STS Journals - Urogenital Flashcards
Bailin JFMS 2022 - Retrospective evaluation of feline dystocia: clinicopathologic findings and neonatal outcomes in 35 cases (2009–2020)
What % of cases was due to maternal factors and what impact did hypoCa and hypoGlycaemia have?
Medical management was successful in…?
69% maternal factors, 31% fetal factors.
No impact of hypoGl/Ca
29%. Maternal survival 94% and neonatal survival 66%
Flock JFMS 2022 - Anti-Müllerian hormone as a diagnostic tool to identify queens with ovarian remnant syndrome
What was the conclusion?
AMH serum concentrations higher than in spayed cats & lower than intact cats with no overlap between groups.
A single determination of AMH in blood serum is a useful diagnostic tool for the diagnosis of ORS in cats, regardless of the hormonal activity of the remnant ovarian tissue.
Haase-Berglund JFMS 2020 - Histologic evaluation of parovarian nodules in the cat
What tissue did the parovarian nodules arise from?
71% contained accessory adrenal gland cortex. 27% contained residual mesonephric structures.
Fontes JAVMA 2020 - Ovarian remnant syndrome in a cat with ovarian tissue in the omentum
What diagnostics were performed?
Serum sample tested positive for anti-Müllerian hormone and had a progesterone concentration consistent with the presence of an ovarian remnant (positive result, > 0.5 ng/mL)
In Tobias - talks about GnRH/hCG being administered and then P4 being measured w. +ve being >2.5ng/mL
Fudge JFMS 2021 - Blood loss and coagulation profile in pregnant and non-pregnant queens undergoing elective ovariohysterectomy
What was observed in pregnant cats?
Greater median blood loss (2ml vs 0.5ml), hypercoagulable w. increased rate of clot lysis
Swaffield JFMS 2020 - Prospective comparison of perioperative wound and pain score parameters in cats undergoing flank vs midline ovariectomy
How did the 2 procedures differ?
No difference in duration of procedure & intra-op complications.
Flank OVE had higher pain scores post-op.
Midline OVE had higher swelling of incision site & pain scores at re-examinations.
Rigdon-Brestie JAVMA 2022 - Retrospective review reveals few complications of ovarian pedicle tie in 15927 cats undergoing ovariohysterectomy at a large HQHVSN clinic and training facility in the United States
What % of cats had pedicle-related haemorrhage?
What% of pedicle drops/tears did NOT result in haemorrhage?
0.12%
84% pedicle drops and tears did not result in haemorrhage
Ribeiro JAVMA 2023 - Bromelain does not provide significant analgesic and anti-inflammatory benefits over placebo in cats undergoing ovariohysterectomy
What is Bromelain?
Bromelain is a standardized complex of proteolytic enzymes extracted from pineapple plants. Thought to have similar effects to NSAIDs (COX-2 inhibition)
Pailler JAVMA 2022 - Findings and prognostic indicators of outcomes for queens with pyometra treated surgically in a nonspecialized hospital setting
What was the survival rate?
What pre-op findings indicated an increased risk of uterine rupture?
100%
Increased HR, closed cervix and heart murmur
Adams VS 2022 - Risk factors for neonatal mortality prior to hospital discharge in brachycephalic and nonbrachycephalic dogs undergoing cesarean section
What was the reported neonatal survival?
How did brachy/nonbrachy puppy survival rate compare?
How did survival rates compare for emergency vs elective c-section?
93%
Similar
Puppies delivered via elective C-section (99%) were more likely to survive vs emergency (87%)
Guest JAVMA 2023 - Performing an ovariohysterectomy at the time of c-section does not pose an increase in risk of mortality, intra- or postoperative complications, or decreased mothering ability of the bitch
How did OVH w. C-section affect the surgery and recovery?
Longer sx time w. OVH (20 mins more), OVH owners perceived them to be more painful
Plater JSAP 2020 - Treatment and outcomes of ureter injuries due to ovariohysterectomy complications in cats and dogs
What % of cases immediately showed clinical signs immediately after recovery from OVH? What were those clinical signs?
Of those that had surgery, what % required additional surgery?
Overall outcome for surgical cases was excellent in what %?
58%, anorexia –> anuria/death/seizures
32% took median of 3d to show clinical signs
44% (7/16)
68%
A key indicator of a ureteric injury is an animal failing to recover normally or becoming unwell shortly after ovariohysterectomy. Anuria is likely in animals with bilateral ureter injury. Excellent outcomes are possible following surgical treatment
Ross JAVMA 2023 - Evaluation of the perioperative analgesic effects of grapiprant compared with carprofen in dogs undergoing elective ovariohysterectomy
What difference was observed between Gapiprant and Carprofen?
