Intermittent urethral obstruction secondary to caudal sliding of a pelvic bladder in 3 dogs.

Three Yorkshire terrier dogs (2 males and 1 female) were presented for investigation of chronic dysuria and stranguria. Physical examination was unremarkable except for a poorly filled bladder. Biological tests, urinalysis, ultrasound, and routine radiography detected no significant abnormality, except for intermittent displacement of the bladder in the pelvis. Manual voiding cysto-urethrography showed marked caudal displacement of the bladder without perineal hernia and revealed intermittent, dynamic urethral obstruction. Obstructive kinking of the membranous urethra was observed in male dogs, and the marked caudal displacement of the bladder in the female dog was suspected to induce similar urethral obstruction, although this was not clearly visualized because of the absence of contrast filling of the obstructed urethra. All dogs showed resolution of the clinical signs following cystopexy. Key clinical message: This report documents the diagnostic value of manual voiding cysto-urethrography for the investigation of dynamic voiding disorders, especially in dogs with a pelvic bladder.

Obstruction urétrale intermittente secondaire au glissement caudal d'une vessie pelvienne chez trois chiens. Trois chiens de race Yorkshire (2 mâles et 1 femelle) furent présentés pour un problème de dysurie chronique et de strangurie. L'examen physique ne révéla rien d'anormal sauf une vessie pauvrement remplie. Des tests biologiques, une analyse d'urine, une échographie et des radiographies de routine ne détectèrent aucune anormalité, sauf pour le déplacement intermittent de la vessie dans le pelvis. Une cysto-urétrographie avec vidange manuelle a montré un déplacement caudal marqué de la vessie sans hernie périnéale et a révélé une obstruction urétrale dynamique et intermittente. Une plicature obstructive de l'urètre membraneuse fut observée chez les chiens mâles, et le déplacement caudal marqué de la vessie chez la chienne fut soupçonné d'induire une obstruction urétrale similaire, bien que ceci n'était pas clairement visualisé étant donné l'absence de remplissage par le milieu de contraste de l'urètre obstruée. La résolution des signes cliniques fut observée chez tous les chiens suite à la cystopexie.Message clinique important :Ce rapport documente la valeur diagnostique d'une cysto-urétrographie avec vidange manuelle pour l'étude de désordres de vidange dynamiques, spécialement chez les chiens avec une vessie pelvienne.(Traduit par Dr Serge Messier).

Os clitoris in dogs: 17 cases (2009-2017).

Medical records of 17 client-owned dogs diagnosed with os clitoris on physical examination or diagnostic imaging were reviewed to describe the clinical signs and surgical management of this condition. All dogs were phenotypically female. The most common presenting complaints included an enlarged clitoris (n = 10), urinary tract infection (n = 5), and licking of the vulva (n = 3). Other frequently reported clinical signs included vaginal discharge and/or lower urinary tract signs such as pollakiuria. Ten dogs were surgically managed with os clitorectomy. Concurrent related procedures included gonadohysterectomy (n = 7), and episioplasty (n = 3). Clitorectomy in the surgically managed dogs created a more normal female anatomy and resolved clinical signs associated with the exposed clitoris.

Os clitoridien chez les chiennes : 17 cas (2009­2017). Les dossiers médicaux de 17 chiennes appartenant à des clients qui avaient été diagnostiquées avec l'os clitoridien lors de l'examen physique ont été étudiés afin de décrire les signes cliniques et la gestion chirurgicale de cette affection. Tous les chiens étaient phénotypiquement femelles. Les plaintes les plus communes à la présentation incluaient un clitoris élargi (n = 10), une infection des voies urinaires (n = 5) et le léchage de la vulve (n = 3). Les autres signes cliniques fréquemment signalés incluaient l'écoulement vaginal et/ou des symptômes des voies urinaires inférieures comme la pollakiurie. Dix chiennes ont été gérées chirurgicalement par une clitoridectomie. Les interventions concomitantes incluent la gonado-hystérectomie (n = 7) et l'épisioplastie (n = 3). La clitoridectomie chez les chiennes gérées par chirurgie a créé une anatomie femelle plus normale et a donné lieu à une résolution des signes cliniques associés au clitoris exposé.(Traduit par Isabelle Vallières).

