Ch 116 Bladder Flashcards
anatomy
- ventral median ligament (contained the urachus in foetus)
- lateral ligaments: distal portion of the ureter and umbilical artery on each side
- Each ureter tunnels obliquely through the dorsolateral bladder wall before opening into the bladder
- urothelium of the bladder consists of mucosa composed of transitional epithelial cells, and submucosa, which contains connective tissue
- The urothelium is covered by a layer of smooth muscle (detrusor muscle)
- there is no anatomically distinct internal sphincter at the vesicourethral junction
- The serosa is the outermost layer of the bladder
Where is the trigone?
Internal region of the bladder between the ureteral opening and the urethral opening at the bladder neck
micturition
Urinary control is regulated by sympathetic, parasympathetic, and somatic innervation.
- The internal urethral sphincter remains contracted via sympathetic α-adrenergic stimulation from the hypogastric nerves (L1-L4), while β-adrenergic stimulation relaxes the detrusor muscle, allowing urine storage.
- Bladder distention activates stretch receptors, triggering parasympathetic pelvic nerve stimulation (S1-S3), leading to detrusor contraction and urination.
- This activation also inhibits sympathetic control and signals the brainstem to relax urethral musculature.
- The pudendal nerve (S1-S3) provides somatic control over the external urethral sphincter, which maintains urethral resistance during storage and relaxes during reflex urination.
- Voluntary control occurs via pudendal nerve innervation and direct cortical influence on the pontine micturition center.
Not all detrusor muscle cells have direct innervation: transmission of neuromuscular impulses also occurs between one innervated detrusor muscle cell and many adjacent muscle cells. Prolonged bladder distention or bladder fibrosis results in loss of this excitation-contraction coupling; subsequent atony of the detrusor muscle results in urine retention and overflow
Blood Supply and Lymphatic Drainage
- the vascular supply also enters the bladder dorsally.
- The caudal vesical artery is the major arterial supply to the bladder. It arises from the vaginal (females) or prostatic (males) branch of the internal pudendal artery.
- Bladder venous drainage is into the internal pudendal veins, and lymphatic drainage is via the hypogastric and sublumbar lymph nodes.
How long does it take for bladder mucosa to heal?
How long for full-thickness defects to reach full strength?
Mucosa fully heads in 5 days
Full thickness strength in 14-21 days
Suture Material, and Suture Patterns
- absorbable, synthetic suture suitable choices for closure.
- Monofilament suture recommended > less tissue drag than multifilament and fewer bacteria adhere
- Nonabsorbable sutures or staples are not required and could predispose to cystic calculi formation.
- Hickey 2020 found calculi associated with PDS/maxon
- polydioxanone and polyglyconate are acceptable in sterile and E.coli–contaminated urine but that poliglecaprone 25 may not have sufficient tensile strength during the critical phase of bladder healing
- suture size ranges from (3-0 to 5-0)
closure pattern
- there is no consistent evidence as to which performs best overall
- - accurate needle placement through the strength-holding submucosal layer
- A single-layer, full-thickness, simple, continuous, or interrupted appositional closure is quick, provides accurate apposition of the strength-holding submucosal layer, and has not been shown to be inferior to a two-layer, inverting, continuous suture pattern
- compromised bladder > omentalise, serosal patch
barbed suture may be appropriate for cystotomy closure but in vivo studies are needed to support this finding (used in laparoscopy, no knot required)
What suture materials are most appropriate for use in the bladder?
What organism disintegrated all tested sutures by day 7?
Polydioxanone and polyglyconate
Proteus mirabilis
What ABx are a reasonable choice for periop antibiosis in the face of a UTI?
Amoxiclav
3rd gen cephalosporin
Enrofloxacin
antibiosis
- absence of infected urine is classified as clean contaminated.
- The infection rate for this class is approximately 5%
- E.coli, Proteus, Staph
- there does not appear to be a significant risk for affecting an intraoperative positive urine culture result by administering prophylactic antibiotics at induction before surgery
What effects does azotaemia have on anaesthesia and surgery?
- Significant impact on animals ability to tolerate anaesthesia due to alterations of pharmacokinetics of, and sensitivty to, drugs
- Interferes with platelet function
What are the effects of hyperkalaemia?
