Stone-induced urethral fistula treatment with microfragmented adipose tissue containing mesenchymal stem cells: a case report from veterinary medicine with potential application in humans.

We report on a case of a two-year-old male dog, breed chow-chow, who suffered from urethral fistula as a result of ureterolithiasis. The urethral defect was identified intraoperatively with methylene blue. An autologous regenerative approach was combined with surgical closure of the defect, due to the well-known healing issues of the urethral wall in such conditions. A part of abdominal fat tissue was dissected to produce microfragmented adipose tissue containing mesenchymal stem cells, which was combined with platelet-rich plasma. The final product was applied in the area around the urethral defect closure. One month after the procedure, healing was confirmed with positive-contrast cystography. This therapeutic approach yielded success, and the follow-up period of one year was uneventful. The observed positive outcome of this approach in the canine model may be considered as a starting point for investigating the translational potential of the treatment in human medicine.

Pyelonephritic end-stage kidney and ureterocutaneous fistula in a Shetland pony.

A 12-y-old Shetland Pony was presented with a mucus-secreting fistula in the right paralumbar fossa. Surgery was performed to unravel the origin of the fistula. The horse died under anesthesia and was forwarded to autopsy. The right kidney was markedly atrophic and fibrotic, consistent with unilateral end-stage kidney. The right ureter was markedly thickened, but with luminal continuity leading into the urinary bladder where a partial obstruction caused by nodular para-ureteral fat necrosis was evident. The lumen of the cutaneous fistula was continuous with the right ureter; therefore, we diagnosed the lesion as a ureterocutaneous fistula. Anomalies of the ureter are uncommon, and ureterocutaneous fistula formation in equids has not been reported previously to our knowledge.

Urethrorectal fistula ligation and transection in a dog with a history of unilateral abdominal cryptorchidism and misdiagnosed anal gland disease.

A 10-month-old unilaterally cryptorchid male labradoodle dog was presented to a specialty surgery referral center with a reported history of persistent anal sac leakage that was unresponsive to conservative management. The dog underwent castration and left anal sacculectomy but was witnessed urinating from the anus postoperatively. A contrast urethrogram was performed, and a urethrorectal fistula located between the distal portion of the pelvic urethra and the caudal aspect of the rectum was diagnosed. One week later, the dog underwent ligation and transection of the fistula. Surgery was successful and the dog recovered unremarkably with complete resolution of clinical signs. A contrast urethrogram 1 mo after surgery confirmed the successful ligation and transection of the fistula. Key clinical message: To the authors' knowledge, this is the first clinical report of urethrorectal fistula ligation and transection in a dog with unilateral abdominal cryptorchidism and misdiagnosed anal sac disease. Our findings underscore the importance of a thorough physical examination, history taking, and clinical workup for appropriate diagnosis and treatment of multiple congenital abnormalities.

Ligature et transection de la fistule urétrorectale chez un chien ayant des antécédents de cryptorchidie abdominale unilatérale et de maladie des glandes anales mal diagnostiquée. Un chien Labradoodle mâle unilatéralement cryptorchide âgé de 10 mois a été présenté à un centre de référence en chirurgie spécialisée avec des antécédents signalés de fuite persistante du sac anal qui ne répondait pas à une prise en charge conservatrice. Le chien a subi une castration et une sacculectomie anale gauche, mais a été vu en train d'uriner par l'anus après l'opération. Un urétrogramme de contraste a été réalisé et une fistule urétrorectale située entre la partie distale de l'urètre pelvien et la face caudale du rectum a été diagnostiquée. Une semaine plus tard, le chien a subi une ligature et une section de la fistule. La chirurgie a été un succès et le chien s'est rétabli sans particularité avec une résolution complète des signes cliniques. Un urétrogramme de contraste 1 mois après la chirurgie a confirmé la réussite de la ligature et de la section de la fistule.Message clinique clé :À la connaissance des auteurs, il s'agit du premier rapport clinique de ligature et de transection de fistule urétrorectale chez un chien atteint de cryptorchidie abdominale unilatérale et d'une maladie du sac anal mal diagnostiquée. Nos résultats soulignent l'importance d'un examen physique approfondi, d'une anamnèse et d'un bilan clinique pour un diagnostic et un traitement appropriés des anomalies congénitales multiples.(Traduit par Dr Serge Messier).