No difference
Benka JAVMA 2023 - Age at gonadectomy, sex, and breed size affect risk of canine overweight and obese outcomes: a retrospective cohort study using data from United States primary care veterinary clinics
Sterilising at what age resulted in a lower obesity/overweight risk?
<1 yr
Arntz VS 2019 - Transvaginal laparoscopic ovariectomy in 60 dogs: Description of the technique and comparison with 2-portal-access laparoscopic ovariectomy
How was the abdomen insufflated? And to what pressure?
What pressure was the vagina insufflated to?
How was the approach closed?
Veress needle - 8mmHg
8-15mmHg
It wasn’t
Pailler JAVMA 2022 - Findings and prognostic indicators of outcomes for bitches with pyometra treated surgically in a nonspecialized setting
What was the survival rate?
What were the predictors identified for uterine rupture?
97%
None identified
Ogden VS 2020 - Outcomes associated with vaginectomy and vulvovaginectomy in 21 dogs
What was the major indication?
What was the main minor complication observed? what % were affected?
What was the rate of major complications?
Leimyoma (10/21)
Urinary incontinence (resolved within 60d in 3 dogs) - 29% (6/21)
2/21 (10%)
Nicoli JSAP 2020 - Resection of vaginal septum using endoscopic-guided sealing devices in female dogs: 8 cases (2015–2018)
What was the rate of complications?
0%
Palerme JAVMA 2021 - Characterization of recessed vulvas in dogs
What % of dogs have recessed vulvas?
What dogs are more likely to develop recessed vulvas?
14%
Higher BCS, spayed (esp if spayed <1yo)
No difference between affected/unaffected dogs wrt prevalence of LUT signs, UTI or perivulvar dermatitis.
Forster JAVMA 2023 - Bilateral pubic and ischial osteotomy in cats offers good exposure for resection of large vaginal masses with minimal postoperative complications
What 2 transient complications were observed?
HL splaying (3/3, 100%), transient stranguria (66%)
Kreisler JAVMA 2018 - Outcomes of elective gonadectomy procedures performed on dogs and cats by veterinary students and shelter veterinarians in a shelter environment
What was the difference in outcomes between the populations?
NONE
Miller JAVMA 2018 - Evaluation of sutureless scrotal castration for pediatric and juvenile dogs
Briefly describe the sutureless procedure
Single midline scrotal incision and autoligation
Complications - all minor and self limiting
Ibrahim VS 2022 - Arterial supply to the scrotum: A cadaveric angiographic study
What is the blood supply to the scrotum?
Which aspect of the scrotum has a more limited blood supply?
What is the clinical relevance of this?
Ventral perineal artery – internal pudendal a. – internal iliac
Cranial aspect has more limited blood supply
Scrotal flaps should be based caudal to scrotum to preserve blood supply
David VS 2024 - Single-port laparoscopic-assisted abdominal cryptorchidectomy in 14 dogs
Describe the port placement
Single port placed midline just cranial to prepuce.
Teste ligated extracorporeally
De Vlaming JAVMA 2019 - Clinical characteristics, classification, and surgical outcome for kittens with phimosis: 8 cases (2009-2017)
Describe the two types of phimosis in kittens
What are the surgical techniques used to manage the phimosis?
What were the outcomes?
Type 1 - generalized preputial swelling owing to urine pooling without penile-preputial adhesions - 6 kittens
Type 2 - focal preputial swelling and urine pooling in the presence of penile-preputial adhesions - 2 kittens
Type 1 - circumferential preputioplasty
Type 2 - preputial urethrostomy
No complications or recurrence observed
Ritson JSAP 2023 - The indications, complications and outcomes of dogs undergoing partial penile amputation: 10 cases (2014-2021)
What was the main reason for the partial penile amputation?
What was the major complication rate? What was the reason for the ppa in these cases?
What was the minor complication rate?
What was the overall outcome?
Neoplasia
2/10 cases (20%) - paraphimosis
4/10 (40%)
Outcome was good to excellent in nine of nine (100%) dogs for which medium- or long-term follow-up data were available
Yipanis VS 2021 - Cranial translation of the elevated prepuce in dogs before and after two modifications: A cadaveric study
What were the two modifications?
What was the max cranial translation observed with and without these modifications?