Bradycardia
Arrhythmias
Potentiates the cardiodepressant effects of anaesthetic drugs
hyperK Tx
- Fluid therapy and bladder decompression or urinary diversion (depending on the cause of the hyperkalemia) are often all that are required to correct hyperkalemia
- severe hyperkalemia, intravenous calcium gluconate, glucose and insulin
diagnostics
cystocentesis
- (C&S, urinalysis, decompress)
catheter biopsy
- applying suction using a syringe via a urinary catheter
- histologic diagnosis in 10 of the 12 dogs
Bladder ultrasonography
- most sensitive
- ultraosund guided biopsy
Positive-contrast cystogram
- reveal the presence of bladder rupture,
- identify radiolucent calculi,
- outline any bladder masses
retrograde urethrocystogram
- lower rupture location is not known.
double-contrast cystogram
- enhanced mucosal detail (lesions, masses, calculi)
intravenous urogram
- Computed tomography (CT) excretory urography
cystoscopy
- direct, magnified view of the mucosal surfaces of the bladder and urethra.
- allows retrieval of calculi or biopsy of bladder tissue, lithotripsy of bladder calculi, laser ablation of ectopic ureters, submucosal injection of collagen
List the options for contrast radiographs for the work-up of suspected urolithiasis
Cystogram
Retrograde cystourethrogram
Double contract cystogram
Intravenous urogram
Cystotomy
- There is no difference urine leakage, adhesions, or calculi formation between dorsal or ventral cystotomy approaches
- cystotomy vs LAC: - Results suggested that LAC may be an acceptable minimally invasive technique for treatment of cystic calculi in dogs. Surgery times were similar to those for dogs undergoing OC; however, surgical and total procedural costs were higher. Further investigation is suggested to determine which patients may benefit from LAC versus traditional OC
What is the reported rate or uroabdomen after cystotomy?
less than 1.5%
Haematuria and dysuria in 37-50%
Cystectomy
- a temporary cystostomy tube or an indwelling urethral catheter may be placed to maintain bladder decompression
- ureteral orifices, then the ureter can be transected and reimplanted
- neurovascular supply to the bladder enters dorsally in the trigone region
What cause bladder regeneration after cystectomy?
- Mucosal regeneration, synthesis and remodelling of scar tissue
- Hypertrophy and proliferation of smooth muscle
- Distention of remaining bladder wall
Regenerating cells arise from the epithelium of the terminal ureters and urethra (trigone)
How much bladder can be removed in dogs?
30-40% - all dogs regained baseline bladder capacity by 10m
More than 90% - Still had 72% decrease in capacity by 9m
40-70% excised in 11 dogs, 2 had persistant pollakiuria
List options for reconstructions when most or all of the bladder required excision
- Seromuscular colonic augmentation (the external wall of the colon became the cranial wall of bladder)
- Ileocystoplasty
- Total cystectomy with urinary diversion to colon (not recommended, high morbidity)
- TOtal cystectomy with diversion to prepuce or vagina
- Porcine SIS (experimental, successful for 40%)
Cystostomy
- traditionally placed surgically via a ventral midline laparotomy. A Foley or mushroom-tipped catheter (8 to 14 Fr) is placed for short-term use. Foley not recommended for long-term use because the balloon may deflate over time > bladder is pexied to abdo wall
- alternative for long-term use is a low-profile silicone human gastrostomy tube
- a minimally invasive inguinal approach is simple and effective for cystostomy tube placement and can usually be performed in under 15 minutes (Bray 2009)
- tube must remain in place for at least 7 days to allow time for a secure adhesion to form between the bladder and body wall.
- Ultrasound-guided placement of a pigtail cystostomy tube may be beneficial as it is not technically challenging, can be performed rapidly, and may avoid the need for general anesthesia (Culler 2019)
What approaches can be used for cystostomy tube placement?
Ventral midline
Minimally invasive inguinal approach
Laparoscopic
What % of patients with cystostomy tubes develop complications?
49%
Inadvertnent removal, displacement, chewing, breakage of mushroom tip on removal, fistula formation, urine leakage, rectal prolapse etc
List the 2 broad options for cystopexy
Tube cystostomy
Incisional cystopexy (3 rows of 6 simple interrupted sutures with 3-0 polypropylene)
Congenital Bladder Abnormalities
vesicourachal diverticula,
patent urachus,
bladder hypoplasia,
genitourinary dysplasia
What is a patent urachus?