Traumatic Rectovesicular Fistula in a Dog.

A 7 mo old intact male Australian cattle dog presented for evaluation of a suspected urethrorectal fistula after being examined by the primary veterinarian for leaking of urine from the rectum at rest and when posturing to urinate. Advanced imaging identified a caudally retroflexed urinary bladder, several healing pelvic fractures, and a rectovesicular fistula. Primary surgical repair of the fistula was performed. The dog recovered well from surgery and was urinating and defecating normally as of 5 mo after the operation. This is the first report of a traumatic rectovesicular fistula in the veterinary literature.

Reconstruction of urethral defects using a fascia lata autograft in a dog.

A castrated male Shih-Tzu dog was presented for evaluation of urine leakage after urethrotomy. A fistula with urine leakage was identified in the perineal region. On retrograde urethrography, the contrast extravasated from the penile urethra into the subcutaneous tissue of the perineum. Urine leakage with urethrocutaneous fistula was diagnosed. During surgery, the disrupted urethra wall and two urethral defects were identified. A fascia lata autograft was used, rather than primary repair of the urethra. Two pieces of fascia lata were harvested and sutured to the urethral defects. The fistula was treated with debridement and drainage. No evidence of urine leakage and dysuria was noted 6 months postoperatively. Thus, this case report describes successful urethral reconstruction using a fascia lata autograft.

IMAGING DIAGNOSIS-URETHROVAGINAL FISTULA CAUSED BY A MIGRATING GRASS AWN IN THE VAGINA.

A young intact female dog was presented with urinary incontinence. Abdominal ultrasound revealed the presence of hyperechoic linear structures within the cranial vagina suggestive of foreign material. A computed tomography (CT) retrograde vaginourethrogram demonstrated the presence of a fistulous tract between the urethra and vagina. A presumptive diagnosis of urethrovaginal fistula due to migration of foreign material was made. The grass awn was removed with vaginoscopic-guided retrieval. Fourteen days later, surgical repair of the fistula and an ovariohysterectomy were done. This case report emphasizes the usefulness of CT for diagnosis and precise anatomical localization of genitourinary tract fistulas.

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.

A urethrorectal fistula due to prostatic abscess associated with urolithiasis in a dog.

An 8-year-old, entire male crossbreed dog had a 2-day history of abdominal pain and straining to urinate and defecate. A diagnosis of urolithiasis with urinary retention, and probable prostatitis was made. The dog was treated with fluids and enrofloxacin. Five days later, ultrasonography of the prostate showed two hypoechoic areas compatible with abscesses. Twelve hours later, the patient started to urinate from the rectum during micturition and urethrorectal fistula was diagnosed. The omentalization of the prostatic abscesses and castration were performed and calculi were removed. The urethrorectal fistula was treated conservatively with an indwelling urinary catheter, a low residue diet and antibiotics. The dog recovered uneventfully without recurrence of the fistula.

Novel perineal approach for repair of a urethrorectal fistula in a bulldog.

A urethrorectal fistula was diagnosed in a 10-week-old, intact male bulldog, presented with a history of urine dribbling from his anus. The fistula was ligated using a novel perineal approach, resulting in resolution of clinical signs. The described procedure is simpler and less invasive than previously described repairs.

Radiographic diagnosis of a rectourethral fistula in a dog.

An English bulldog was referred to the Veterinary Medical Teaching Hospital-University of Wisconsin (VMTH-UW) for re-evaluation of an 8-year history of chronic, recurrent prostatitis and cystitis. The patient was first referred to the VMTH-UW at 11 months of age with a history of antibiotic-responsive hematuria and stranguria. Four urinary tract contrast studies were performed during the 8-year time span; however, a rectourethral fistula was not diagnosed until the fourth study. The article presents a literature review of rectourethral fistula, describes the case management of the dog in this study, and provides an explanation as to the potential reasons the fistula was not diagnosed on the three previous imaging studies.

