of hospitalization (DOH) in anesthetized dogs receiving opioid-based analgesia (OBA) vs those receiving bupivacaine epidural-based analgesia (EPID) during cystotomy. STUDY DESIGN: Retrospective cross-sectional study. ANIMALS: Fifty-six client-owned dogs undergoing cystotomy. METHODS: Clinical records of dogs undergoing cystotomy between January 2015 and December 2017 were reviewed. Demographic data, duration of anesthesia and surgery, anesthetic management, perioperative opioid consumption expressed in morphine equivalents (ME), perioperative use of adjuvant analgesics, time to first micturition, time to eat, time to ambulate, and DOH were recorded. Opioid consumption and DOH were compared with a Wilcoxon rank-sum test, followed by linear regression analysis as appropriate. Time to first micturition, time to eat, and time to walk unassisted were modeled with Cox-proportional hazard models. RESULTS: Dogs treated with EPID during surgery required 1.5 mg/kg ME less compared with those treated with OBA (P = .04) during surgery. Three of 19 dogs treated with EPID vs 15 of 37 dogs receiving OBA required intraoperative adjuvant analgesics (P = .06). Dogs treated with EPID regained motor function slower than dogs treated with OBA (P = .01); however, there was no difference in time to urinate, time to eat, or DOH between treatments. CONCLUSION: Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy. CLINICAL SIGNIFICANCE: The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.

Influence of barbed suture on leak pressures after double-layer inverting closure of cystotomy sites in sheep.

OBJECTIVE: To determine the influence of barbed suture on double-layer inverting closure of cystotomy sites in sheep. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Urinary bladders harvested from ovine (n = 26) cadaveric specimens. METHODS: After collection and specimen preparation, a 3-cm-long incision was created on the ventral aspect of the urinary bladder. The cystotomy was repaired with barbed (n = 13) or nonbarbed analogous monofilament absorbable suture (n = 13) in a double-layer inverting suture pattern. Time required for closure in seconds was recorded for each test. Each bladder was connected to a pressure transducer to monitor intraluminal pressure during infusion with dyed Hartmann's solution until leakage occurred. Intraluminal pressure at time of initial leakage and leakage site were also recorded. Two-sample t tests were used to compare initial leakage pressure and closure time between the 2 types of suture (P = .05). RESULTS: The mean ( ± SD) leakage pressure of ovine urinary bladder incisions did not differ between closures with barbed sutures (42.3 ± 21.7 mmHg) and nonbarbed closures (32.5 ± 14.4 mmHg, P = .187). Cystorrhaphies were performed faster with barbed suture (307 ± 50 seconds) than with nonbarbed suture (390 ± 62 seconds, P = .001). CONCLUSION: The use of barbed suture did not affect mean leakage pressure of ovine urinary bladder incisions but decreased the time required to complete cystorrhaphies in this model. CLINICAL SIGNIFICANCE: This study provides evidence to support the use of knotless barbed suture for open ovine cystorrhaphies. Use of such suture for laparoscopic and laparoscopic-assisted procedures in sheep warrants caution until cyclic and in vivo testing is performed with appropriate laparoscopic instrumentation.

Urinary calculi in a shih tzu dog with hyperadrenocorticism.

An 11-year-old spayed female shih tzu dog was presented with pollakiuria, stranguria, and hematuria. Radiographs revealed a large number of radiodense urinary calculi within the bladder. Physical examination, complete blood cell count, biochemistry and ACTH stimulation test suggested possible hyperadrenocorticism. A cystotomy was performed and the patient was treated for hyperadrenocorticism.

Calculs urinaires chez une chienne Shih Tzu atteinte d'hyperadrénocorticisme. Une chienne Shih Tzu stérilisée âgée de 11 ans a été présentée avec de la pollakiurie, de la strangurie et de l'hématurie. Les radiographies ont révélé un grand nombre de calculs urinaires radio-opaques dans la vessie. L'examen physique, une formule sanguine complète et la biochimie ont suggéré la possibilité d'hyperadrénocorticisme. Une cystotomie a été réalisée et la patiente a été traitée pour l'hyperadrénocorticisme.(Traduit par Isabelle Vallières).

