Ch 113 Prostate and 114 Kidney Flashcards

1
Q

Culp JAVMA 2021

Procedural description and prospective evaluation of short-term outcome for the use of prostatic artery embolization in dogs with carcinoma of the prostate

A

To describe the procedure of prostatic artery embolization (PAE) in dogs with prostatic carcinoma and to evaluate the short-term outcome for treated dogs.

ANIMALS 20 client-owned dogs with prostatic carcinomas between May 2014 and July 2017.

PROCEDURES In this prospective cohort study, dogs with carcinoma of the prostate underwent PAE with fluoroscopic guidance. Before and after PAE, dogs underwent CT and ultrasonographic examinations of the prostate, and each owner completed a questionnaire about the dog’s clinical signs. Results for before versus after PAE were compared.

RESULTS Prostatic artery embolization was successfully performed in all 20 dogs. Tenesmus, stranguria, and lethargy were significantly less common 30 days after PAE (n = 2, 1, and 0 dogs, respectively), compared with before PAE (9, 10, and 6 dogs, respectively).

Median prostatic volume was significantly less 30 days after PAE (14.8 cm3; range, 0.4 to 48.1 cm3; interquartile [25th to 75th percentile] range, 6.7 to 19.5 cm3), compared with before PAE (21.7 cm3; range, 2.9 to 77.7 cm3; interquartile range, 11.0 to 35.1 cm3).

All dogs had a reduction in prostatic volume after PAE, with a median prostatic volume loss of 39.4% (95% CI, 20.3% to 59.3%).

CONCLUSIONS AND CLINICAL RELEVANCE Prostatic artery embolization was associated with decreased prostate volume and improved clinical signs in this cohort. The short-term response to PAE appears promising, and evaluation of the long-term impact on survival time is needed.

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2
Q

Del Magno Vet Surg 2021

Surgical treatment and outcome of sterile prostatic cysts in dogs

A

Objective: To describe the surgical treatment and outcome of a large cohort of dogs with sterile prostatic cysts (PCs).
Study Design: Retrospective study.
Animals: Forty-four client-owned dogs.

Results: Extra- and intraparenchymal cysts were diagnosed in 29 and 11 dogs, respectively. Four dogs had both types.

Extraparenchymal cysts were treated by partial resection and omentalization (n = 22) and complete resection (n = 7).

Drainage and intracapsular omentalization were performed in all dogs with intraparenchymal cysts. The four dogs with both types of cyst were treated by omentalization.

Resolution was documented in 39/44 dogs (88.6%).

Intraoperative complications occurred in one dog (urethral tear).

Major complications resulting in death occurred in three dogs (oliguric kidney injury, cardiac arrhythmia, and persisting urinary tract obstruction).

Minor complications (n = 10) consisted of temporary urinary incontinence (n = 2), permanent urinary incontinence (n = 5), urinary retention (n = 2), and dysuria (n = 1).

Recurrence occurred in two dogs with extraparenchymal cysts.

Median long-term follow-up was 528 days (range, 250–730 days). Thirty-nine dogs had no signs associated with prostatic disease at long-term follow-up.

Conclusion: Partial or complete resection and/or omentalization of sterile PCs led to resolution of clinical signs in most dogs, although postoperative urinary incontinence was frequent. Impact: This study is the largest case series relative to canine sterile PCs treated surgically and provides evidence on the prognosis and rate of complications.

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3
Q

Bennett Vet Surg 2018

Total prostatectomy as a treatment for prostatic carcinoma in 25 dogs

A

Objective: To describe the complications and outcome after total prostatectomy in dogs with histologically confirmed prostatic carcinoma. Study Design: Multi-institutional retrospective case series.

Animals: 25 client-owned dogs. Methods: Medical records of dogs undergoing total prostatectomy were reviewed from 2004 to 2016. Data retrieved included signalment, presenting signs, preoperative clinical findings, laboratory data, diagnostic imaging, surgical technique, histologic diagnosis, postoperative complications, occurrence of postoperative metastasis, and survival.

