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1.
OBJECTIVE: To evaluate use of balloon-expandable and self-expanding metallic stents in management of malignant urethral obstructions in dogs. DESIGN: Original study. ANIMALS: 12 dogs with malignant urethral obstructions. PROCEDURES: The extent and location of urethral obstructions and the diameter of adjacent unaffected luminal segments were determined by use of fluoroscopically guided wires and measuring catheters. Stents were chosen to extend approximately 1 cm proximal and distal to the obstruction. Stent diameters were chosen to be approximately 10% greater than the diameter of healthy portions of the urethra to prevent displacement. Stents were placed in the urethra under fluoroscopic guidance to restore luminal patency. RESULTS: 3 dogs received balloon-expandable metallic stents, and 9 dogs received self-expanding metallic stents. The placement procedures were rapid, safe, and effective at restoring luminal patency and were not associated with major complications. Complications included recurrent urethral obstruction secondary to blood clot formation and urethral edema in 1 dog and stent dislodgement into the urinary bladder in 1 dog. All dogs were able to urinate immediately after the procedure. Nine dogs (3/4 females and 6/8 males) were continent or mildly incontinent after stent placement. Of the remaining 3 dogs, 2 developed severe incontinence and 1 had an atonic bladder. Seven dogs were considered to have good to excellent outcome, 3 had fair outcome, and 2 had poor outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Transurethral placement of metallic stents was a safe and effective palliative treatment option for dogs with malignant urethral obstructions.  相似文献   

2.
Objective— To describe a surgical technique for resection of the entire bladder neck, including the trigone and proximal urethra in dogs with invasive tumors causing life-threatening urinary tract obstruction.
Study Design— Clinical case reports.
Animals— Dogs (n=2) with bladder tumors.
Methods— Circumferential excision of the bladder neck and proximal urethra with preservation of the neurovascular pedicles was performed to remove a rhabdomyosarcoma (dog 1) and a transitional cell carcinoma (dog 2) involving the trigone and bladder neck that were causing urinary tract obstruction. Reconstruction of the bladder and proximal urethra included bilateral ureteroneocystostomy. Adjuvant chemotherapy was administered postoperatively to both dogs.
Results— Postoperatively, dogs 1 and 2 were continent after 7 and 17 days, respectively, and regained normal urinary function after resolution of a transient pollakiuria. Dog 1 had no evidence of local or regional recurrence; however, a large solitary pulmonary metastatic lesion was diagnosed 8 months later. The dog was euthanatized despite a lack of clinical signs. Dog 2 had at least 1 metastatic lesion in the abdominal wall 6 months later and was euthanatized at 580 days because of renal failure.
Conclusion— En-bloc removal of the bladder neck and proximal urethra with preservation of the dorsal vascular and nervous pedicles, although a technically challenging procedure, can be performed without associated urinary incontinence or bladder wall necrosis.
Clinical Relevance— In dogs with invasive bladder tumors causing life-threatening urinary tract obstruction, resection of the bladder neck and proximal urethra should be considered as a promising surgical alternative to urinary diversion.  相似文献   

3.
Proximal urethral obstruction was diagnosed 2 days after bilateral perineal herniorrhaphy in a 12-year-old male Pomeranian-cross dog. The obstruction was caused by ligation of the proximal urethra during resection of a presumed paraprostatic cyst. Surgical repair involved reconstruction of the urethra and bladder wall, but urinary incontinence persisted.  相似文献   

4.
Congenital urethral sphincter mechanism incompetence is a cause of urinary incontinence in female dogs and cats. In some of these animals, urethra hypoplasia is the primary diagnosis, with the urethra being almost absent in some patients. Treatment of this problem can be difficult. This paper describes two techniques for the surgical treatment of eight cats and one dog with severe urethral hypoplasia. In five animals, partial excision of the bladder neck was performed to create a longer "urethra." In the other four, an attempt was made to conserve bladder volume while simultaneously creating a urethra with a bladder neck flap reconstruction technique. One cat was lost to follow-up, but the clinical signs resolved in three cats and the remaining animals improved. Two cats had recurring cystitis, possibly associated with bladder neck diverticula because of uterine horn remnants terminating abnormally in the bladder. The results in this limited series suggest that reconstructive surgery in cases of severe urethral hypoplasia improves continence control.  相似文献   