Comparison of leak pressures for single-layer simple continuous suture pattern for cystotomy closure using barbed and monofilament suture material in an ex vivo canine model.

OBJECTIVE: To compare leak pressures following simple continuous closure of cystotomy with barbed suture to an analogous monofilament suture, in an ex vivo canine model. STUDY DESIGN: Ex vivo, simple randomized study. ANIMALS OR SAMPLE POPULATION: Urinary bladders harvested from canine cadavers (n = 21). METHODS: Urinary bladders were harvested from cadavers immediately following euthanasia. A 3-cm cystotomy was made on ventral midline of the urinary bladder. Urinary bladders were randomly assigned a suture for closure. A digital pressure transducer was inserted through 1 ureter, and the other ligated, while colored isotonic saline was infused into the urinary bladder via a Foley catheter inserted in the urethra. The initial leak pressure was defined as the pressure at which the colored saline solution first leaked from the cystotomy, and the maximum leak pressure was recorded when the pressure reached a plateau or catastrophic failure occurred. A Welch's 2-sample t test was used to compare leak pressure between the barbed and non-barbed closures, with significance set at P < .05. RESULTS: There was no significant difference in the initial or maximum leak pressure between the barbed and non-barbed closures. CONCLUSIONS: This study showed no difference in initial or maximum leak pressure between cystotomy closures with barbed or non-barbed suture under ex vivo conditions. This indicates barbed suture may be appropriate for cystotomy closure but in vivo studies are needed to support this finding.

IMAGING DIAGNOSIS-A LUMINAL LAMINATED DEBRIS BALL IN THE URINARY BLADDER OF A DOG.

A 5-year-old dog presented with pollakiuria and urinary incontinence. Abdominal radiographs revealed an oval, multilayered structure with soft tissue opacity and gas lucency in the urinary bladder. Ultrasonography showed an oval luminal structure with hyper- and hypoechoic layers and internal reverberation artifacts. Following cystotomy, the hemisected plane showed a layered, pale whitish matrix with a gas layer around the core. Histopathological examination showed no evidence of cells, bacteria, or fungi. The core and laminae comprised fibrinous and mineral debris. A final diagnosis of a freely floating, gas-filled laminated debris ball was made.

Therapy of calcium oxalate urolithiasis in a rhesus macaque (Macaca mulatta).

A rhesus macaque (Macaca mulatta) was presented for anuria. Examination revealed calcium oxalate concrements in the bladder. A cystotomy was performed, and a therapy with alfuzosin was conducted. Over 1 year after the treatment, the rhesus macaque had not shown any more signs of stranguria. This is the first case reporting the successful treatment of urolithiasis in a rhesus macaque.

Laparoscopic-assisted cystotomy for urolith removal in dogs and cats - 23 cases.

This report describes the outcomes of a modified laparoscopic-assisted cystotomy for urolith removal in dogs and cats. Modifications of the original techniques included a temporary cystopexy to the abdominal wall, utilization of a laparoscope instead of cystoscope, and retrograde flow of saline in the bladder with pressurized saline. The medical records of 23 client-owned animals for which laparoscopic-assisted cystotomy was used for urolith extraction were reviewed. Twenty-six procedures were performed in 23 animals. There were intraoperative complications in 19.2% of cases leading to open conversion in 11.5%. Rate of complications directly related to the procedure was 11.5%. Four cases had documented urolith recurrence with a mean time to recurrence of 335 days.

Cystotomie assistée par laparoscopie pour l'enlèvement des urolithes chez les chiens et les chats ­ 23 cas. Ce rapport décrit les résultats d'une cystotomie assistée par laparoscopie pour l'enlèvement des urolithes chez les chiens et les chats. Les modifications des techniques originales ont inclus une cystopexie temporaire à la paroi abdominale et un flux rétrograde de la solution saline dans la vessie avec une solution saline sous pression. Les dossiers médicaux de 23 animaux appartenant à des propriétaires pour lesquels la cystotomie par laparoscopie avait été utilisée pour l'extraction des urolithes ont été examinés. Vingt-six interventions ont été réalisées chez 23 animaux. Il y a eu des complications peropératoires dans 19,2 % des cas causant une conversion ouverte à 11,5 %. Le taux des complications directement reliées à l'intervention était de 11,5 %. Pour quatre cas, il y a eu une récurrence documentée des urolithes avec une durée moyenne de 335 jours.(Traduit par Isabelle Vallières).