Results: Twenty-five dogs underwent total prostatectomy for prostatic carcinoma. Urinary anastomotic techniques included urethrourethral anastomosis in 14 dogs, cystourethral anastomosis in 9 dogs, ureterocolonic anastomosis in 1 dog, and anastomosis between the bladder neck and penile urethra in 1 dog. All dogs survived to discharge. Fifteen dogs were diagnosed with transitional cell carcinoma, 8 dogs with prostatic adenocarcinoma, 1 with prostatic cystadenocarcinoma, and 1 with an undifferentiated carcinoma. Permanent postoperative urinary incontinence was present in 8 of 23 dogs. The median survival time was shorter in dogs with extracapsular tumor extension compared with those with intracapsular tumors. The overall median survival time was 231 days (range, 24-1255), with 1- and 2-year survival rates equal to 32% and 12%, respectively.

Conclusion and Clinical Significance: Total prostatectomy, combined with adjunct therapies, prolongs survival and lowers complication rates compared to previous reports of dogs with prostatic carcinoma. It should be noted, however, that case selection likely played a significant role in postoperative outcome.

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4
Q

Skorupski JSAP 2022

Prospective comparison of prostatic aspirate culture and cystocentesis urine culture for detection of bacterial infection in dogs with prostatic neoplasia

A

Objective: The purpose of this study was to determine whether prostatic aspirate culture is a superior method to detect infection compared to culture of urine collected by cystocentesis in dogs with prostatic neoplasia.

Materials and Methods: A prospective study was conducted and dogs with suspected or confirmed prostatic neoplasia were enrolled. Urinalysis was done and culture and antimicrobial susceptibility testing was performed on paired urine and prostatic aspirate samples collected at a single timepoint.

Results: Ten dogs with prostatic neoplasia were enrolled. All dogs had one or more clinical sign consistent with lower urinary tract disease. One dog (10%) had a positive urine culture, but negative prostatic aspirate culture, one dog (10%) had a positive prostatic aspirate culture, but negative urine culture, and one dog (10%) had both positive urine and prostatic aspirate cultures. Using prostatic aspirate culture as the reference standard, urine culture had a sensitivity for detecting infection of 87.5% (95% confidence interval 52.9 to 99.4) and specificity of 50% (92.6 to 97.4) in this population of dogs.

Clinical Significance: Positive cultures were uncommon with both culture collection methods. Study results did not identify prostatic aspirate culture to be a more sensitive method of detecting prostatic infection than urine culture collected by cystocentesis in these dogs with prostatic neoplasia.

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5
Q

Petrovsky JAVMA 2019

Endoscopic nephrolithotomy for the removal
of complicated nephroliths in dogs and cats:
16 kidneys in 12 patients (2005–2017)

A

To describe techniques and outcomes for dogs and cats undergoing endoscopic nephrolithotomy (ENL) for the removal of complicated nephroliths.

ANIMALS 11 dogs and 1 cat (n = 16 renal units) with complicated nephroliths that underwent ENL via a surgically assisted ENL approach (12 renal units) or a percutaneous nephrolithotomy approach (4 renal units) between December 2005 and June 2017.

RESULTS Indications for nephrolith removal included massive calculi displacing parenchyma (n = 7), recurrent urinary tract infections (5), and ureteral outflow obstruction (4).

Median nephrolith diameter was 2.5 cm (range, 0.5 to 5.7 cm). Nephrolith composition differed among patients; calcium oxalate was the most common type (n = 7 [including 2 mixed nephroliths containing ≥ 60% calcium oxalate]).

Following ENL (median duration, 180 minutes), 15 of 16 renal units were completely nephrolith free.

Procedure-related complications included renal puncture–associated hemorrhage requiring a blood transfusion (n = 1), renal capsule tear (1), and ureteral puncture (1); all were managed without adverse consequence. Five of 12 patients remained alive at the final follow-up (median, 557 days after ENL), and none died from the procedure.

CONCLUSIONS AND CLINICAL RELEVANCE
ENL as performed was safe and effective in removing complicated nephroliths in a renal-sparing manner for the patients in this study. This procedure requires technical training and could be considered for the treatment of complicated nephrolithiasis in dogs and possibly cats.