First modification - incising the skin between the two lateral skin incisions so that the incision passed caudal to the bulbus glandis.
Second modification - dissecting the mucosa of the penis off the bulbus glandis without opening the preputial cavity - releasing the attachment of the lamina interna
Without modifications - 15mm
With modifications - 37mm
Bertran JSAP 2021 - Penile urethral resection and anastomosis augmentation with regional tissue tension relieving technique: A cadaveric mechanical study and clinical outcome in two dogs
What tissue was the R+A augmented with? And how was it sutured?
How did it affect the biomechanical properties?
Tunica albuginea, circumferentially with 5-0 Monocryl
Increased the resistance to tensile load of the anastomosis
Milgram JSAP 2019 - A proposed technique for one-step preputial reconstruction in the dog
What vessel supplies the reverse axial pattern flap?
How is this skin flap performed?
What minor complication was observed?
Superficial branch of the dorsal penile artery
Mucosa of prepuce from fornix incised circumferentially & reflected cranially until it covered the urethral opening, then skin closed over.
Minor skin necrosis at cranial edge of the incision
Giansetto VS 2022 - Preputial urethrostomy with preservation of the local anatomy in 4 dogs
Describe the procedure
What surgery would this be an alternative to?
What was the outcome?
Stenosis site identified, transect and ligate distal end of urethra. Stay sutures in proximal urethra. Forceps into prepuce as caudal and dorsal then cut over and push into abdomen, then suture urethra end to the hole, with catheter in place.
Alternative to prepubic urethrostomy in male dogs
Functional urethral stoma obtained in all dogs
Del Magno VS 2021 - Surgical treatment and outcome of sterile prostatic cysts in dogs
How were the prostatic cysts treated?
What complication was seen intra-operatively?
What was the major complication rate?
Minor complication rate? And what were those minor complications?
What was the resolution rate?
Extraparenchymal cysts treated by partial resection & omentalisation/complete resection.
Intraparenchymal cysts treated by omentalisation.
Urethral tear
Major complications in 3/44 dogs - 7%
23% (10/44) - permanent urinary incontinence (n = 5), temporary urinary incontinence (n = 2), urinary retention (n = 2), and dysuria (n = 1)
Resolution in 89%
Skorupski JSAP 2022 - Prospective comparison of prostatic aspirate culture and cystocentesis urine culture for detection of bacterial infection in dogs with prostatic neoplasia
Which were more sensitive, prostatic aspirates or cystocentesis?
Both similar
Petrovsky JAVMA 2019 - Endoscopic nephrolithotomy for the removal of complicated nephroliths in dogs and cats: 16 kidneys in 12 patients (2005-2017)
What type of stone is most commonly seen as a nephrolith?
Describe the percutaneous approach
What % of cases were successfully performed?
What procedure related complications were observed?
Calcium oxalate
For the PCNL approach, the patient was positioned in lateral recumbency, contralateral to the affected kidney. The PCNL was performed by use of
ultrasonographic, fluoroscopic, and endoscopic guidance. With ultrasonographic guidance, the affected renal pelvis was accessed through the greater curvature
of the kidney by use of a trocar needle until the nephrolith was touched or urine was obtained in the hub of the needle. A guide wire was then placed through the needle, down ureter and out the prepuce/vulva. The renal access tract was the dilated with a balloon catheter and an endoscope was placed into the renal pelvis
15/16 (94%)
Haemorrhage, renal capsule tear and ureteral puncture
Johnson JAVMA 2024 - Unilateral nephrectomy in dogs is associated with a high rate of intraoperative and postoperative complications
What was the intra-op complication rate? What was the most common complication?
What was the short-term post-op complication rate? What was the most common complication?
What was the most common indication for surgery?
What long term complication was seen, and what was the rate?
45%, hypotension
43% - AKI
Neoplasia - renal cell carcinoma
CKD. Interestingly, post-op AKI and NSAID admin was NOT associated with formation of CKD
Rosenblum JAVMA 2022 - Bilateral renal descensus and intravesicular ureteroneocystostomy for treatment of bilateral ureteral ligation and transection that occurred during ovariohysterectomy in two cats
Briefly describe in simple terms this procedure
What was the outcome?
Caudal relocation of both kidneys (without renal a.+v. transection/reimplantation), ureteral reimplantation with an intravesicular approach (ureter spatulated and sutured inside the bladder)
One developed septic peritonitis, but both survived
Kulendra JSAP 2021 - Survival and complications in cats treated with subcutaneous ureteral bypass
What SUB was used?