Foetal communication between urinary bladder and allantoic cas persists, resulting in urine being discharged through urachal tube and exiting abdomen at the umbilicus
What is a congenital vesicourachal diverticulum?
the external opening of the urachus closes but a blind-ending diverticulum remains at the bladder apex
What are the physiologic effects of uroabdomen?
- Azotaemia
- Dehydration
- Metabolic acidosis
- Hyperkalaemia
- Death within 47-90hr
Fluid therapy, combined with urine drainage if necessary, is often successful in normalizing electrolyte levels, improving hydration, and decreasing azotemia sufficiently to substantially decrease the anesthetic risk
How can you perform peritoneal dialysis in a patient with uroabdomen?
Place an indwelling abdominal drain
Instill 20ml/kg warmed isotonic fluid
Leave in situ for 45 minutes and then drain
Can be repeated hourly
Bladder Rupture
- bladder is the most common site of rupture after trauma
- likely to have concurrent injuries
- Animals with a ruptured bladder may still appear to urinate normally and may have a palpable bladder
- positive-contrast retrograde urethrocystogram
- negative resuslt > repeat or intravenous urogram is performed to assess the ureters and kidneys
- Diversion of urine may be achieved via an indwelling urethral catheter, an abdominal drain, or both. Alternatively, a cystostomy tube
- All unviable bladder tissue must be resected and the bladder closure is omentalized
prognosis for urinary tract rupture after trauma is more likely to be governed by the extent and severity
uroperitoneum
fluid should be submitted for urea and creatinine measurements, hematocrit, total protein estimation, and cytology
- If the abdominal creatinine content is higher than in a serum sample taken at the same time, then the abdominal fluid is highly likely to be urine.
- - Urea is a small molecule that rapidly equilibrates across the peritoneum. Therefore, if the abdominal fluid is negative for urea, it is definitely not urine
- Potassium concentrations in abdominal fluid are also higher than those in peripheral blood when uroabdomen is present
What are the most common calculi in dogs and cats?
- Struvite (magnesium ammonium phosphate)
- Calcium oxalate
- both radiopaque
urate, calcium phosphate, silica, xanthine, cystine, mixed. Dried, solidified blood (cats)
hematuria, pollakiuria, stranguria, and dysuria
What % of dogs with a negative urine culture will have a positive culture from the urolith, mucosal biopsy or both?
24%
Which uroliths are not amenable to dissolution and therefore requir removal?
Calcium oxalate
Silicate
List methods for retrieval of uroliths (6)
- Catheter-assisted retrieval
- Transurethral cystoscopic retrieval
- Voiding hydropulsion ( fully voided in 15/21)
- Lithotripsy (Ho:YAG) - retrieved by basket extraction / cystoscope or by hydropropulsion
- Laparoscopic assisted or percutaneous cystotomy
- Surgical cystotomy
What is the rate of incomplete removal of cystoliths at cystotomy?
20%
What minimised urine spillage during a minimally invasive laparoscope-assisted cystotomy?
Packing swabs around the bladder
Using a purse string suture
Trochar with a diaphragm
What recommendations can be made to reduce recurrence?
Increased water intake
Elimination of obesity
Appropriate diet or medical therapy
urate/calcium: high-moisture, protein-restricted, alkalinizing diet
What are the recurrence rates of various uroliths?
Urolithiasis is likely to recur
Struvite
- 21% dogs
- 2.7% cats
- UTI management, acidifying diet
Calcium oxalate
- 50% in dogs within 3 yr
- 7% cats
Urate
- 33% dogs
- 13% cats
Cysteine
- 47% dogs
- diet, 2-MPG
Silicate
- 12% dogs
Recurrence rates not differ widely among methods (medical dissolution, minimally invasive, or surgical retrieval)
No controlled studies have looked at recurrence rates
Bladder Calculi
- rads: false-negative findingsfor certain types
- Pneumocystography, double-contrast cystography and ultrasonography are the most sensitive techniques for detection of calculi > false-negative rates 3.4% to 6.5% for all calculi.
- entire urinary tract must be imaged (consider CT)
- Medical therapy for the dissolution of struvite, urate, and cystine cystoliths
- medial trial: If no reduction in urolith size or number occurs by 1 month, a nonstruvite composition is likely, and alternative interventions should be considered (urethral obstructions possible)
- inspection and palpation of the entire mucosal lining > sterile rigid scope can be passed through the cystotomy incision to examine
- essential to repeatedly flush the urethra in a retrograde manner
- repeat appropriate imaging after sx
lithotripsy
- smooth and smaller than the urethral diameter. GA recommended.