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6
Q

Johnson JAVMA 2024

Unilateral nephrectomy in dogs is associated with a high rate of intraoperative and postoperative complications

A

OBJECTIVE To determine the incidence of complications in the intraoperative and postoperative period for dogs undergoing nephrectomy for renal disease.

ANIMALS 69 dogs.

RESULTS Complications occurred in 44.9% and 42.6% of dogs in the intraoperative and postoperative periods, respectively. Most of these were lower-grade complications, though a total of 7 dogs died during the postoperative period.

An acute kidney injury was diagnosed in 12 dogs postoperatively, with 2 dogs euthanized due to the severity of the injury.

Long-term follow-up was available for 53 dogs, with 24 (45.3%) dogs developing chronic kidney disease. Postoperative acute kidney injury (P = .385) and NSAID administration (P = .519) were not statistically associated with the development of chronic kidney disease in this population.

CLINICAL RELEVANCE Unilateral nephrectomy is associated with high intraoperative and postoperative complication rates in dogs. Chronic kidney disease was diagnosed in almost 50% of the population with available long-term follow-up

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7
Q

Hsu JFMS 2022

Upper urolithiasis in cats with chronic kidney disease: prevalence and investigation of serum and urinary calcium concentrations

A

Objectives This study aimed to define the prevalence of upper urolithiasis in cats with chronic kidney disease (CKD) in a referral population, and to compare urinary calcium:creatinine ratio (UCa:Cr), and total and ionised calcium between cats with CKD with and without upper urolithiasis.

Methods The medical records of cats diagnosed with CKD were reviewed for signalment, body weight, diet and prevalence of upper urolithiasis. Cats with preserved urine samples were further classified into two groups: urolithiasis group (upper urolithiasis identified by abdominal ultrasonography) and control group (CKD of unknown origin). Serum biochemical analysis, CKD stage, blood gas analysis, urine specific gravity and UCa:Cr were compared between groups using a two-sample t-test or Mann–Whitney U-test for continuous variable and a χ2 test or Fisher’s exact test for categorical variables. Multivariable binary logistic regression analysis was used to identify risk factors.

Results Among the 140 cats with CKD, the prevalence of upper urolithiasis was 73%.

Fifty cats (5, 29 and 16 cats with CKD stages 1, 2 and 3, respectively) with urine samples met the inclusion criteria and were included in the analysis.

Among cats with CKD, being purebred (odds ratio [OR] = 81.56; P = 0.03)
and being fed dry food only (OR = 25.06; P = 0.001) were identified as independent upper urolithiasis risk factors;

those with upper urolithiasis were more likely to be exclusively fed with urine-acidifying food (P <0.001) and
have increased serum ionised calcium (iCa) (P = 0.044), fractional excretion of calcium (P = 0.45) and UCa:Cr (P = 0.005) than cats with CKD without upper urolithiasis.

Conclusions and relevance Cats with CKD that were purebred, fed dry food and fed urine-acidifying food only often had upper urolithiasis. A higher UCa:Cr may be a result of increased serum iCa and may cause upper urolithiasis.

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8
Q

Lemieux JFMS 2021

Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012–2018)

A

Objectives The aim of the study was to describe renal pelvis (RP) and ureteral ultrasonographic measurements in a population of cats with confirmed benign ureteral obstruction (UO) by antegrade pyelography. The secondary objective was to further describe clinical findings associated with minimally dilated obstructed kidneys in an attempt to better understand its occurrence.

Methods Retrospective case series of cats diagnosed with benign UO were confirmed by antegrade pyelography. Medical records were reviewed and signalment, diagnostic imaging results, serum creatinine (SCr) concentration and urine culture results were recorded. Each obstructed kidney was categorized into two groups: group 1 included all RP measurements ⩽4 mm and group 2 included all RP measurements >4 mm.

Results A total of 82 cats with 114 obstructed ureters met the inclusion criteria.
Fifty (61%) cats had a unilateral UO and 32 (39%) had a bilateral UO.

Thirty (26%) kidneys were included in group 1 while 84 (74%) were included in group 2.