What was the mortality prior to discharge rate?
What % had major complications associated with SUB? What was the most common major comp?
What factor was associated with long term survival?
SUB 2.0
10%
48%, UTI
Creatinine concentration @ presentation
>440uml/L - MST 530d (1.5yr)
<440umol/L - MST 949d (3yr)
Dirrig JSAP 2020 - Diagnostic imaging observations in cats treated with the subcutaneous ureteral bypass system
What SUB was used?
What % of cats were identified to have abnormalities with SUB devices? What abnormalities did that include?
What other finding was reported?
2.0 SUB
53% - catheter blockage/kinking/leaking
54% of obstructed ureters became patent after bypass placement, although the majority remained slightly dilated or had irregular margins compatible with chronic inflammation.
Kulendra JSAP 2021 - Survival and complications in cats treated with subcutaneous ureteral bypass
What was the MST and the magic creatinine number @ presentation?
> 440uml/L - MST 530d (1.5yr)
<440umol/L - MST 949d (3yr)
Butty JFMS 2021 - Subcutaneous ureteral bypass device placement with intraoperative ultrasound guidance, with or without microsurgical ureterotomy, in 24 cats
How did the performance of a microsurgical ureterotomy effect the population?
No benefit in terms of long/short complications or outcome
Dropkin JFMS 2021 - Use of tissue plasminogen activator to alleviate postoperative subcutaneous ureteral bypass obstruction secondary to blood clot in seven cats
Was it successful and if so over what timeframe?
What complications were observed?
YES, SUB patency re-established in 2 days
No complications observed
Penington JFMS 2021 - Factors associated with positive urine cultures in cats with subcutaneous ureteral bypass system implantation
What was the % of +ve urine cultures long term?
What was associated with an increased risk of a post-op +ve culture?
What was associated with a need to remove/replace the implant?
24%
+ve pre-op culture
E.coli infection
Vrijsen JFMS 2021 - Complications and survival after subcutaneous ureteral bypass device placement in 24 cats: a retrospective study (2016–2019)
What was the complication rate?
What was the pre-discharge mortality rate?
What % required revision surgery?
80% - 33% partial SUB obstruction, 21% UTI, 21% pyelonephritis, 13% cystitis.
21% mortality pre-discharge.
25% revision surgery.
Balsa JAVMA 2019 - Factors associated with postobstructive diuresis following decompressive surgery with placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats: 37 cases (2010-2014)
What factors were associated with the duration and severity of post-op diuresis?
Pre-op values of creatinine, K, PO4 and BUN
and
Absolute changes in serum concentrations of creatinine, potassium, and BUN from before surgery to after surgery positively correlated with POD duration.
Lorange VS 2020 - Postoperative outcomes of 12 cats with ureteral obstruction treated with ureteroneocystostomy
What was the long term outcome of the 12 cats?
How did the use of a double pigtail catheter impact outcome?
11/12 had acceptable long term outcome
Long term complications were more common in catheter group
Hoshi JSAP 2022 - Direct renal pelvicocystostomy using tube cystoplasty in a cat with ureteral obstruction
Briefly describe the procedure
What suture material did they use?
What was the long term outcome?
Wide rectangular apex-based full-thickness flap was created from the ventral aspect of the urinary bladder, which was sutured longitudinally to form a large-diameter tube. The resulting tube-shaped portion of the bladder was then directly anastomosed to the renal pelvis.
3-0 PDS
No major complications or obstruction was observed
Kennedy JFMS 2022 - Feline ureteral obstruction: a case-control study of risk factors (2016–2019)
What management factor was associated with a greater likelihood in developing ureteral obstruction?
Cats fed dry food were 16x more likely to develop ureteral obstruction vs wet food
No association with age, sex, breed, housing & total calcium.
McEntee JFMS 2022 - Evaluation of preoperative ultrasonographic parameters to predict renal recovery in long-term survivors after treatment of feline ureteral obstructions: 2012–2019
What parameters were identified to predict renal recovery?
No imaging findings OR bloodwork was associated with long-term serum creatinine values
Hardie VS 2023 - Evaluation of two nephrocystostomy techniques for ureteral bypass in cats
Describe the two techniques
Which one was more likely to be obstructed?
What were common complications seen?
Both 2 stage surgery. Difference is in how the bladder is attached to kidney.
