Treatment of retroperitoneal sarcoma results in improved outcomes.

OBJECTIVE: To report the clinical characteristics, treatments, and outcomes in a cohort of dogs with histologically confirmed retroperitoneal sarcoma (RPS) and to identify potential variables of prognostic significance. ANIMALS: 46 client-owned dogs from 10 clinics with histopathologic diagnosis of a sarcoma originating from the retroperitoneal space. METHODS: Medical records were retrospectively reviewed to obtain information regarding clinical characteristics, treatments, and outcomes. Recorded variables were analyzed to report descriptive data for all cases and overall survival time. Multivariate analysis was utilized to evaluate prognostic factors for overall survival. RESULTS: Hemangiosarcoma was the most common histologic subtype diagnosed (76.1%). Cytoreductive and curative intent surgical excision of the RPS was attempted in 12 and 22 dogs, respectively; 12 dogs underwent no surgery or had an exploratory laparotomy with incisional biopsy only. Nineteen dogs received adjuvant chemotherapy, either injectable or metronomic, and 1 dog received adjuvant radiation therapy. Fourteen of the 34 (41.2%) surgically treated dogs developed evidence of local recurrence, but there was no difference in local recurrence when comparing dogs categorized as curative intent versus cytoreductive surgery. The median overall survival time was 238 days. On multivariable analysis, treatment approach was associated with survival with surgical excision (vs palliative treatment) and adjuvant chemotherapy following surgery being protective against death. A diagnosis of hemangiosarcoma was associated with a greater hazard of death. CLINICAL RELEVANCE: This study demonstrates a substantially greater survival time than previously published and suggests a survival benefit from surgical excision and adjuvant chemotherapy.

Minimally invasive splenectomy is associated with a low perioperative complication rate and short operative time in cats.

OBJECTIVE: To report the perioperative outcome and complications in cats undergoing minimally invasive splenectomy. ANIMALS: 17 client-owned cats. METHODS: Perioperative data were collected from cats undergoing minimally invasive splenectomy from September 2010 to June 2023. Data included history, signalment, preoperative examination and diagnostic testing results, operative technique and time, perioperative outcomes, complications, hospitalization duration, histopathological diagnosis, and outcome. RESULTS: 13 spayed females and 4 neutered males were included, with a median age of 144 months (48 to 196 months). Seven cats underwent total laparoscopic splenectomy (TLS), with 1 cat requiring conversion from TLS to laparoscopic-assisted splenectomy (LAS) due to splenomegaly and an additional cat requiring conversion from TLS to open splenectomy due to uncontrollable splenic capsular hemorrhage. Ten cats underwent LAS, with 1 cat requiring conversion to open splenectomy due to splenomegaly. Additional procedures were performed in 13 cats, with the most common being liver biopsy in 10 cats. Median operative times were 50 minutes (45 to 90 minutes) for TLS and 35 minutes (25 to 80 minutes) for LAS. An intraoperative complication occurred in 1 cat. All but 1 cat survived to discharge. Median follow-up time was 234 days (18 to 1,761 days), with 15 of 16 cats confirmed alive at 30 days and 9 of 16 cats alive at 180 days postoperatively. CLINICAL RELEVANCE: Minimally invasive splenectomy in this cohort of cats was associated with short operative times and a low perioperative complication rate. Veterinary surgeons may consider minimally invasive splenectomy as an efficient and feasible technique in the treatment of splenomegaly or modestly sized splenic masses for diagnostic and therapeutic purposes in cats.

Hepatic abscessation in dogs: A multicenter study of 56 cases (2010-2019).