Design, fabrication, and evaluation of 3-D-printed cystotomy spoons as a retrieval method in dogs.

OBJECTIVE: Current cystotomy methods often implement the use of off-label devices, resulting in urocystolith extraction difficulty and potentially leading to postoperative complications and discomfort for the patient. The objective of this study was to create 3 novel 3-D printed cystotomy spoons that offer a dedicated solution for removing urocystoliths from a patient's urinary bladder. ANIMALS: Clinical use of the 3 novel 3-D printed cystotomy spoons were ultimately evaluated in 4 dogs and 1 cat that presented for urocystotlith removal at 3 different veterinary hospitals in northwest Arkansas. METHODS: The novel cystotomy spoons were designed using SolidWorks, 3-D printed with a Dental Surgical Guide resin, and underwent prototype testing that included chlorhexidine soaking, autoclave sterilization, 3-point bend testing, and Finite Element Analysis. The efficiency of the spoons was then evaluated through a limited proof-of-concept study utilizing a postoperative questionnaire for the participating clinicians. RESULTS: Practitioner feedback indicated positive experiences using 1 or more of the novel 3-D printed cystotomy spoons while performing a cystotomy surgery. However, successful use of the spoons was ultimately limited to dogs in the 23 to 34 kg weight range. CLINICAL RELEVANCE: Novel 3-D printed cystotomy spoons have the potential to mediate urocystolith extraction difficulty and reduce postoperative complications. Additionally, this research demonstrates how veterinarians might develop custom 3-D models and prints to meet patient-specific needs. As such, further development could impact the standard of healthcare and the veterinary industry by promoting the use of additive manufacturing in veterinary medicine.

Do post-surgical multiresistant urinary infections occur in horses? Case of unilateral pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria as a complication of cystotomy.

Pyelonephritis is a serious condition that is rarely described in horses. In contrast, urinary tract infections are common in humans and small animals, and multi-drug-resistant urinary infections are an emerging threat. In this report, we describe a horse with unilateral pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria belonging to the Enterobacter cloacae complex. [Correction added on 9 August 2023, after first online publication: The preceding sentence was corrected.] An 11-year-old Swedish warmblood gelding was diagnosed with a cystolith and a cystotomy through an open left para-inguinal approach was performed. Seven days after surgery the horse presented with pyrexia, dullness and colic. Diagnostic testing and renal transabdominal ultrasonography confirmed the presence of a right-sided pyelonephritis. Culture and antimicrobial susceptibility testing revealed a pure growth of extended-spectrum beta-lactamases-producing E. cloacae complex bacteria with resistance against beta-lactams, aminoglycoside and trimethoprim-sulphonamide classes. Treatment included prolonged oral antimicrobials according to susceptibility testing results (enrofloxacin), judicious use of non-steroidal anti-inflammatory drugs, fluid therapy and gastric ulcer prophylaxis. The horse recovered successfully and is currently in good health (follow-up of 5 years). Once the infection resolved, unilateral renal scarring occurred. Multidrug-resistant upper-urinary infections occur in horses and should be considered in a post-surgical patient that develops fever. Early diagnosis, urine bacterial culturing and antimicrobial susceptibility testing were crucial in this case to successful management.

Laparoscopic-assisted cystotomy and cystostomy for treatment of cystic calculus in a gelding.