Nine (8%) kidneys had an RP dilation ⩽2 mm. Median RP and ureteral diameters were 6.6 mm (range 1.1– 37.0 mm) and 3.2 mm (range 0.0–11.0 mm), respectively.

RP size correlated positively with ureteral diameter in the study population (P <0.0001), but not in group 1 when analyzed separately (P = 0.47).

UO was secondary to stones in 80 (70%) ureters.
Seventeen (21%) cats had a positive urine culture.

At admission, 79 (96%) cats were azotemic with a median preoperative SCr concentration of 444 μmol/l (range 108–1326 μmol/l).

The mean (95% confidence interval [CI]) preoperative SCr concentration was significantly higher in group 1 (762 μmol/l [498–1165 μmol/l]) than in group 2 (409 μmol/l [333–502 μmol/l]).

RP size in the two groups correlated negatively with preoperative SCr concentration (P = 0.0002).

Conclusions and relevance Feline UO may be associated with minimal RP dilation and the severity of RP and ureteral dilation can be highly variable. Absence of significant RP dilation does not rule out UO in cats.

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9
Q

McEntee JFMS 2022

Evaluation of preoperative ultrasonographic parameters to predict renal recovery in long-term survivors after treatment of feline ureteral obstructions: 2012–2019

A

Results No preoperative imaging characteristics or biochemical findings were found to be significantly associated
with long-term serum creatinine concentrations. The length of the kidney was found to be associated with change
in blood urea nitrogen and creatinine with decompression but not with long-term renal values.
Conclusions and relevance In this study, long-term renal function based on preoperative ultrasound imaging
findings could not be predicted in cats with unilateral ureteral obstruction, regardless of the severity of the
biochemical parameters, renal pelvic dilation (large or small pelvis), kidney size or thickness of renal parenchyma
assessed.

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10
Q

Prullage JFMS 2022

Does intravenous contrast medium administration result in altered renal biomarkers? A study in clinically stable cats with and without azotemia

A

Objectives The aim of this study was to determine the prevalence of post-contrast acute kidney injury or comparable side effects on kidney function in cats receiving the non-ionic, iodinated agent ioversol and/or paramagnetic agent gadoteric acid.

Results No significant short-term effects on mean creatinine, SDMA and UPC measurements were seen. Borderline proteinuria (UPC, 0.2–0.4) was detected in 11.4% of cases after contrast media administration. A UPC of more than 0.2 in five cases indicated that contrast media may affect kidney function, leading to (transient) proteinuria.

Conclusions and relevance This study found no side effect on renal function following the administration of ioversol or gadoteric acid, provided patients were adequately hydrated. However, the clinical relevance of proteinuria in some cats needs to be evaluated in future studies.

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11
Q

Tanvetthayanont JFMS 2020

Impact of gonadal status on ultrasonographic renal parenchymal dimensions in healthy cats

A

Objectives The aim of this study was to evaluate the effect of gonadal status on ultrasonographic renal parenchymal dimensions in healthy cats

**Reduction of renal cortex thickness in humans can be an early indicator of CKD. **

Methods Forty healthy cats (10 intact males, 10 intact females, 10 castrated males and 10 spayed females) presented to the Division of Obstetrics, Gynecology and Reproduction, and the Diagnostic Imaging Unit at The Small Animal Teaching Hospital, Faculty of Veterinary Science, Chulalongkorn University. They were ultrasonographically examined to assess renal length, aortic luminal diameter, cortical thickness and medullary thickness.

Results Regardless of gonadal status, the renal length, aortic luminal diameter, cortical thickness and medulla thickness of males were greater than those of females (P <0.05). In general, neutered cats had thicker medullae (0.36 ± 0.08 cm) and higher mean renal length:aortic luminal diameter ratio (12.15 ± 1.48) than intact cats (0.32 ± 0.08 cm and 11.22 ± 1.37 cm, respectively) (P <0.05), but no differences were observed in renal length, cortical thickness or aortic luminal diameter. Interestingly, when comparing between sexes with relatively equal body weight, only sex had an impact on renal length.

Conclusions and relevance Gonadal status has an effect on medullary thickness and mean renal length:aortic luminal diameter ratio.

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