OBJECTIVE: To investigate the clinical findings, treatment strategies, and outcomes in dogs with confirmed hepatic abscessation. DESIGN: Retrospective cohort study from 2010 to 2019. SETTING: Multicenter study. ANIMALS: Fifty-six client-owned dogs with hepatic abscessation confirmed by culture, cytology, or histopathology. MEASUREMENTS AND MAIN RESULTS: Dogs were presented for lethargy (39/56), hyporexia (31/56), and vomiting (26/56). Abnormal physical examination findings included increased temperature (41/56) and abdominal pain (22/54). CBCs revealed neutrophilia (31/49), toxic changes (25/49), anemia (28/49), and thrombocytopenia (23/49). Biochemical analyses revealed increased alkaline phosphatase (45/50), increased alanine aminotransferase (40/50), hypoalbuminemia (25/48), and hyperbilirubinemia (19/49). Hypoglycemia was found in 13 of 49 dogs. Hepatic abscesses ranging from 0.5 to 15 cm in diameter were identified ultrasonographically in 37 of 48 dogs; 19 of 37 had solitary abscesses, and 18 of 37 had multifocal abscessation. Escherichia coli was the most commonly cultured organism, isolated in 18 of 42 cases. Histopathology revealed underlying hepatic neoplasia in 10 of 47 dogs. Surgical management was performed in 41 of 49 dogs, and 35 of 41 survived to discharge. Medical management was performed in 8 of 49 dogs, and 5 of 8 survived to discharge. With univariate analysis, hypoglycemia and multifocal abscessation were associated with decreased odds of survival (odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.03-0.9, P = 0.04; OR: 0.07, 95% CI: 0.01-0.6, P = 0.02, respectively). With multivariate analysis, only multifocal abscessation was associated with decreased odds of survival (OR: 0.09, 95% CI: 0.01-0.87, P = 0.04). CONCLUSIONS: Hepatic abscessation, although rare, should remain a differential diagnosis for dogs presenting with nonspecific clinical signs and increase liver enzyme activities, especially with concurrent increased temperature and neutrophilia. Rate of survival to discharge for dogs in this study was consistent with previously reported survival rates, with 40 of 56 (71%) of the total population surviving to discharge. No variables assessed were able to predict survival to discharge; however, hypoglycemia and multifocal abscessation should be assessed in larger populations to determine prognostic significance.

A Systematic Review of Canine Cystectomy: Indications, Techniques, and Outcomes.

This review provides a summary of the literature encompassing partial and total cystectomy procedures in dogs and subsequent conclusions that can be drawn. Surgical excision as a component of treatment for lower urinary tract neoplasia in dogs may enhance survival time and result in acceptable quality of life, though risk for surgical complications is substantial, particularly following total cystectomy procedures. However, for dogs with urothelial carcinoma, cystectomy is generally not considered curative and disease progression is common. Appropriate case selection and thorough preoperative discussion with owners regarding potential risks and benefits of cystectomy are imperative for successful outcomes.

Partial ulnar ostectomy, stereotactic body radiation therapy, and palliative radiation therapy as local limb sparing treatment modalities for ulnar tumors in dogs.

Background: Information on dogs that undergo limb preserving local treatment for ulnar tumors is currently limited. Objective: To describe the clinical characteristics and outcomes in dogs that underwent partial ulnectomy or radiation therapy (RT) for ulnar bone tumors, and to evaluate potential risk factors for outcomes as well as pre-treatment factors for association with treatment modality selected. Animals: Forty client-owned dogs that underwent partial ulnectomy or RT for an ulnar tumor from July 2006 to July 2021. Methods: The medical records database from a single institution were retrospectively reviewed, and data were recorded and analyzed. Results: Radiation therapy was performed in 24 dogs, with 12 stereotactic body RT (SBRT) and 12 palliative RT (PRT) plans, and partial ulnectomy was performed in 16 dogs. Biomechanical complications occurred in 6/12 (50%) dogs that underwent SBRT, 6/12 (50%) dogs that underwent PRT, and 3/16 (18.8%) dogs that underwent ulnectomy. The majority of dogs had a good functional outcome following partial ulnectomy, and no dogs required surgical stabilization of the carpus even with lateral styloid process excision. Pathologic fracture occurred in 4/12 (33.3%) dogs following SBRT and 5/12 (41.7%) dogs following PRT. Local progression or recurrence was documented in 5/12 (41.7%) dogs that underwent SBRT, 2/12 (16.7%) dogs that underwent PRT, and 2/16 (12.5%) dogs that underwent ulnectomy. The overall median survival time was 198 days, and factors that were significantly associated with improved survival time included adjuvant chemotherapy administration and partial ulnectomy as local treatment method for dogs that received chemotherapy. Clinical relevance: Both RT and ulnectomy were effective and well tolerated local treatment modalities for dogs with ulnar tumors.