Simple - 8F catheter advanced through caudal pole, bladder sutured around to renal capsule
Bladder cuff NCT - 6mm chunk of caudal pole removed, 10F catheter placed, bladder mucosal cuff sutured into renal pelvis
Catheter was removed with cystotomy 41-118d post-op
All simple sx became blocked after catheter removal, all bladder NCT were patent
Haematuria, clot urethral obstruction, dislodged catheter, UTI
Oyamada VS 2023 - Extravesicular, two-layer, side-to-side ureteroneocystostomy combined with tension-relieving techniques for feline proximal ureteral obstruction: A retrospective study
Describe the 2 layer S-t-S ureteroneocystostomy technique
Name some tension-relieving techniques for proximal ureteral damage
What was the most common long term post-op complication? What rate?
What was the long term outcome?
Ureterotomy at site of obstruction. 2 layer closure with inner incisions sutured to bladder mucosa
Renal descensus, uretericystopexy, nephrocystopexy
UTI (3/10 - 30%)
7/10 - 70% - alive at long term follow up (~650d) w.out recurrent obstruction
Beeston JSAP 2023 - The utility of clinicopathological findings and point-of-care ultrasound in increasing the index of suspicion of ureteral obstruction in azotaemic cats presenting to the emergency room
What imaging findings are more likely associated with obstructive disease (c.f. non-obstructive disease)?
What biochemical findings are more likely associated with obstructive disease (c.f. non-obstructive disease)?
Renal pelvis dilation - imaging
Hyporexia, hyperCa, hypoK (although the paper contradicts itself with K)
Dekerle VS 2022 - Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation
What % of dogs achieved continence (+/- adjunctive medical/sx tx)?
How did the two tx compare?
88%
Fewer minor complications & post-op recurrence of incontinence after CLA vs open sx
Hoey VS 2021 - Long-term outcome of female dogs treated for intramural ectopic ureters with cystoscopic-guided laser ablation
What was the rate of complete/near complete continence?
What intra-op complication was observed and how was it managed?
What was the rate of post-op UTI?
How did post-CLA neutering affect continence scores?
80%
Urethral tear - managed conservatively
6/34 (18%)
It did not affect the continence score
Jacobson JAVMA 2022 - Cystoscopic-guided scissor transection of intramural ectopic ureters as a novel alternate minimally invasive treatment option to laser ablation in female dogs: 8 cases (2011–2020)
What was the rate of complete continence? Continence achieved with meds?
3/7 (43%) complete continence
3/7 (43%) required medication
Song VS 2024 - Receiver operating characteristics of computed tomography (CT) compared to cystoscopy in diagnosis of canine ectopic ureters: Thirty-five cases
What % of ectopic ureters did CT identify? and ectopic ureteral orifice location?
78%
Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively.
Basically CT is not great
Russell JAVMA 2023 - Persistent urinary incontinence in female Golden Retrievers following laser ablation of intramural ectopic ureters may be associated with the presence of historical urinary tract infection
What was the long term urinary continence?
What factors were associated with an increased risk of long term u.incontinence?
64%
Hx of UTI
Milligan JSAP 2020 - Outcome of SUB placement for the treatment of benign ureteral obstruction in dogs: nine dogs and 12 renal units (2013 to 2017)
What was the most common long-term complication?
Mineralisation - 6/12 (50%). 4 required exchange (33%)
Milligan JSAP 2020 - Outcome of SUB placement for the treatment of benign ureteral obstruction in dogs: nine dogs and 12 renal units (2013 to 2017)
What was the rate of worsening azotaemia long term?
What was the rate of UTI? What did all these dogs have in common?
0%
5/9 - all had hx of pre-op UTIs
Duval JFMS 2022 - Use of tetrasodium EDTA acid for the treatment of intraluminal obstruction of subcutaneous ureteral bypass devices
What protocol was utilised to treat intraluminal obstruction?
In what % was it successful?
What was the rate of recurrence?
4% tEDTA infusions BID for 3 days (complete), SID for 2d then weekly (partial).
Successful de-obstruction in 11/16 (69%) SUBs.
6/11 (55%) had recurrence of obstruction (median 87d)
Floriano VS 2019 - Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: a retrospective study of 56 cases
What was the conclusion of this study?
Perioperative LS epidural with bupivacaine reduced intra-op opioid requirements.
No difference in time to urinate or eat.
Buote JFMS 2022 - Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score
How did MI cystotomy compare to open cystotomy using the composite outcome score?
Minimally invasive technique reduced odds of developing the composite outcome (pain score >2, failure to remove all stones & post-op complication) vs open surgery.
Nurra JFMS 2022 - Clinical use and complications of percutaneous cystostomy pigtail catheters in 25 cats
How long were the catheters left in place for?