OBJECTIVE: To report laparoscopic-assisted cystotomy and inguinal cystostomy for treating bladder urolithiasis in a gelding. STUDY DESIGN: Clinical report. ANIMALS: Twelve-year-old Appaloosa gelding. METHODS: A laparoscopic approach was used to locate and grasp the bladder, which was exteriorized through an enlarged instrument portal for cystotomy to remove the calculus. During withdrawal, the calculus fragmented into multiple pieces. To avoid urethral occlusion and facilitate elimination of these fragments, an inguinal cystostomy was created. The seromuscular layer of the bladder was circumferentially secured to the abdominal fascia and bladder mucosa margins were sutured to the skin. RESULTS: At 2-year follow-up, the gelding was in good condition with mild urine scald of the left ventral abdomen. CONCLUSION: Laparoscopic-assisted cystotomy was used for calculus removal and inguinal cystostomy for successful fragment elimination.

Bladder wall adhesion causing a vesicular septum in a dog following surgical cystotomy.

CASE DESCRIPTION: An 8-year-old spayed female Yorkshire Terrier-Poodle dog was evaluated for persistent pollakiuria and stranguria following routine cystotomy for calcium oxalate cystoliths. CLINICAL FINDINGS: The dog presented for a cystotomy with intermittent hematuria. Postoperative radiographs revealed no remaining cystoliths. Urine, cystolith, and bladder mucosal aerobic cultures were negative. Pollakiuria, stranguria, and hematuria developed immediately after surgery and persisted despite antibiotics. Ultrasound revealed suspected fibrous adhesions within the urinary bladder lumen connecting the dorsal and ventral bladder wall creating a septum. This was confirmed cystoscopically 4 weeks after surgery. TREATMENT AND OUTCOME: Cystoscopic-guided laser ablation was performed to incise abnormal tissue connecting the ventral and dorsal bladder wall using a holmium:yttrium-aluminum-garnet laser. Three weeks later, ultrasound revealed adhesion resolution though mild pollakiuria and stranguria persisted. Oxybutynin was prescribed and clinical signs resolved. At 27 months after ablation, hematuria occurred with recurrent cystoliths. These cystoliths were removed by percutaneous cystolithotomy, documenting a cystoscopically normal bladder wall. The patient had normal urination for 55.5 months after ablation, with normal bladder wall thickness on ultrasound repeated at 27 and 36 months after ablation. CLINICAL RELEVANCE: To the authors' knowledge, an adhesion creating a septum between the dorsal and ventral bladder wall has not been previously reported as a complication after cystotomy in any species and should be considered as a cause of persistent lower urinary signs after surgery. Ultrasound identified the lesion in this dog. Because bladder abnormalities can develop quickly after surgery, ultrasound might be considered if urine testing is not supportive of infection. Cystoscopic-guided laser ablation was a successful minimally invasive treatment in this case.

Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score.

OBJECTIVES: The aim of this study was to compare the outcomes of cats undergoing open cystotomy with those undergoing minimally invasive surgery (MIS) for removal of cystic calculi by use of a composite outcome score. METHODS: Twenty-eight cats were retrospectively enrolled and divided into two groups: open cystotomy (n = 14) and MIS (n = 14). The primary outcome measure was a composite outcome score, including three variables: pain scores ⩾2 at either 6 or 12 h postoperatively; failure to remove all stones as determined by postoperative radiographs; and postoperative complications requiring a visit to the hospital separate from the planned suture removal appointment. Other data collected included signalment, history, other procedures performed during anesthesia, willingness to eat the day after surgery and the financial cost of the procedures. RESULTS: There was no significant difference in age, weight, sex or breed between the two groups. The risk of experiencing the composite outcome was 3/14 (21.4%) in the MIS group and 10/14 (71%) in the open procedure group (P = 0.02). The cats in the open surgery group had 8.3 times greater odds of developing the composite outcome than cats in the MIS group (odds ratio 8.3, 95% confidence interval 1.3-74.4; P = 0.02). In the MIS group, 10/14 cats were eating the day after surgery vs 3/14 in the open procedure group (P = 0.02). The procedural cost was higher in the MIS group, with a median cost of US$945 (interquartile range [IQR] US$872-1021) vs US$623 (IQR US$595-679) in the open group (P <0.01). CONCLUSIONS AND RELEVANCE: In this study the composite outcome score provided evidence to support the use of MIS techniques in cats with cystic calculi. The composite outcome score should be considered in future veterinary studies as a promising method of assessing clinically relevant outcomes.

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.