Modified hemipelvectomy techniques in dogs and cats appear well tolerated with good functional outcomes.

OBJECTIVE: To describe the clinical characteristics, procedural techniques, complications, and outcomes of dogs and cats undergoing any of the following modified hemipelvectomy techniques: concurrent partial sacrectomy and/or partial vertebrectomy, osseous excision crossing midline, and reconstruction without the use of local musculature. ANIMALS: 23 client-owned animals (20 dogs and 3 cats) that underwent modified hemipelvectomy techniques. Animals that underwent traditional (nonmodified) hemipelvectomy techniques were excluded. PROCEDURES: The medical records of 3 academic institutions were reviewed, and data were recorded and analyzed. RESULTS: Modified hemipelvectomy was performed with partial sacrectomy and/or vertebrectomy in 11 dogs, excision crossing pelvic midline with concurrent limb amputation in 5 dogs and 2 cats, and closure without use of native muscle or mesh in 4 dogs and 1 cat. Surgery was performed for tumor excision in all cases. Excision was reported as complete in 16 of 23, incomplete in 6 of 23, and not recorded in 1 of 23 animals. All animals survived to discharge. Only animals undergoing partial sacrectomy/vertebrectomy (4/11) experienced postoperative mobility concerns. Major intra- or post-operative complications (grades 3 and 4) occurred in 2 dogs that underwent partial sacrectomy/vertebrectomy, and 1 of these animals experienced a complication that resulted in death. The median time to death or last follow-up was 251 days (range, 3 to 1,642). CLINICAL RELEVANCE: The modified hemipelvectomy techniques reported in this cohort were overall well tolerated with good functional outcomes. These findings support the use of these modified hemipelvectomy techniques in dogs and cats, and previous notions regarding tolerable hemipelvectomy procedures should be reconsidered. However, additional studies with larger numbers of patients undergoing modified hemipelvectomy techniques are needed to gain more information.

Grade shifts in recurrent canine soft tissue sarcomas and mast cell tumors.

OBJECTIVE: To determine the incidence of histologic grade shift (alteration of grade relative to the original tumor) in recurrent canine soft tissue sarcoma (STS) and mast cell tumor (MCT), and to determine the level of agreement between blinded pathologist review and original histology interpretation of STS and MCT grades. ANIMALS: 15 dogs with recurrent cutaneous/subcutaneous STS and 5 dogs with recurrent cutaneous MCT. All included dogs underwent excision of both the primary and recurrent tumors and had tumor samples available for review. PROCEDURES: The medical records and histology database from a single institution were reviewed, and data were recorded and analyzed. A single board-certified veterinary pathologist performed blinded evaluation of all excisional tumor samples, including both primary and recurrent disease, and these were evaluated independently and in conjunction with initial pathologic diagnoses. RESULTS: Based on single pathologist review, 7 of 15 (46.7%) dogs with recurrent STS had grade shift characterized by a higher or lower recurrent tumor grade in 4 of 7 and 3 of 7 cases, respectively, and 1 of 5 dogs with recurrent MCT had grade shift characterized by an increased grade of the recurrent tumor. Variability in reported grade between original histology report and pathologist review occurred for 13 of 30 (43.3%) STS excisional biopsy samples and 0 of 10 MCT excisional biopsy samples. CLINICAL RELEVANCE: Grade shift has been reported in multiple tumor types in people and has the potential to alter prognosis and treatment recommendations. This is the first study to document this phenomenon in dogs. Additional large-scale studies are needed to determine factors associated with grade shift as well as prognostic significance of grade shift for recurrent canine STS and MCT.

Short- and long-term outcomes associated with anal sacculectomy in dogs with massive apocrine gland anal sac adenocarcinoma.