Disorders of micturition in small animal patients: clinical significance, etiologies, and management strategies.

OBJECTIVES: To review the physiology of micturition, the pathophysiology of micturition disorders, and current pharmacological agents used to treat these disorders. To discuss different urinary catheterization techniques, along with the risks of catheter-associated urinary tract infections attributed with these techniques. ETIOLOGY: Many critically ill veterinary patients are at risk of developing a number of neurological and non neurological micturition-related disorders. DIAGNOSIS: Micturition disorders can be diagnosed based on physical examination findings, urinary voiding contrast studies, urethral pressure profiles, and diagnostic testing such as urinalysis and urine cultures. THERAPY: Therapy can be either pharmacological, involvement of urinary catheterization, surgical, or a combination of all the above. The goal of the treatment is to correct the underlying causes resulting in the micturition-related disorder, and if possible, allow the patient to regain their normal physiological micturition behavior. PROGNOSIS: Depending on the underlying disease process and duration of the micturition disorder, the prognosis can be variable. In many instances, near-normal or normal function can return, but in severe cases, the patient may not regain its normal, appropriate micturition response.

Effectiveness of manual bladder expression in paraplegic dogs.

OBJECTIVE To determine the effectiveness of manual bladder expression in paraplegic dogs by comparing urine volumes measured by use of intermittent catheterization and ultrasonography. ANIMALS 36 paraplegic dogs. PROCEDURES 93 measurements of bladder volume were collected for the 36 dogs. Residual urine volume was determined by use of intermittent urethral catheterization and estimated by use of ultrasonography. RESULTS Manual bladder expression voided a mean of 49% of urine from the bladder in this population of dogs. There was no correlation (R2, 0.06) between the effectiveness of manual bladder expression and body weight. Ultrasonographic estimation of bladder volume had good correlation (R2, 0.62) with bladder volume determined by use of intermittent bladder catheterization, but clinically unacceptable variation for predicting actual bladder volume (mean difference, 22 mL; 95% confidence interval, -96 to 139 mL). CONCLUSIONS AND CLINICAL RELEVANCE Manual bladder expression was ineffective at completely emptying urine from the bladder of paraplegic dogs, but the effectiveness of the procedure was not affected by body weight. Manual bladder expression would likely be a useful procedure to prevent increases in pressure within the bladder. Ultrasonographic estimation of bladder volume could be a useful predictor of actual bladder volume, but it was susceptible to wide variations among dogs, and results should therefore be interpreted with caution.

Micturition disorders.

Evaluation of dogs and cats with micturition disorders can be challenging. It is important to determine the duration, timing, and frequency of the disorder, as well as assessing for any additional medical problems, such as neurologic or orthopedic disease, that may be affecting micturition. Observation of the patient during voiding can be particularly helpful in determining the type of disorder. Treatment of micturition disorders is varied and outcome depends on an accurate diagnosis. Patient response is also highly variable, even with appropriate therapy, and owners' expectations must be set accordingly.

Evaluation of complications and feasibility of indwelling epidural catheter use for post-operative pain control in dogs in the home environment.