What was the complication rate?
Name some of the complications seen
8d
40%
Catheter dislodgement, urine leakage, UTI and bladder rupture
Hornsey JFMS 2021 - Factors affecting survival to discharge in 53 cats diagnosed with uroabdomen: a single-centre retrospective analysis
What was the rate of survival to discharge?
What factors were associated with survival?
74%
Survival was NEGATIVELY correlated with creatinine levels at presentation (no other factors associated including sx vs medical)
Scharf VS 2020 - Use of a bipolar sealing device to seal partial cystectomy with and without augmentation with a single-layer simple continuous suture pattern in an ex vivo canine model
Which closure technique had a lower initial leakage pressure?
Which closure technique were able to sustain greater pressure to catastrophic failure?
Suture sealed cystectomy
Suture sealed cystectomy
So suture closure leaked earlier but was more resistant to catastrophic failure
Monnet VS 2023 - Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study
How did barbed suture vs conventional suture compare with respect to leakage pressures?
No effect on leakage pressure
Barbed suture - faster w. fewer suture bites
Visser VS 2020 - Resection of urachal anomalies in dogs with recurrent lower urinary tract disease
What dogs were treated?
What treatment was performed?
What was the outcome?
Dogs median age 12m presenting with recurrent LUTD and Bacterial urinary tract infection
Partial cystectomy (apex)
64% had no ongoing LUTD signs, 27% improved
9% no improvement
Maeta VS 2022 - Modified Toyoda technique for total cystectomy and cutaneous ureterostomy in a cat
Milovancez VS 2020 - Partial cystectomy with a bipolar sealing device in seven dogs with naturally occurring bladder tumours
How was the partial cystectomy performed?
Immediately after cystectomy with bipolar device, how many dogs showed evidence of urine leakage?
Post-op uroabdomen was seen in how many dogs? Why?
Ligasure device with oversewing of simple continuous layer
4/7
1/7 - suture was placed in thermal effect zone
Reyes VS 2024 - Feasibility of laparoscopic stapled partial cystectomy in canine cadavers
What stapler was used?
What port locations and patient positioning was used?
What was the intravesical pressure plateau?
How many cases were successfully performed?
Lap GIA
Umbilical port and paramedian port (R) - see pic
89mmHg
10/11 - 91%
Himelman JAVMA 2019 - Use of cystoscopy or cystourethroscopy in treating benign macroscopic haematuria caused by lower urinary tract haemorrhage in three dogs
What was the cause of the lower urinary tract haemorrhage?
How was it managed?
What was the outcome?
Small lesions in bladder/urethra. Arthrography had not identified the cause of the bleeds
Laser ablation
Good - resolution of bleeding
Adair VS 2023 - Retrospective comparison of modified percutaneous cystolithotomy (PCCLm) and traditional open cystotomy (OC) in dogs: 218 cases (2010–2019)
What was the conversion rate?
How did PCCLm and OC compare?
4%
With PCCLm - increased anaesthesia time, less LUT signs
No difference in incomplete urolith removal, SSI or inflammation
Cruciani VS 2020 - Removal of lower urinary tract stones by percutaneous cystolithotomy: 68 cases (2012-2017)
What was the rate of minor complications?
What was the rate of major complications?
What was the rate of stone recurrence?
24% (lower urinary tract signs)
1/68 (1%) - wound dehiscence
21% when followed >1y post-op
Harris JAVMA 2023 - d,l-Methionine in combination with amoxicillin–clavulanic acid successfully dissolves spontaneously occurring infection-induced struvite urocystoliths in dogs: a pilot study
What % had urolith dissolution (over what time frame)?
73% (8/11)
Median of 2 months
Young JSAP 2021 - Radiographic diagnoses in 80 cats before and 73 cats after unobstructing the urethra
When did radiographs have a greater frequency of diagnosis (before or after obstruction)?
What was the most common cause of urethral obstruction?
Before - mostly due to urethral plugs being detected
Urethral plugs
Bresciani VS 2022 - Modified prepubic urethrostomy with body wall tunnelling: Description of technique and long-term outcome in eight male cats
What was the modification which the authors describe?
What was the outcome?
Tunnelling of the urethra through the rectus abdominis musculature (from dorsocranial to ventrocaudal)
Well tolerated by all cats, no intraop complications
2 cats required revision due to weight gain
Segal JSAP 2020 - Evaluation of urethral orifice cross- section dimensions following perineal urethrostomy in male cats
What was the rate of stenosis and urinary obstruction?