OBJECTIVE: To evaluate short- and long-term outcomes for dogs undergoing anal sacculectomy for massive (> 5 cm) apocrine gland anal sac adenocarcinoma (AGASACA). ANIMALS: 28 client-owned dogs with massive AGASACA. PROCEDURES: A retrospective multi-institutional study was performed. Pre-, intra-, and post-operative data was collected, and variables were statistically analyzed for associations with progression-free interval (PFI) and overall survival (OS). RESULTS: At the time of anal sacculectomy, 19 (68%) dogs underwent concurrent iliosacral lymph node extirpation, including 17 of 18 (94%) dogs with suspected nodal metastasis preoperatively. Five (18%) dogs experienced grade 2 intraoperative complications. Ten (36%) dogs experienced postoperative complications, including 1 grade 3 and 1 grade 4 complication. No dogs had permanent fecal incontinence, tenesmus, or anal stenosis. Nineteen dogs received adjuvant chemotherapy, radiation, or both. Local recurrence occurred in 37% of dogs. Dogs with lymph node metastasis at surgery were more likely than dogs without metastasis to develop new/progressive lymph node metastasis (10/17 [59%] vs 0/10 [0%]; P = .003) and distant metastasis (7/17 [41%] vs 0/10 [0%]; P = .026). Median PFI was 204 days (95% CI, 145 to 392). Median OS was 671 days (95% CI, 225 to upper limit not reached). Nodal metastasis at the time of surgery was associated with shorter PFI (P = .017) but not OS (P = .26). Adjuvant therapy was not associated with outcome. CLINICAL RELEVANCE: Dogs with massive AGASACA experienced prolonged survival following anal sacculectomy despite a high incidence of local recurrence and metastasis. Lymph node metastasis at the time of surgery was a negative prognostic indicator for PFI but not OS.

Outcomes in dogs undergoing surgical stabilization and non-stereotactic radiation therapy for axial and appendicular bone tumors.

Background: Information on dogs that undergo radiation therapy (RT) with non-stereotactic protocols in addition to surgical stabilization with implant placement for treatment of bone tumors is limited. Objective: Our primary objectives were to describe the clinical characteristics as well as short- and long-term outcomes, including complications, function, and disease progression, in dogs that underwent both surgical stabilization with implant placement and non-stereotactic RT for local treatment of a bone tumor. Methods: A bi-institutional retrospective case series was performed. Animals: Eight client-owned dogs that underwent both surgical stabilization with implant placement and non-stereotactic RT for local treatment of a bone tumor were included. Results: Tumor types included osteosarcoma or suspected osteosarcoma (5), plasma cell tumor (2), and grade 3 fibrosarcoma (1). Radiation protocols were hypofractionated (palliative intent) in 5 dogs and fractionated (definitive intent) in 3 dogs. Five dogs experienced complications following both RT and surgery, including grade 1 complications in two dogs, a grade 2 complication in one dog, both grade 1 and 2 complications in one dog, and both grade 2 and 3 complications in one dog. Clinical signs subjectively improved in all dogs that had outcomes relative to function documented post-surgery/RT (7). Of these 7 dogs, 4 maintained long-term improvement in function and clinical signs, whereas 3 experienced subsequent recurrence/progression of clinical signs at a median of 133 days (range 91-186) postoperatively in association with biomechanical complications (screw loosening), surgical site infection, and local disease progression in 1 dog each; subsequent treatment resulted in improved clinical signs for each of these 3 dogs, such that overall good long-term functional outcomes were experienced. No dogs required amputation or additional vertebral surgery as salvage for local disease control or palliation. The median progression free interval was 206 days (range 25-1078), and the median survival time was 253 days (range 122-1078) with 1 additional dog lost to follow-up at 575 days. Two dogs experienced local disease progression, and 6 dogs experienced systemic disease progression; both dogs that developed local disease progression received palliative intent RT protocols. Clinical relevance: In this cohort, dogs with primary bone tumors that underwent surgical stabilization with implant placement and hypofractionated or fractionated non-stereotactic RT for local treatment had a low incidence of major complications, good limb function and ambulation post-treatment, and relatively prolonged survival times despite disease progression.

Case series: Pleural effusion caused by urinary ultrafiltrate in two cats without evidence of urinary obstruction, trauma, or simultaneous perinephric pseudocysts.