AIMS: The objective of this study was to describe the use of indwelling epidural catheters post-operatively in dogs in a home environment, and to report associated complications. METHODS: Dogs undergoing surgical procedures of the hind limb (n=83) were included in the study and were administered 0.05 or 0.10 mg/kg epidural morphine via an indwelling epidural catheter every 6 hours. Data compiled relating to catheter placement included time of placement, ease of placement and problems encountered, number of attempts of placement, and individual placing the catheter. A client questionnaire was provided to evaluate side effects, complications, pain, and ease of use of the epidural catheter system after discharge from the hospital and catheter removal at home. Side effects were compared between the dogs receiving 0.05 or 0.1 mg/kg epidural morphine. RESULTS: The most common patient complication was abnormal urination patterns (32/82, 39%); specifically dribbling urine where laying, emptying the entire bladder where laying, not urinating for extended periods of time, and taking a longer time to pass urine were reported. There were no significant differences in the number or types of side effects reported in either dosing group. The most common technical issues reported by owners were difficulty getting the needle into the injection port (10/81, 12%) and removing the adhesive covering keeping the epidural catheter system in place (19/78, 24%). There were no reports of inflammation or discharge at the catheter site in any of the dogs. Of the respondents surveyed, 76/79 (97%) found the epidural catheter system easy to use at home in the post-operative period. CONCLUSIONS: Indwelling epidural catheters are a feasible method of administration of post-operative analgesia in the immediate post-operative period in the home environment and were associated with only a few minor complications in this population.

[Vulval hypoplasia in an alpaca cria - first case report in Germany]. / Vulvahypoplasie bei einem Alpakacria - Erstbeschreibung eines Falls in Deutschland.

This is the first German case report of an alpaca cria suffering from a congenital vulvahypoplasia. Symptoms, diagnostics and therapy are described. The 24-hours-old cria was referred to the hospital due to reduced general condition and colic. The existent vulvahypoplasia led to impaired urination, causing further complications such as urovagina and urinary stasis up to the renal pelvis. Surgical construction of the rima vulvae cured the cria. As indicated by several cases published on the clinical picture of vulvahypoplasia during recent years, this congenital deformation could become an increasing problem in the alpaca population.

Evaluation of a modification of the McKinnon technique to correct urine pooling in mares.

The urethral fold of 30 mares was split transversely into dorsal and ventral shelves, and the ventral shelf was used to help create a urethral extension. The dorsal shelf was stretched caudally and sutured to the roof of the extension so that it covered at least the cranial half of the extension. For 20 mares, a relaxing, vaginal incision was created cranial to the external urethral orifice to enable the dorsal shelf to be retracted further caudally. Ten of the 30 mares (33.3 per cent) developed a defect, but none developed a defect in that portion covered by the dorsal shelf of the urethral fold. Two of the 30 mares (6.7 per cent) developed a defect so small that the defect could be detected only by inserting a dye, under pressure, into the tunnel. The total number of mares that developed only a grossly visible and palpable defect was eight of 30 (26.6 per cent). Four of the 10 mares that did not receive the relief incision and six of 20 mares that did receive the relief incision developed a defect in the extension. Modifying the McKinnon technique by transversely splitting the urethral fold and retracting the dorsal half helps prevent a defect from forming in the cranial portion of the extension. The dorsal shelf can be retracted further caudally by creating a relief incision on the floor of the vagina.

Transobturator vaginal tape inside out for treatment of urethral sphincter mechanism incompetence in female dogs: cadaveric study and preliminary study in continent female dogs.

OBJECTIVES: (1) To describe a surgical technique adapted from the "transobturator vaginal tape inside-out" (TVT-O) used in women and to define the trajectory of the tape on canine cadavers, and (2) to determine the urodynamic and morphological effects of the TVT-O in continent bitches. STUDY DESIGN: Cadaveric and experimental in vivo study. ANIMALS: Fresh female canine cadavers (n=12) and spayed female Beagle dogs (2). METHODS: (1) TVT-O was inserted in 12 cadavers. Dissection was performed and distances between the tape and neighboring structures were recorded. (2) TVT-O was inserted in 2 continent female Beagle dogs. Urethral pressure profilometry and vaginourethrograms were performed preoperatively, immediately after surgery, and 2, 4, and 6 months postoperatively. Histopathology was performed 6 months after surgery. RESULTS: (1) TVT-O tape was consistently located in a perineal space before entering the obturator foramina and was located at a safe distance from major neurovascular structures including the femoral vessels and obturator nerve. (2) TVT-O was performed without any surgical or postoperative complications in 2 continent bitches. Histopathologic examination of the tissues surrounding the tape revealed a mild fibroblastic proliferation with a mild to minimal lymphoplasmacytic inflammatory infiltration. CONCLUSIONS: TVT-O is a feasible and accurate procedure that can be performed in continent bitches with a low risk of complications.