5.
The mucosal margin of the urethra is best assessed by positive contrast urethrography, but ultrasonography offers complementary information such as urethral wall thickness and size of medial iliac lymph nodes. Ultrasonography of the urethra is quick, noninvasive and does not require sedation or general anesthesia. In patients with complete urethral obstruction, ultrasonography may be the only way to image the urethra. Twelve dogs which were presented to Tufts University School of Veterinary Medicine with clinical signs referable to the urinary bladder, urethra or vagina were examined ultrasonographically. Seven were neutered females and five were neutered males. Each dog had a hyperechoic, nonshadowing line at the epithelial surface of the proximal urethra. In the seven female patients and one of the males, the urethral wall was also thick and hypoechoic to surrounding tissue. In the other males, the urethral epithelial changes were at the level of the prostate, and the limits of the urethra were not visible. In six dogs, the urethral change was the only abnormality seen, while in six, bladder wall, bladder luminal and/or prostatic parenchymal changes were also detected. Three patients had hydronephrosis, and one had enlarged medial iliac lyumph nodes. Biopsies were obtained via suction with urinary catheterization (n = 6), exploratory celiotomy (n = 3), urethroscopy (n = 2), or at post-mortem (n = 1). A histopathologic diagnosis of urethral transitional cell carcinoma was obtained in ten dogs. The ultrasonographic appearance was not pathognomonic for transitional cell carcinoma, as one dog with transitional cell dysplasia and one dog with severe ulcerative and necrosupperative cystitis and urethral stricture had similar findings.  相似文献   

6.
Objectives : To describe a minimally invasive technique for treating urethral obstructions in male dogs and to review the postoperative results. Methods : All dogs (n=9) had urethral obstruction due to calculi. Obstructions were verified by radiographic and ultrasonographic examinations. Dogs with impaired kidney function were not included in the study. A 5‐mm diameter trocar and cannula were placed in the ventral midline, 2 cm cranial to the umbilicus, allowing placement of a 10‐mm diameter cannula under visual guidance, adjacent to the apex of the bladder. The bladder was then partially exteriorised and sutured to the skin. A 5‐mm diameter cystoscopy sheath was introduced into the bladder lumen and advanced into the urethra. Continuous retrograde flushing was used to dislodge the calculi from the site of obstruction and collect them upstream. Results : The nine dogs were followed up for a minimum of 6 months. No major postoperative complications were identified. One dog exhibited transient macroscopic haematuria (for 3 weeks postoperatively). All urethral calculi were removed in the nine dogs. No recurrence was found during the follow‐up period. Clinical Significance : A minimally invasive approach is used to treat urethral obstructions resulting from calculi in the male dogs.  相似文献   

7.
Prostatic and membranous urethral diameter was measured in 24 normal mature male Beagle dogs during maximum distension retrograde urethrocystography. This technique involved retrograde urethral distension by infusion with contrast medium until the urinary bladder was distended and the vesicourethral junction remained opened as observed by fluoroscopy. Lateral and ventro-dorsal radiographs were made during subsequent injections of 5–10 ml of contrast medium. The prostatic urethra was consistently greater in diameter than the membranous urethra. However, the numerical ratio between the prostatic urethral diameter and the membranous urethral diameter varied among these dogs by a factor of 2 at the numerical extremes.  相似文献   

8.
Retrograde urethrography with viscous contrast medium was performed in male and female dogs and cats before and after bladder distention. The viscosity of commercially prepared contrast medium was increased by addition of an aqueous lubricant. The diameter of the proximal urethra of female dogs (regions 1 and 2) was larger during urethrography (p<0.05) following bladder distention. The diameter of regions 1 and 2 of the proximal uretha of female cats in lateral recumbency was larger during urethrography (p<0.05) following bladder distention. The diameter of the distal urethra of female dogs and cats was not significantly different before or after bladder distention. The diameter of the prostatic urethra of male dogs was larger (p<0.003) following bladder distention. The diameter of the membranous and penile urethra of male dogs was not significantly different before or after urinary bladder distention. Similarly, the diameter of the urethral lumen in male cats was not significantly different before or after bladder distention. The increased viscosity of the contrast medium due to the aqueous lubricant failed to distend all areas of the male and female canine and feline urethra maximally during urethrography when the bladder was not distended. On the basis of the results of this study, the authors recommend urinary bladder distention with a lubricant-free positive contrast medium to generate intravesical hydrostatic pressure sufficient to induce urethral distention. The degree of bladder distention should be determined by digital palpation.  相似文献   