- Removal of all cystoliths using this technique was achieved in 15 of 21 animals ~70%
- crushing or fragmenting of uroliths using shockwaves or laser energy. Laser lithotripsy is the most efficient
- Depending on their size, urolith fragments can then be retrieved by basket extraction with the aid of the cystoscope or by voiding hydropropulsion
- Small male dogs with large numbers of uroliths may be poor candidates for laser lithotripsy.
- Short-term complications of laser lithotripsy include urethral swelling or obstruction, perforation of the bladder or urethra, and hematuria
- Lithotripsy takes longer than cystotomy > no difference in their outcome, same number required subsequent sx
laparoscopic or cystoscopic assisted
- Percutaneous cystolithotomy allowed removal of bladder and urethral stones with rapid postoperative recovery and few major perioperative or short-term postoperative complications (Cruciani 2020)
- eliminates the need for a pneumoperitoneum and only requires one laparotomy incision. For percutaneous cystolithotomy the bladder is located by palpation following distention with saline via a urethral catheter, and an abdominal incision is made directly over the apex of the bladder
- LAC may be an acceptable minimally invasive technique for treatment of cystic calculi in dogs. Surgery times were similar to those for dogs undergoing OC; however, surgical and total procedural costs were higher
- recommended that a negative urine culture be obtained before sx
What is polypoid cystitis?
What disease can it resemble?
An uncommon nonneoplastic inflammatory disease
Can resemble TCC but is typically located in cranioventral aspect of bladder
List surgical options for polypoid cystitis
Partial cystectomy
Submucosal resection
Excisional mucosal biopsy using a clamp placed across the base
Resection using laparoscope-assisted cystoscopy
What is the most common bladder neoplasia in dogs and cats?
What breeds are overrepresented?
TCC
malignant, highly invasive, and has a predilection for the trigone region.
The vast majority (>90% of cases) consists of intermediate- to high-grade InvUC, papillary (50%) or non-papillary (50%) tumors and infiltrating (≥90%) or non-infiltrating (≤10%) tumors.
- Airedale terriers
- Beagles
- Shelties
- Collies
- Scottish terriers
ddx
- lymphoma,
- embryonal rhabdomyosarcoma,
- adenocarcinoma,
- squamous cell carcinoma,
- hemangioma, hemangiosarcoma,
- fibroma, fibrosarcoma,
- leiomyoma, and leiomyosarcoma
In what % of cases does it effect both the bladder and urethra?
Prostate?
Bladder and urethra in 56%
Prostate in 29% of male dogs
List factors which may be associated with the development of TCC
Female
Obesity
Older topical insecticides
Phenoxy herbicides
Nitrosamine exposure
Cyclophosphamide
Living in highly industrial area
TCC
- high risk for developing secondary urinary tract infections
- Ultrasonography is a very sensitive method of imaging bladder masses and can determine the degree of invasion into the bladder wall and any extension into the ureters and urethra + check the entire abdomen
- Bone mets and sternal l.n. enlargement correlated with survival
- Definitive diagnosis > catheter biopsy technique or cystoscopy (Percuraneous FNA not recommended dt seeding)
- Staging of bladder neoplasia is important to guide therapy and provide an accurate prognosis
- the animal is likely to die as a consequence of this disease. In a study in which the cause of death was known for 85 dogs with transitional cell carcinoma, 61% died because of the primary tumor, 14% died of metastatic disease, and 25% died of non–tumor-related causes
What % of TCC will have metastatised to the LNs and to the lungs?
LN 16% at diagnosis, 40% at necropsy
Thoracic: 14% at diagnosis, 49% at necropsy
What Tx is associated with the best results for TCC?
Recieving multiple different treatment protocols over the course of their disease (leads to control of TCC growth in 75% with a MST of 1yr)
- Response monitored every 4-8 weeks
- Different treatment instituted if cancer progresses or unacceptable toxicity occurs
What % of stents will relieve urinary obstruction in the face of TCC?
And cause urinary incontinence?
over 95% relieve obstruction
26-39% urinary incontinence
MST 78d
stent migration and reobstruction
TCC Tx
- Nonsteroidal drugs, classically piroxicam, offer a good option (180d)
- chlorambucil (200d)
- Total cystectomy procedures have been associated with high morbidity without substantial long-term benefit, so these procedures are no longer recommended.