Urethral duplication and chromosomal translocation in a Swiss braunvieh heifer.

As it was urinating, a six-month-old Swiss braunvieh heifer produced a second stream of urine from a fistula that opened on the ventrolateral margin of the left vulval lip. A catheter was introduced into this opening and passed easily into the bladder. Urethrography showed that the fistula joined the urethra in the mid-pelvic region and that a single canal originated from the bladder. Endoscopy confirmed this finding and also revealed a duplication of the vaginal portion of the cervix, a division of the cranial vagina by a septum and a fibrous band in the region of the hymenal ring. Cytogenetic examination revealed reciprocal translocation between chromosomes 20q23 and 22q23. A diagnosis of urethra duplex, duplication of the vaginal portion of the cervix and reciprocal autosomal translocation between chromosomes 20 and 22 was made on the basis of these findings.

Urethrorectal fistula in a horse.

Anomalies of the urethra are uncommon. Urethrorectal fistula in horses has only been reported in foals and only in conjunction with other congenital anomalies. This report describes the diagnosis, surgical management, and possible etiologies of a unique case of urethrorectal fistula in a mature gelding.

Abnormal micturition and recurrent cystitis associated with multiple congenital anomalies of the urinary tract in a dog.

A 7-year-old castrated male Miniature Poodle had recurrent episodes of cystitis, perineal dermatitis, and urine leaking from the perineum during active micturition. Urethrorectal fistula, urethroperineal fistula, and urethral duplication were diagnosed by positive-contrast fluoroscopic retrograde cystography and voiding cystourethrography. The urethrorectal fistula was resected through an ischial-pubic flap osteotomy, and the urethroperineal fistula was resected by use of a perineal approach. The dog developed urinary incontinence that resolved by 48 hours after surgery. Cystitis and urine scald were not evident 6 months after surgery. Treatment of urethral duplication is not necessary, unless clinical signs of cystitis or urine leakage develop.

Postoperative evaluation of renal function after surgical correction of a ureterovaginal fistula in a cat.

Unilateral hydronephrosis and urinary incontinence, secondary to a ureterovaginal fistula, were corrected in a cat after surgical excision of the fistula and implantation of the affected ureter into the bladder. Salvage of the kidney was attempted because underlying chronic bilateral renal disease was suspected. Renal scintigraphy was used to monitor improvement in the function of the previously obstructed kidney after surgery.

Surgical management of congenital and perinatal abnormalities of the urogenital tract.

Surgical management of various congenital and perinatal abnormalities of the urogenital tract are discussed, including ruptured bladder, ruptured urachus, ureteral defect, patent urachus and umbilical remnant infection, ureteral ectopia, congenital inguinal hernia, and atresia ani and rectourethral or rectovaginal fistula.

[Surgical treatment of a case of chronic endometritis in cattle]. / Operatieve behandeling van een geval van chronische endometritis bij het rund.

An adhesion localised between the uterus and bladder was removed by surgery in a four-year-old cow with chronic endometritis. This adhesion was found to contain a fistula, through which urine could enter the uterus.

Urethral extension for correction of urovagina in cattle. A review of 14 cases.

Urethral extension was performed in 14 cows with clinical urovagina and infertility. Urovagina was corrected in nine cows (64%) and was reduced in the others. Formation of fistulas at the cranial end of the extension site was the most frequent complication (4 cows). In one cow, the urethral extension was not extended far enough caudally. Eleven cows (79%) returned to fertility after surgery. Severity of urine pooling, cranial displacement of the urethral orifice, and severe preoperative vaginitis may explain the failure of the urethral extension in some cows.

Urethrorectal fistulectomy in a dog, using a perineal approach.

Using urethrography, urethrorectal fistula was diagnosed in a 3-year-old male Labrador Retriever with a 2 1/2-year history of recurrent urinary tract infection characterized by intermittent hematuria and pollakiuria. Fistulectomy was performed, and the dog recovered without complication.