9.
Objective— To evaluate the efficacy of a surgically placed, static hydraulic urethral sphincter (SHUS) for treatment of urethral sphincter mechanism incompetency (USMI).
Study Design— Prospective study.
Animals— Spayed female dogs (n=4) with acquired USMI.
Methods— Urinary incontinence was assessed using a subjective continence score before and after implantation of an SHUS on the proximal urethra via ventral median celiotomy. Dogs were assessed for urinary continence, urinary tract infections, and implant-associated complications for 30 months. Residual incontinence was treated with percutaneous inflation of the SHUS with sterile saline solution through a biocompatible subcutaneous administration port.
Results— At last follow-up (26–30 months after surgery), continence scores improved from a median preoperative score of 3/10 to a median postoperative score of 10. One dog developed wound drainage over the subcutaneously placed administration port but remained continent after port removal. Three occluders were percutaneously filled with additional saline (median, 0.18 mL; mean, 0.16 mL) to improve continence after surgery.
Conclusions— Application and adjustment of an SHUS provided sustained improvements in continence score in all dogs.
Clinical Relevance— In this pilot study, 3 of 4 dogs with hydraulic urethral sphincter implantation had successful percutaneous adjustment and maintained improved continence scores for 2 years after surgery. Continence was maintained in the 4th dog even after administration port removal. Based on this pilot study, the SHUS warrants further clinical evaluation for treatment of dogs with USMI unresponsive to medical management.  相似文献   

10.
Vaginourethroplasty for Treatment of Urethral Obstruction in the Bitch   总被引：1，自引：0，他引：1  
Vaginourethroplasty was performed in six bitches with infiltrative, obstructive urethral disease. The initial clinical signs included dysuria, hematuria, pollakiuria, and stranguria. Diagnosis was based on the clinical signs, plain radiography and contrast vagino-urethrogram examination, and urethral biopsy. Five dogs were diagnosed as having urethral neoplasia; the sixth dog had granulomatous urethritis. In all six dogs, up to 50% of the urethra and the urethral tubercle were resected to ensure adequate surgical margins. One dog was euthanatized 4 months after surgery for recurrence of a transitional cell carcinoma at the surgical site. Long-term resolution of the problem (minimum of 12 months) was achieved in the other five dogs. The frequency of serious complications, including urinary incontinence and ascending lower urinary tract infections, was low.  相似文献   

11.
Twenty dogs with abscessation of the prostate gland were treated by celiotomy, drainage, and digital exploration of the gland through bilateral capsulectomy wounds. Omentum was introduced through the capsulectomy wounds and packed into the abscess cavities around the prostatic urethra. Most dogs were discharged from the hospital within 48 hours of the surgery. Long-term resolution of the problem (no recurrence within 12 months) was achieved in 19 dogs. One dog had recurrent abscessation that was managed by the placement of dependant Penrose drains. Temporary tube cystostomy was performed postoperatively in one dog for the management of transient dysuria. One dog with septic peritonitis resulting from preoperative abscess rupture was managed by concurrent open peritoneal drainage. Intracapsular prostatic omentalization was a simple and effective means of managing prostatic abscessation with minimal requirement for postoperative hospitalization of the patient. The frequency of serious complications, including postoperative urinary incontinence, was low.  相似文献   

12.
Treatment of urinary incontinence in dogs by endoscopic injection of Teflon   总被引：1，自引：0，他引：1  
Twenty-two dogs with urethral sphincter incompetence, nonresponsive to phenylpropanolamine administration, were treated by urethral submucosal injection of Teflon. Urinary continence was achieved in all dogs for at least 2 months. Urinary incontinence recurred in 14 dogs (64%) and was controlled by a second Teflon injection in 11 of 12 dogs (92%). Minor complications included transient stranguria, with or without hematuria, after 4 of 35 injection procedures. One dog had temporary partial urethral obstruction after treatment.  相似文献   