What increased the risk of stenosis?
20%
Post-op orifice being </=8Fr catheter
Slater JFMS 2020 - Welfare of cats 5–29 months after perineal urethrostomy: 74 cases (2015–2017)
What was the main result from this study?
100% owners reported same QOL post-surgery as prior to development of urinary problems.
Watson JFMS 2020 - Evaluation of postoperative complication rates in cats undergoing perineal urethrostomy performed in dorsal recumbency
What was the major complication rate?
What was the most common long-term complication? (frequency?)
0% - authors speculate that this is due to better visualization for dissection and tissue apposition
(13% for PU in Tobias)
UTI - 33%
Slunsky JFMS 2019 - Effect of intraoperative positioning on postoperative neurological status in cats after perineal urethrostomy
What was the finding?
Reduced perineal reflex and increased spinal pain 24hr post-op in both groups
No difference between positioning
Nye JAVMA 2020 - Retrospective multicentric study comparing durations of surgery and anaesthesia and likelihoods of short- and long-term complications between cats positioned in sternal or dorsal recumbency for perineal urethrostomy
What was the difference between the two positioning techniques?
No difference in duration of surgery, or with likelihood of short/long-term complications.
Dumartine JFMS 2022 - Outcomes and postoperative complications after transpelvic urethrostomy used as first-line surgery in 38 male cats with obstructive lower urinary tract disease
Why did the authors decide that TP approach is appropriate?
What was the short term complication rate? - what complications were seen
What was the long term complication rate? - what comps were seen
Wider urethra in intrapelvic region
18% - LUTDz and stomal stenosis
34% - LUTDz, UTI and stenosis
Moores VS 2020 - Pubic fractures secondary to extended transpelvic urethrostomy in a cat
What is the recommended amount of bone which should be removed in a TPU?
How much was removed in this case (%)?
How was this case managed?
What did the authors suggest should be done in the future to prevent this occuring?
12mm length, 10mm width
20mm length and 5 mm width (approximately 130% to 160% of the length and 50% of
the width)
Conservative management - good outcome
Recommends rest after TPU or extended TPU to minimise risk of #
Merindol JFMS 2022 - Feline urinary incontinence: a retrospective case series (2009–2019)
What was the most common cause of urinary incontinence in a neuro normal cat?
Urethral obstruction (majority due to urethral stricture)
Seneviratne JFMS 2021 - Comparison of surgical indications and short and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy
What was the most common indication for PPU?
Which technique was associated with the greatest number of complications? And give examples of those complications
What were the long-term complication rates for PU, TPU and PPU?
Trauma
PPU, short-term dermatitis, long term incontinence
PU - 14%
TPU - 33%
PPU - 70%
Sousa-Filho JFMS 2020 - Clinical outcomes of 28 cats 12–24 months after urethrostomy
What was the rate of complications for PU and PPU?
What complications were less likely in PU cases?
PU - 32%, PPU 83%
Recurrent UTI, urine scald and bacteriuria
Conway JAVMA 2022 - Prazosin administration increases the rate of recurrent urethral obstruction in cats: 388 cases
What other factors are associated with an increased risk of recurrence?
What is Prazosin?
Perception of gritty feeling and difficulty placing catheter associated with increased risk of recurrence
Competitive alpha1-antagonist
Reineke JAVMA 2021 - Multicenter evaluation of decompressive cystocentesis in the treatment of cats with urethral obstruction
What was observed?
No difference in time/difficulty for urinary catheter placement
Wang JFMS 2024 - Effect of tamsulosin on urethral tone in healthy male cats
What is tamsulosin?
What effect did it have?
selective alpha1 adrenergic antagonists
none
David JAVMA 2023 - Comparison of urethral length and orifice diameter in cats undergoing transpelvic or subpubic urethrostomy for perineal urethrostomy revision (cadaveric study)
What is a subpubic urethrostomy?
What was the observed reduction in urethral length seen between PU/TPU/SPU?
How did the TPU and SPU urethral orifice compare?
Similar to prepubic - With SPU, a pubic flap is created through a pubic osteotomy. The postprostatic urethra is transposed and tunnelled subcutaneously allowing the urethrostomy opening to be placed caudal to the inguinal fat pad
PU 24%, TPU 36%, SPU 56% - TPU resulted in 1.5x longer residual urethral length than SPU
Urethral orifice diameter after TPU did not differ from SPU
Basically TPU has no disadvantage c.f. SPU
Yipaditr JAVMA 2022 - Buccal mucosal graft urethroplasty in male cats with traumatic complete urethral rupture
Describe the procedure briefly
How long was the u.cath left in post-op?