- Palliative placement of a cystostomy tube (could lead to seeding of the tumor in the abdomen) or stent
- addition of intensity-modulated and image-guided radiation therapy appeared to prolong survival compared to historical data employing medical therapy alone. Median survival time from time of initial diagnosis was 179 days
Sx
- histopathologically tumor-free margins are unlikely»_space;It is generally accepted that TCC of the bladder is characterized by a ‘field cancerization effect’, where multiple independent foci of neoplasia may be present throughout the bladder
- Partial cystectomy may be performed in combination with chemotherapy
- partial or cytoreductive surgeries > literature unclear from these studies whether or not surgery provides these dogs with a survival advantage as they either had small case numbers or insufficient information
- surgery may provide a survival advantage. Median survival times of dogs undergoing debulking surgery and medical therapy (chemotherapy or piroxicam) was 272 days versus 150 days for those with medical treatment alone
- median ST with partial full-thickness cystectomy and daily piroxicam therapy, with or without chemotherapy, was 772 days. Dogs with non-trigonal (marvel 2017)
- cats: median progression-free interval was 89 days
Marvel 2017: Clinical outcome of partial cystectomy for transitional cell carcinoma of the canine bladder
The median ST with partial full-thickness cystectomy and daily piroxicam therapy, with or without chemotherapy, was 772 days.
Dogs with non-trigonal bladder TCC treated with full thickness partial cystectomy and daily piroxicam (+/− chemotherapy) may have improved outcome compared to dogs treated with medical therapy (retrospective, most <75% bladder removal, Post-operative complications occurred in 16 dogs (43%). The most common complication was urinary incontinence, which occurred in five of the 16 dogs (31%), 11% abdo wall seeding, tumors in a trigonal location have a worse outcome following surgery, 80% local recurrence
Griffin 2020: Lower urinary tract transitional cell carcinoma in cats: Clinical findings, treatments, and outcomes in 118 cases
The trigone was the most common tumor location (32/118; 27.1%) as assessed by ultrasound examination,
Metastatic disease was documented in 25 of 118 (21.2%)
cats MST 155 days, nsaid and partial cystectomy associated with survival. The median estimated percentage of bladder wall excised during partial cystectomy (reported in 15/28 [53.6%] cats) was 50% (range, 20%-65%)
Improvement in clinical signs was reported after surgery in 21 of 28 (75.0%) cats that underwent partial cystectomy,
Radical cystectomy
- severe hyperammonemia, metabolic alkalosis, diarrhea, vomiting, and neurologic complications
- Total cystectomy is a potential treatment option for the management of transitional carcinoma of the bladder.
- remove the source of pain because of the tumor, inflammation and urinary tract obstruction, and to remove the primary tumor, which may limit or prevent metastatic spread of disease.
- Further clinical evaluation of this procedure is needed to determine its clinical efficacy with regards to tumor control, complications and patient quality of life
Use of the subcutaneous ureteral
bypass device and urethral stenting
for treatment of malignant urinary
outflow tract obstructions in cats
Mariel S Covo 2024
berent
retrospective study was conducted of 14 cats, diagnosed or suspected transitional cell carcinoma (TCC
Repeat urethral obstruction due to tumor in growth occurred in 6/13 (46%) cats with a SEMS, and no cats developed recurrent ureteral obstructions after placement of the SUB device.
Three cats had additional covered stents placed after urethral re-obstruction. The median survival time (MST) from the time of device placement was 52 days in group 1 and 80 days in group 2). The MST from the time of mass identification of the cats that did and did not receive adjunctive
therapy was 349 days (mean 358; range 124–602) and 43 days
The frequency of any positive urine culture after placement
of a SUB device has been reported to be in the range
of 24–37%, with chronic infections being under 10% in
most of the largest studies to date
Single-step, non-surgical placement of permanent low-profile cystostomy tubes in dogs: 10 cases (2018-2023)
C. Lea1 and D. Kelly 2024
successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low-profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement
Lack of cystopexy does not appear to result in complications
Cystine and urate cystoliths in dogs are frequently visible on radiographs prior to surgical or nonsurgical removal
Camille Andrews 2024
31 of 331 (9%) were cystine stones, 49 of 331 (15%) were urate, and 1 of 331 (0.3%) was a mix of urate and cystine. When radiographs were taken prior to stone removal, 24 of 28 (85%) of urate, 24 of 26 (92%) of cystine, and 1 of 1 (100%) of urate/cystine were visible on radiographs.