13.
Repair of urethral defects using fascia lata autografts in dogs   总被引：10，自引：0，他引：10  
OBJECTIVE: To evaluate the feasibility of urethroplasty using a free fascia lata (FL) graft in the dog. STUDY DESIGN: In vivo experimental study. ANIMALS: Mixed-breed dogs (n=14). METHODS: Half of the circumference of the urethra, approximately 1.5 cm long, was excised in 14 male dogs to induce a urethral defect. FL (approximately 2 cm x 2 cm) harvested from the lateral thigh was sutured to the urethra using a 3-0 polyglactin 910 continuous pattern. Dogs were monitored daily for bladder distention and had urethral catheters until normal voiding was observed. On day 60, each dog had a positive contrast urethrogram, and then 8 dogs were euthanatized for gross and histologic examination. Six dogs were monitored for urologic problems for 6 months, and a positive contrast urethrogram was repeated. RESULTS: All dogs recovered successfully; 4 dogs had difficulty voiding for 2-3 days and urine was aspirated from these dogs every 3 hours until signs of painful urination disappeared. On positive contrast urethrograms, urethral anatomy was considered normal except in 4 dogs that had an irregular contour. Gross urethral examination confirmed an absence of ulceration, stricture, diverticula, or fistula formation, and the FL-lined graft survived in all dogs. No degenerative and reparative responses were observed. On histologic examination of the penile urethra, the lumen was intact, covered with transitional epithelium, and surrounded by corpus spongiosum with cavernous spaces and blood-filled vessels. CONCLUSIONS: Free FL grafts are incorporated satisfactorily and would appear to be useful for repairing urethral defects. CLINICAL RELEVANCE: FL grafts should be considered for repair of urethral defects in dogs.  相似文献   

14.
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.  相似文献   

15.
An ectopic ureter extending to the urinary bladder and to the proximal portion of the urethra was diagnosed in a 6-month-old dog with urinary incontinence. The diagnosis was made by use of excretory urography. The kidney and ureter were removed. When urinary incontinence continued, positive-contrast cystography was performed. The ectopic ureter was found to bypass the bladder via a submucosal extension that emptied into the urethra.  相似文献   

16.
A modified technique for fixation of the deferent ducts to the abdominal wall as a therapy for urinary incontinence caused by urethral sphincter mechanism incompetence (USMI) in male dogs is described, and the results in seven dogs are reported. The goal of this treatment was to achieve an effect similar to colposuspension in female dogs with USMI. An increase in urethral length of an average of 28 mm was obtained (range, 5 to 50 mm, measured radiographically). Preoperatively, the neck of the bladder was located intrapelvically in five of seven dogs. Postoperatively, the neck of the bladder was located intra-abdominally, near the caudo-ventral abdominal wall, in all dogs. After a follow-up period of 12 to 49 months, the response to surgery, based on lack of or decrease of incontinence, was excellent in three dogs, good in another three, and poor in one dog.  相似文献   

17.
A recently developed urodynamic testing procedure was used to evaluate disorders of micturition in 2 dogs. The procedure simultaneously recorded intravesical pressure and urine flow during micturition. In an 11-year-old spayed female Sheltie that could not urinate normally, a micturition study demonstrated functional outflow obstruction of the urinary bladder. Although the urethra was patent, the urethral resistance factor, as calculated from pressure and flow data, was extremely high during voiding efforts. A urethral transitional cell carcinoma along with secondary infection, inflammation, and fibrosis were found to be responsible for the dog's problem. Ability to urinate was restored following removal of the affected portion of the urethra. In a 6-year-old spayed female Doberman Pinscher with urinary incontinence during sleep, a micturition study demonstrated urethral incompetence. During infusion of 0.9% NaCl solution into the bladder, the fluid flowed through the urethra before the detrusor muscle contracted, and urethral resistance during voiding was low. The dog's incontinence was responsive to estrogen administration.  相似文献   

18.
Because of their superficial anatomical resemblance, the male dog seems to be suitable for studying the physiologic and pathological alterations of the bladder neck of human males. The present study was carried out to compare and contrast the muscular anatomy of the male dog lower urinary tract with that of humans. The complete lower urinary tract, including the surrounding organs (bulb of penis, prostate, rectum and musculature of the pelvic floor) were removed from adult and newborn male dogs and histologically processed using serial section technique. Based on our own histological investigations, three-dimensional (3D)-models of the anatomy of the lower urinary tract were constructed to depict the corresponding structures and the differences between the species. The results of this study confirm that the lower urinary tract of the male dog bears some anatomical resemblance (musculus detrusor vesicae, prostate, prostatic and membranous urethra) to man. As with human males, the two parts of the musculus sphincter urethrae (glaber and transversostriatus) are evident in the canine bladder neck. Nevertheless, considerable differences in formation of individual muscles should be noted. In male dogs, no separate anatomic entity can be identified as vesical or internal sphincter. The individual course of the ventral and lateral longitudinal musculature and of the circularly arranged smooth musculature of the urethra is different to that of humans. Differences in the anatomy of individual muscles of the bladder neck in the male dog and man suggest that physiological interpretations of urethral functions obtained in one species cannot be attributed without qualification to the other.  相似文献   