Objectives: To describe the diagnostic techniques, surgical treatments, and outcomes of two cats with recurrent pleural transudate caused by urinary ultrafiltrate. Animals: Two cats without evidence of trauma, urinary tract obstruction, or concurrent perinephric pseudocysts that were evaluated and treated for recurrent pleural transudate caused by urinary ultrafiltrate. Study design: Short case series. Methods: Multiphase contrast CT scan revealed leakage of contrast media from the kidneys bilaterally into the retroperitoneal spaces in both cats. Renal scintigraphy performed in one cat revealed progressive accumulation of 99mTc diethylenetriamine penta-acetic acid (Tc-DTPA) in the pleural space. Exploratory laparotomy localized the leakage of fluid to renal capsular defects bilaterally in both cats. The retroperitoneum was incised bilaterally to promote fluid drainage into the peritoneum, and nephropexies were performed. Results: One cat had long-term survival with recurrent, though decreasing volumes of, pleural effusion. The second cat was euthanized 16 days postoperatively for progressive renal disease. Conclusion: The diagnosis of spontaneous urinary ultrafiltrate accumulation in the pleural space of cats without evidence of trauma, urinary tract obstruction, or concurrent perinephric pseudocysts has not previously been reported. The surgical correction described reduced but did not completely eliminate the rate of pleural effusion accumulation.

Suspected contrast-induced nephropathy in three sequential patients undergoing computed tomography angiography and transarterial embolization for nonresectable neoplasia.

CASE DESCRIPTION: During the same week, 3 sequential patients (a 10-year-old 8.7-kg spayed female poodle cross [dog 1], 13-year-old 2.6-kg spayed female domestic longhair cat, and 13-year-old 9.0-kg castrated male mixed-breed dog [dog 2]) underwent CT-angiography (day 0) and transarterial embolization (day 1) for nonresectable hepatocellular carcinoma (n = 2) or prostatic carcinoma (1). CLINICAL FINDINGS: Contrast-induced nephropathy (CIN) was suspected in all animals on the basis of higher serum creatinine concentrations after contrast medium administration (exposure), compared with baseline concentrations before exposure, consistent with CIN definitions. The total dose of contrast medium was < 3 mL/kg for each exposure. For all 3 patients, creatinine concentration peaked at a median of 3 days (range, 2 to 3 days) after the first exposure (day 0), and the median absolute and relative increases in creatinine concentration after exposure (vs baseline concentrations before exposure) were 2.9 mg/dL (range, 2.2 to 3.7 mg/dL) and 410% (range, 260 to 720%), respectively. TREATMENT AND OUTCOME: The patients received individually tailored supportive care for acute kidney injury. Serum creatinine concentrations began to improve at a median of 4 days (range, 3 to 4 days) and returned to within reference limits at a median of 7 days (range, 3 to 13 days) following initial exposure. CLINICAL RELEVANCE: CIN should be considered as a potential complication following IV administration of contrast medium. Short-term outcome following CIN can be excellent with supportive care.

Choledochal stenting for treatment of extrahepatic biliary obstruction in cats.

BACKGROUND: Limited information currently exists regarding the clinical progression and outcomes of cats that undergo choledochal stenting as a treatment for extrahepatic biliary obstruction (EHBO). HYPOTHESIS/OBJECTIVES: Describe clinical characteristics, indications for choledochal stent placement, procedure, and outcomes in a cohort of cats undergoing choledochal stenting and evaluate risk factors associated with survival as well as recurrence of EHBO in affected cats. ANIMALS: Twenty-three client-owned cats undergoing choledochal stent placement. METHODS: Retrospective study. Medical records from 6 academic institutions were reviewed, and data were extracted and analyzed statistically. RESULTS: Median age of cats was 10.1 years (range, 2-16), and all cats had at least 2 clinical signs. Most common clinical signs were vomiting in 20/22 (90.9%), inappetence in 19/22 (86.4%), and lethargy in 19/23 (82.6%). Procedural complications were uncommon and rarely related to the stenting procedure. Clinical signs improved postoperatively in 15/20 (75.0%) cats and serum total bilirubin concentration decreased postoperatively in 13/19 (68.4%) cats. Eighteen (78.3%) cats survived to discharge. Recurrence of EHBO was documented in 7/18 (38.9%) cats that survived to discharge. Cholelithiasis was associated with recurrence of EHBO. Median survival time for cats that survived to discharge was 931 days (range, 19-3034). Absence of peritoneal effusion was associated with survival to discharge. CONCLUSIONS AND CLINICAL IMPORTANCE: Choledochal stenting was an effective treatment modality in cats with EHBO with few procedural complications and potential for prolonged survival, but substantial risk for recurrence of EHBO was identified.