Urinary bladder agenesis in an alpaca (Vicugna pacos) cria.

A 10-day-old female alpaca (Vicugna pacos) cria with a history of urinary straining and dribbling was presented for evaluation. The animal had markedly elevated blood fibrinogen (800 mg/dl), mildly elevated phosphorus (9.3 mg/dl), and minimally elevated blood urea nitrogen (38 mg/dl) concentrations. The total protein (5.0 g/dl) concentration was mildly decreased. These findings were suggestive of mild renal disease. An abdominal ultrasound revealed bilateral hydronephrosis and hydroureter, and no urinary bladder was identified. Gross postmortem examination revealed urinary bladder agenesis and bilateral hydronephrosis and hydroureter, with both ureters opening into a sinus in the caudal vagina. Histologic examination of the kidneys showed necrosuppurative pyelonephritis with pelvic dilation, and both ureters had mild lymphoplasmacytic and histiocytic inflammation.

Predicting recovery of urination control in cats after sacrocaudal injury: a prospective study.

OBJECTIVES: To determine whether intact tail base pain sensation predicts control of urination after sacrocaudal fracture-subluxation in cats. METHODS: Twenty-one cats affected by sacrocaudal fracture-subluxation were diagnosed routinely by radiography. The ability of each cat to detect a painful stimulus applied to the tail base was tested by application of pressure using a standard surgical instrument. Cats were then hospitalised for up to 30 days and categorised according to whether they showed control of urination. A value of P<0.05 was regarded as significant. The results were analysed to produce data regarding sensitivity, specificity and the positive and negative predictive value of the test. RESULTS: All 11 cats that had intact tail base sensation showed control of urination within three days. Four of the 10 cats without tail base pain sensation did not recover control of urination by day 30. CLINICAL SIGNIFICANCE: Intact tail base sensation predicts control of urination and is therefore a useful screening test.

Evaluation of a modified surgical technique to correct urine pooling in cows.

Various surgical techniques to correct urovagina in cows describe creating a mucosal extension from the urethral orifice to the labia; however, a fistula often forms in the mucosal extension. The objective of the present study was to determine if the incidence of fistula formation could be decreased by covering transposed submucosal tissue on the dorsal aspect of the urethral extension with a mucosal graft. Cows in both the control group (19) and the experimental group (19) received a modified McKinnon technique of urethral extension; cows in the experimental group also had a sheet of mucosa, obtained from the dorsal aspect of the vestibule, grafted to submucosa exposed during creation of the urethral extension. During histological examination of the biopsy of the graft and its recipient site (harvested 1 week after surgery), neither inosculation nor revascularization of the graft was evident in any sample. Fourteen of 19 (74%) cows in the control group and 10 of 19 (53%) cows in the experimental group developed a fistula in the extension (P=0.18). We concluded that application of a mucosal graft to the subcutaneous tissue exposed to the vestibule using the McKinnon technique of creating a urethral extension was of little or no benefit in preventing the formation of a fistula in the extension. Furthermore, during evaluation of the extensions, digital palpation alone was often insufficient for detection of a fistula.

Bladder outlet obstruction in a 6-month-old alpaca secondary to pelvic displacement of the urinary bladder.

A 6-month-old female alpaca was presented for stranguria. Based on the history, physical examination findings, and radiographic studies, the alpaca was diagnosed with bladder outlet obstruction, secondary to pelvic displacement of the bladder, a condition previously unreported in camelids. Cystopexy was performed and the alpaca recovered unremarkably.