19.
Objective —To evaluate a sling procedure using a polyester ribbon passed through the obturator foramen, around the urethra, and fixed outside the pelvis for the treatment of female dogs with refractory urethral sphincter mechanism incompetence (USMI). Animals —26 female dogs with USMI that had not improved with medical management. Methods—All dogs underwent a transpelvic sling procedure, and in 13, with a radiographic diagnosis of a pelvic bladder, additional colposuspension was performed. Multichannel urethral pressure profilometry (UPP) and diuresis cystourethrometry (UCM) were performed in all dogs before and in seven dogs 2 to 14 months after surgery. Long-term results of surgery and medical therapy were determined. Results — 13 dogs (50%), 6 of these without additional colposuspension, were continent after surgery and remained continent during a follow-up period of 12 to 36 months (mean, 19 months). Seven, three of which had colposuspension, had improved markedly. Four of these dogs became continent with additional medical therapy. Five dogs did not improve, and three of these were eventually euthanatized. In one dog, the sling was removed after 5 days because of persistent stranguria. Surgery and medical therapy together resulted in continence in 17 dogs (65%) during a follow-up period of 6 to 36 months (mean, 22 months). Postoperative dysuria or stranguria occurred in six dogs, and four of these underwent a colposuspension procedure. Two dogs developed a fistula, 2 and 3 years after surgery. Preoperatively, decreased urethral resistance was suggested by the findings of UPP and UCM in 25 dogs, and an abnormally high compliance was found in 3, detrusor instability in 2, and a low threshold pressure in 1 dog. There was no apparent correlation between these findings and the outcome of surgery. Urethral closure pressures measured after surgery were significantly increased but were still lower than the normal range in all dogs with persistent or recurrent incontinence. Conclusions —A transpelvic sling procedure, with or without additional colposuspension, can be useful in the management of dogs with refractory urinary incontinence. The procedure is not beneficial if it does not increase urethral pressure close to, or within, the normal range.  相似文献   

20.
OBJECTIVE: To assess cystoscopic transurethral resection (TUR) for the palliative management of dogs with neoplastic infiltration of the urethra. STUDY DESIGN: Prospective clinical trial. ANIMALS: Six client-owned dogs. METHODS: Cystoscopic examination and electrosurgical TUR were performed in dogs with urination difficulties caused by prostatic or urethral neoplasia. TUR was performed in a retrograde manner in female dogs and antegrade in male dogs via exploratory celiotomy and ventral cystotomy. Cystoscopic examination was used to determine the extent of neoplastic involvement of the urethra. TUR involved piecemeal removal of neoplastic tissue from the urethral lumen using an electrocautery cutting loop. Hemorrhage was controlled with a cystoscopic cauterized roller-ball. In 2 male dogs, intraoperative radiation therapy (IORT) was used to treat both prostatic neoplasia and the sublumbar lymph node bed. Surgical technique, complications, adjuvant treatment, and outcome were recorded. RESULTS: TUR was performed in 3 male dogs with prostatic carcinoma and 2 female dogs with urethral transitional cell carcinoma (TCC). In 1 female dog, TUR was attempted but not successful because of cystoscope diameter. Iatrogenic urethral perforation occurred during TUR in 3 dogs. In 2 dogs, prolonged exposure to lavage fluid resulted in clinical and biochemical abnormalities consistent with TUR syndrome. Dysuria resolved in 5 dogs within 10 days of TUR. Treatment-related complications included urinary tract infection and tumor seeding. Local tumor progression and metastasis occurred in all dogs. CONCLUSIONS: TUR (in combination with chemotherapy+/-IORT) resulted in rapid palliation of urination difficulties in male dogs with prostatic carcinoma. In female dogs with urethral TCC, however, electrosurgical TUR cannot be recommended because of a high intra- and postoperative complication rate with no improvement in postoperative management compared with historical reports of tube cystostomy. CLINICAL RELEVANCE: TUR is a novel alternative for the palliation of male dogs with prostatic carcinoma. In female dogs with urethral TCC, electrosurgical TUR does not provide any advantages compared with tube cystostomy.  相似文献   

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