Bilateral intracorporeally sutured inguinal herniorrhaphy using 3-dimensional laparoscopy in a dog.

A 7-month-old, intact male, mixed breed dog with bilateral inguinal hernias underwent general anesthesia for laparoscopic bilateral inguinal herniorrhaphy via a 3-port approach. A 3-dimensional laparoscopic system was used to perform the procedure immediately following prescrotal open castration. Intracorporeal suturing with polypropylene was performed, and 2 cruciate sutures were placed to close each inguinal ring. The caudal aspect of each inguinal ring was left slightly open so as not to disrupt the passage or patency of vessels and nerves. No intra- or post-operative complications occurred. One year after surgery, the dog has no evidence of recurrence of the inguinal hernias. Key clinical message: This case report demonstrates a novel minimally invasive approach to inguinal herniorrhaphy in a dog with no reported complications and a good long-term outcome. Intracorporeally sutured inguinal herniorrhaphy is feasible in dogs with good results, although additional cases are needed to gain experience with this technique in dogs with varying presentations of inguinal hernias.

Herniorraphie inguinale bilatérale suturée intra-corporellement par laparoscopie tridimensionnelle chez un chien. Un chien de race mixte, mâle, intact, âgé de 7 mois, avec une hernie inguinale bilatérale, fut mis sous anesthésie générale pour une herniorraphie inguinale bilatérale laparoscopique via une approche à trois voies. Un système laparoscopique tridimensionnel a été utilisé pour effectuer la procédure immédiatement après la castration préscrotale ouverte. Une suture intracorporelle avec du polypropylène a été réalisée et deux sutures croisées ont été effectuées pour fermer chaque anneau inguinal. L'aspect caudal de chaque anneau inguinal a été laissé légèrement ouvert afin de ne pas perturber le passage ou la fonctionnalité des vaisseaux et des nerfs. Aucune complication per- ou postopératoire n'est survenue. Un an après la chirurgie, le chien ne présente aucun signe de récidive des hernies inguinales.Message clinique clé :Ce rapport de cas démontre une nouvelle approche minimalement invasive de la herniorraphie inguinale chez un chien sans complications signalées et un bon résultat à long terme. Une herniorraphie inguinale suturée de manière intracorporelle est réalisable chez les chiens avec de bons résultats, bien que des cas supplémentaires soient nécessaires pour acquérir de l'expérience avec cette technique chez les chiens présentant des présentations variables de hernies inguinales.(Traduit par Dr Serge Messier).

Canine and feline haemangiosarcoma.

INTRODUCTION: Haemangiosarcoma (HSA) is a malignant neoplasm of dogs and cats that is suspected to originate from a pluripotent bone marrow progenitor with a complex and multifactorial pathogenesis. APPROACH: Pertinent literature was identified, reviewed, and summarized for inclusion in the manuscript. RESULTS/INTERPRETATION: Dogs are more frequently diagnosed with HSA than cats, and primary sites of this disease include dermal, subcutaneous/intramuscular, and visceral (most commonly the spleen). Dogs and cats with HSA generally have a poor prognosis owing to the rapid and widespread metastasis typically associated with this disease. However, some forms such as cutaneous HSA behave in a less aggressive fashion with improved outcomes. Surgical excision and anthracycline-based chemotherapy remain the mainstays of treatment, although novel treatment modalities are currently under investigation for potential roles in treatment of this disease. CONCLUSION: This review aims to describe the clinical presentation and progression of the various forms of HSA in dogs and cats as well as to provide a systematic review of the veterinary literature with a focus on the various published treatment options and associated outcomes.

Ethylene vinyl alcohol copolymer to treat an intracranial arteriovenous malformation in a dog.