What complications were observed?
What was the long term outcome?
In each cat, a section of buccal mucosa was harvested, sutured, and formed into a tubule by use of an 8F indwelling catheter as support. This tubular graft was connected to both ruptured ends of the urethra to renew the urinary passage
2 weeks - then retrograde performed to ensure no urethral leakage
Urethral stenosis in 2/15
13/15 had no complication - did v.well. At long term assessment, all cats were doing well
Kim JAVMA 2019 - Outcomes following balloon dilation for management of urethral obstruction secondary to urothelial carcinoma in dogs: 12 cases
What % of dogs responded (clinical signs improved)?
What complications were observed?
What % recurred - what sort of time frame? How were they managed?
75% (9/12)
Complications included hematuria, urinary incontinence, and dysuria; these resolved
within a few days after treatment
5/12 (40%) - at 48-296d
Further dilations resulted in clinical improvement
Satanyasuwan JSAP 2023 - Application of preputial tube- flap urethroplasty to establish a neourethra in a male dog with complications after preputial urethrostomy
What was the outcome?
Dog showed full recovery with no leakage
Sx - 14yo poodle w. preprostatic urethral rupture. Revision surgery was performed with preputial tube- flap urethroplasty via preputiotomy. A longitudinal flap was raised from the prepuce and anastomosed to the end of the previously cut urethra to create a neourethra and reduce tension at the urethrostomy site.
Bohlen JSAP 2022 - Artificial urethral sphincter in male dogs with urethral sphincter mechanism incompetence: 19 cases (2010–2017)
What was the short and long term continence rate?
What was the complication rate? Give examples of these complications
Short term continence improved in 80%
Long term 60%
53% completely continent
Complication rate 56% - 31% major complications - mechanical urethral obstruction, dyssynergia, fistula at port & port rotation.
Fournet JSAP 2021 - Treatment of urinary incontinence in a cat with genitourinary dysplasia using a urethral sphincter occluder
Outcome?
Long term continence, UPP used to guide inflation
Lutz VS 2020 - Do prevalence rates and severity of acquired urinary incontinence differ between dogs spayed by laparoscopy or laparotomy?
What was the outcome?
What % of the population were deemed to be UI?
What were risk factors identified for UI?
No difference between rate of UI between procedures
20%
Age and time since spaying
Pegram JSAP 2019 - Associations between neutering and early-onset urinary incontinence in UK bitches under primary veterinary care
What factors were associated with EO UI?
Neuter status (OR 2x), early age neutering (<6m), >30kg @ time of neutering (3.86x)
Pegram JSAP 2019 - Spaying and urinary incontinence in bitches under UK primary veterinary care: a case-control study
What factors were associated with UI?
Spay status, increasing age and BW
Age at neutering NOT associated
Mickelson VS 2021 - Evaluation of a microvascular anastomotic coupler for end-to-side arterial and venous anastomosis for feline renal transplantation
What % of anastomosis were successful?
100%
Byer JFMS 2022 - Retroperitoneal fibrosis as a postoperative complication following renal transplantation in cats
What was the rate of retroperitoneal fibrosis?
How does it present?
How was it managed?
Mortality rate?
7% (6/81)
Mod-severe azotaemia w. hydroureter/hydronephrosis
Reimplantation of the proximal ureter/renal pelvis to the bladder
2/6 (33%)
Aronson JAVMA 2022 - Characterization of preoperative cardiovascular status and association with outcome following feline renal allograft transplantation: 166 cases
How did the preop cardiac status impact the outcome?
What other factors were identified?
Hypertension, murmur, echo changes & CHF were not associated with survival after transplant.
Age was only significant variable associated with survival - risk increased by 11% for each year of age.
Ludwig JAVMA 2021 - Toxoplasma gondii infection in feline renal transplant recipients: 24 cases (1998-2018)
What % of (pre-op) seropositive cats developed infection?
What prophylactic treatment is advised for all seropositive cats?
What was the mortality rate?
0% - all +ve cats came from seronegative pop
Clindamycin oral meds for life
6/8 (75%)
Friday VS 2023 - Effect of metastatic calcification on complication rate and survival in 74 renal transplant cats (1998–2020)
What effect was noted?
Cats w. pre-transplant metastatic calcification had shorter MST (147d) than without (646d)
Associated with increased risk of death (by 240%)