Radiopacity is commonly used as one of the criterion to determine whether a dissolution or prevention diet is an appropriate management technique, particularly when determination of the stone type has yet to be performed. As a result, these findings may prompt clinicians to investigate other patient-specific factors before a specific dietary recommendation is made.
Feasibility of laparoscopic stapled partial cystectomy
in canine cadavers
Bianca C. Reyes 2024
Study Design: Prospective, cadaveric study.
Sample Population: Eleven canine cadavers.
Laparoscopic partial cystectomy was performed with an endoscopic
gastrointestinal anastomosis (GIA) stapler
successfully performed in 10 of
11 cadavers.
successfully performed in 10 of
11 cadavers.
Use of an endoscopic GIA stapler may provide a minimally
invasive option for partial cystectomy in dogs. Further evaluation for
application to clinical cases is warranted.
Retrospective comparison of modified percutaneous
cystolithotomy (PCCLm) and traditional open cystotomy
(OC) in dogs: 218 cases (2010–2019)
Katherine V. Adair 2022
PCCLm → shorter GA time, less post-op LUT signs
- no difference: incomplete urolith removal, SSI and inflammation rates
- incisional infection associated with PCCLm complications
Modified Toyoda technique for total cystectomy and
cutaneous ureterostomy in a cat
Noritaka Maeta 2022
total cystectomy for TCC → complete excision, 16-month survival
- obstruction of one ureter at 14-months post-op
- urinary incontinence managed with an absorbent diaper
Removal of lower urinary tract stones by percutaneous
cystolithotomy: 68 cases (2012–2017)
Benoît Cruciani 2020
median sx time 95min (45-420), lithotripsy required in 2/70 (3%)
- 58/70 (83%) discharged within 24-hours
- complications: intra-op: 1/70 procedures, 6% residual stones did not require removal
post-op: 16/68 (24%) minor LUT signs, 1/68 major (sx wound dehisence)
- recurrence: 7/33 (21%) cases with follow-up >1year
Partial cystectomy with a bipolar sealing device in seven
dogs with naturally occurring bladder tumors
Milan Milovancev 2020
successful sealed partial cystectomy in 7/7 dogs – median sx time 69min
- no leakage prior to suture closure in 3/7, variable leakage in 4/7
- may expose abdomen to tumour-laden urine
- 1/7 required revision cystorraphy after uroabdomen
- suture augmentation placed in BSD peripheral thermal effect zone
Impact of epidural bupivacaine on perioperative opioid
requirements, recovery characteristics, and duration of
hospitalization in dogs undergoing cystotomy:
A retrospective study of 56 cases
Dario Floriano 2019
Perioperative lumbosacral epidural with bupivacaine reduced
intraoperative opioid consumption in dogs anesthetized for cystotomy.
Clinical significance: The use of epidural bupivacaine in dogs undergoing
cystotomy may reduce intraoperative opioid requirements without affecting return
of bladder function or DOH.
Influence of barbed suture on leak pressures after double-layer
inverting closure of cystotomy sites in sheep
Daniel J. Duffy 2018
- ex vivo ovine
- double-layer closure → ~2x initial leak pressure regardless of suture type
- both single and double-layer closure → adequate seal/leak pressure
Duffy 2018 – barbed suture for double-layer inverting closure of cystotomy sites - ex vivo ovine
- no difference in mean leak pressure for barbed vs non-barbed closure
Radical cystectomy and subsequent ureterohysterostomy in a
bitch
Tiare Delaune 2018
initial bilateral ureterovaginal anastomosis
- right-sided dehiscence of anastomosis → right ureterohysterostomy/anastomosis
+ stent across cervix
→ intraluminal obstruction of uterine stent, loss of right ureter patency
severe right hydronephrosis at 12 months → death at 14m
Retrospective comparison of modified percutaneous cystolithotomy (PCCLm) and traditional open cystotomy (OC) in dogs: 218 cases (2010-2019)
Adair 2023
- PCCLm → shorter GA time to open, less post-op LUT signs
- no difference: incomplete urolith removal, SSI and inflammation rates
- incisional infection associated with PCCLm complications
The PCCLm may result in reduced lower urinary tract signs postoperatively compared to OC, but other clear advantages of the PCCLm were not identified in this study