Urodynamic testing in the diagnosis of small animal micturition disorders.

Urodynamic testing provides a quantitative assessment of the function of the small animal lower urinary tract. Most commonly these techniques are utilized to assess urethral tone (urethral pressure profile or UPP) and bladder detrusor muscle function (cystometrogram or CMG). A UPP may be indicated in cases of canine and feline micturition disorders. Examples include suspected primary sphincter mechanism incontinence (PSMI), ureteral ectopia, other congenital abnormalities, suspected neurological disorders, and mechanical or functional urethral obstruction. A UPP can be performed effectively utilizing human dedicated equipment. A CMG may be indicated to assess detrusor function in all of the above cases as well as cases of suspected atonic or infiltrated urinary bladder. This procedure can also be performed using the same human equipment. These tests are useful not only in providing an accurate diagnosis, but also in providing a sensitive prognostic indicator for clinical outcome of micturition disorders with and without pharmacological or surgical therapy. A leak pressure point may also be established in dogs with urinary incontinence, and may be even more sensitive than a UPP to predict clinical incontinence in some cases.

Control of urine marking by use of long-term treatment with fluoxetine or clomipramine in cats.

OBJECTIVES: To determine whether clomipramine differs from fluoxetine in reducing feline urine marking; whether reduction of marking continues in cats treated >8 weeks; whether recurrence of marking, after abrupt drug withdrawal, is less in cats treated >8 weeks; and whether cats that are successfully treated but resume marking after drug withdrawal can be successfully treated again with the same drug regimen. DESIGN: Positive-controlled, double-masked clinical trial. ANIMALS: 22 neutered cats (2 females, 20 males) > or =1 year old with objectionable urine marking. PROCEDURE: Cats that marked vertically > or =3 times/wk were treated with fluoxetine (1 mg/kg [0.45 mg/lb], q 24 h, PO) or clomipramine (0.5 mg/kg [0.23 mg/lb], q 24 h, PO) for 16 weeks, and efficacy was compared. Recurrence of marking was determined after abrupt withdrawal of fluoxetine at 16 or 32 weeks. Reduction in marking in cats treated with fluoxetine for 8 weeks after returning to marking following drug withdrawal was compared with the initial 8 weeks of successful treatment. RESULTS: Efficacy of fluoxetine and clomipramine was similar. Treatment >8 weeks revealed increasing efficacy in reduction of marking. Return of marking after termination of fluoxetine administration occurred in most cats. Cats successfully treated initially with fluoxetine responded similarly to repeated treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Clomipramine and fluoxetine were equivalent in treating urine marking. Longer treatment increased efficacy. Most cats return to marking after abrupt drug withdrawal. A second course of treatment can be expected to be as effective as the first.

Evaluation of long-term effects of endoscopic injection of collagen into the urethral submucosa for treatment of urethral sphincter incompetence in female dogs: 40 cases (1993-2000).

OBJECTIVE: To evaluate long-term success of endoscopic injection of collagen into the urethral submucosa in female dogs with urinary incontinence caused by urethral sphincter incompetence. DESIGN: Retrospective study. ANIMALS: 40 incontinent female dogs. PROCEDURE: Medical records were reviewed for outcome and other results for dogs in which a cystoscope was passed into the urethra for deposition of 3 collagen deposits into the submucosa. RESULTS: 27 (68%) dogs were continent for 1 to 64 months (mean, 17 months) after the collagen injection. In another 10 dogs, incontinence improved and in 6 of these dogs, full continence was regained with administration of additional medication. In 3 dogs, incontinence was unchanged. As long as 12 months after injection, there was a deterioration in the initial result in 16 dogs, after which their condition stabilized. Mild and transient adverse effects developed in 6 (15%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Long-term success of endoscopic injection of collagen was satisfactory. Relapse of incontinence might be caused by flattening of the collagen deposits rather than resorption of the collagen.