A 6-year-old neutered male German shepherd dog was evaluated for obtundation, blindness, and bilateral exophthalmos. A magnetic resonance imaging scan of the brain was performed and identified an arteriovenous malformation (AVM) with several feeding arterial branches, and venous drainage through the cavernous sinus. Venous vessels rostral to the AVM were severely distended and extended into the retrobulbar spaces. Liquid embolization by injection of ethylene vinyl alcohol copolymer was performed from access points in the maxillary arteries and internal carotid arteries. No intraprocedural complications were encountered, and the dog was discharged the next day. Bilateral enucleation eventually was performed because of exposure keratopathy. At 31 months post-embolization, owners reported that the dog was doing very well clinically with high activity level and normal appetite, and the dog also appeared to be pain free. Although intracranial AVMs are very rare in companion animals, successful treatment using liquid embolization is possible and should be considered.

Surgical treatment of retroiliac ectopic ureters with secondary hydronephrosis and hydroureter in a dog.

CASE DESCRIPTION: An 8-month-old 41.2-kg (90.6-lb) sexually intact male Dogue de Bordeaux with urinary incontinence and signs of nausea was referred for further evaluation and treatment of bilateral hydronephrosis, hydroureter, and ectopic ureters. CLINICAL FINDINGS: Clinicopathologic analyses revealed urine specific gravity and serum concentrations of urea nitrogen and creatinine within reference limits. Abdominal ultrasonography and CT revealed unilateral abdominal cryptorchidism, ureters that bilaterally passed dorsal to and appeared compressed by the external iliac arteries (retroiliac ureters), and bilateral hydronephrosis, hydroureter, and ectopic ureters. On CT, minimal uptake of contrast medium by the right kidney indicated either a lack of renal function or ureteral obstruction. TREATMENT AND OUTCOME: The dog underwent exploratory laparotomy, right ureteronephrectomy, left neoureterocystostomy, bilateral castration, and incisional gastropexy without complication and was discharged 2 days postoperatively. Eleven days after surgery, the dog had improved but continued urinary incontinence, improved left hydronephrosis and hydroureter, and serum concentrations of urea nitrogen and creatinine within reference limits. At 24 months after surgery, the dog was reportedly clinically normal, other than having persistent urinary incontinence. CLINICAL RELEVANCE: To our knowledge, this was the first report of a dog with retroiliac ureters and compression-induced ureteral obstruction with secondary hydroureter and hydronephrosis. Retroiliac ureters should be considered as a differential diagnosis in young dogs with ureteral obstruction. Our findings indicated that a good outcome was possible for a dog with retroiliac ureters treated surgically; however, the presence of additional congenital anomalies should be considered and may alter the prognosis in dogs with retroiliac ureters.

Use of percutaneous transvenous coil embolization in the treatment of intrahepatic portosystemic shunts in four cats.

CASE DESCRIPTION: 4 cats (6 to 9 months old) were evaluated because of clinical signs consistent with a portosystemic shunt (PSS). CLINICAL FINDINGS: Among the 4 cats, 3 had neurologic abnormalities including ataxia, head pressing, disorientation, and obtundation. One cat was evaluated because of urethral obstruction; a retrieved urethral stone was determined to have urate composition. Clinicopathologic findings (hypoproteinemia, low BUN concentration, and high serum bile acids concentration) were consistent with a PSS in all cats. A diagnosis of intrahepatic PSS (IHPSS) was made for all cats on the basis of ultrasonographic and CT findings. TREATMENT AND OUTCOME: All cats underwent percutaneous transvenous coil embolization (PTCE). No major intraprocedural complications were encountered, and all cats were discharged from the hospital. For the 3 cats that were presented with neurologic signs, an evaluation performed at 12, 14, or 48 months after the procedure revealed resolution of the neurologic signs, and owners reported that the behavior of each cat appeared normal. One cat that initially had neurologic and gastrointestinal signs had lower urinary tract signs after PTCE and developed an acquired extrahepatic PSS. CLINICAL RELEVANCE: Although IHPSSs in cats are uncommon, the outcomes of PTCE for the 4 cats of the present report suggested that this treatment may benefit cats with an IHPSS. No short-term complications were encountered, and all cats had improvement in clinical signs following PTCE, although an acquired extrahepatic PSS was later identified in 1 cat. Further investigation of the use of endovascular techniques for the treatment of IHPSSs in cats and other species is warranted.

Percutaneous radiologically guided gastrostomy tubes: Procedural description and biomechanical comparison in a canine model.

OBJECTIVE: To describe the novel placement of percutaneous radiologically guided gastrostomy (PRG) tubes in a canine cadaveric model and to biomechanically compare PRG and percutaneous endoscopic gastrostomy (PEG) tube constructs. STUDY DESIGN: Descriptive and biomechanical experimental study. ANIMALS: Fifteen large breed (>25 kg) canine cadavers. METHODS: Percutaneous endoscopic gastrostomy tubes, low-profile PRG tubes, and standard PRG tubes were each placed in five canine cadavers. Body wall and stomach (with attached gastrostomy tube constructs) were harvested and biomechanically tested. Data regarding the maximal load to failure and procedure time were statistically analyzed. RESULTS: Percutaneous endoscopic gastrostomy and PRG tube placement was successful in all cadavers with no procedure-related complications. Gastrostomy tube placement time was longer for the PEG group vs the low-profile PRG (P = .005) and standard PRG (P = .037) groups. Peak construct strength was lower for the PEG group vs the low-profile PRG (P = .002) and standard PRG (P = .010) groups. The site of failure varied among groups. CONCLUSION: Percutaneous radiologically guided gastrostomy tubes were successfully placed in all cases with shorter placement time and greater peak construct strength compared with PEG tubes. CLINICAL SIGNIFICANCE: Due to the increased load to failure as well as decreased placement time recorded for PRG tubes relative to PEG tubes, PRG tubes may be considered as an alternative minimally invasive gastrostomy option in large breed canine patients. Further evaluation in clinical animals is required. Results of this work were presented at the 2019 American College of Veterinary Surgeons Surgery Summit; October 16-19, 2019; Las Vegas, Nevada.

Lower urinary tract transitional cell carcinoma in cats: Clinical findings, treatments, and outcomes in 118 cases.

BACKGROUND: Lower urinary tract transitional cell carcinoma (TCC) is an important but rarely described disease of cats. OBJECTIVES: To report the clinical characteristics, treatments, and outcomes in a cohort of cats with lower urinary tract TCC and to test identified variables for prognostic relevance. ANIMALS: One-hundred eighteen client-owned cats with lower urinary tract carcinoma. METHODS: Medical records were retrospectively reviewed to obtain information regarding clinical characteristics, treatments, and outcomes. Recorded variables were analyzed statistically. RESULTS: Median age of affected cats was 15 years (range, 5.0-20.8 years) and median duration of clinical signs was 30 days (range, 0-730 days). The trigone was the most common tumor location (32/118; 27.1%) as assessed by ultrasound examination, cystoscopy, or both. Treatment was carried out in 73 of 118 (61.9%) cats. Metastatic disease was documented in 25 of 118 (21.2%) cats. Median progression-free survival and survival time for all cats were 113 days (95% confidence interval [CI], 69-153) and 155 days (95% CI, 110-222), respectively. Survival increased significantly (P < .001) when comparing cats across the ordered treatment groups: no treatment, treatment without partial cystectomy, and treatment with partial cystectomy. Partial cystectomy (hazard ratio [HR], 0.31; 95% CI, 0.17-0.87) and treatment with nonsteroidal anti-inflammatory drugs (HR, 0.55; 95% CI, 0.33-0.93) were significantly associated with longer survival times. CONCLUSIONS AND CLINICAL IMPORTANCE: The results support treatment using partial cystectomy and NSAIDs in cats with TCC.

Veterinary Clinics: Tumor Ablation.

Over the past decade, interventional oncology techniques have become integrated into the treatment plans of companion animals with cancer on a regular basis. Although procedures such as stenting are performed commonly, other less frequently utilized techniques for locoregional therapy, such as embolization and ablation, are emerging and demonstrating promise. Tumor ablation techniques are categorized into two subgroups: chemical ablation and energy-based ablation. Increased utilization of ablation will allow for the determination of specific indications and evaluation of outcomes for these techniques.