ACVIM consensus statement on diagnosis and management of urinary incontinence in dogs.

Urinary incontinence (UI) is a disorder of micturition that can occur in dogs of any age, sex, and breed depending on the underlying cause and time of onset. Diagnosis and treatment for various causes of UI in dogs have been described by multiple comprehensive single author review articles, but large prospective clinical trials comparing treatment outcomes in veterinary medicine are lacking. The objectives of this consensus statement therefore are to provide guidelines on both recommended diagnostic testing and treatment for various causes of UI in dogs. Specifically, pathophysiology directly related to the canine urinary system will be reviewed and diagnostic and therapeutic challenges will be addressed. A panel of 12 experts in the field (8 small animal internists [L. Adams, J. Bartges, A. Berent, J. Byron, J. Foster, A. Kendall, S. Vaden, J. Westropp], 2 neurologists [J. Coates, N. Olby], 1 radiologist [G. Oetelaar], and 1 surgeon [C. Adin]) was formed to assess and summarize evidence in the peer-reviewed literature and to complement it with consensus recommendations using the Delphi method. Some statements were not voted on by all panelists. This consensus statement aims to provide guidance for management of both male and female dogs with underlying storage or voiding disorders resulting in UI.

A retrospective study of vector borne disease prevalence among anemic dogs in North Carolina.

BACKGROUND: Anemia is an important cause of morbidity and mortality in dogs. Further understanding of the prevalence of vector borne diseases (VBD) in anemic dogs is needed. OBJECTIVES: The objective of this retrospective study was to describe the rate of exposure to or infection with VBD among anemic dogs presented to a teaching hospital in North Carolina and to further characterize the anemia in dogs with VBD exposure. ANIMALS: A total of 597 anemic dogs that were concurrently tested for VBD were examined at a referral veterinary hospital between January 2012 and December 2018. METHODS: Retrospective descriptive study. Demographic, clinicopathologic, and VBD testing data were obtained from medical records. RESULTS: Of the 597 anemic dogs examined, 180 (30.15%; 95% CI: 26.49-34.01%) tested positive for one or more VBD. There was no difference in the severity of anemia or the proportion of dogs displaying a regenerative anemia between dogs testing positive and negative for VBD. CONCLUSIONS: A large proportion of anemic dogs from this region test positive for exposure to or infection with VBD. Our study supported the use of PCR and serology run in parallel to maximize the chance of detecting exposure to or infection with VBD compared to either serology or PCR alone. At this time, it is unknown whether infection with VBD contributed to the development of anemia in these patients. However, given the prevalence of VBD exposure in anemic dogs, testing for VBD in anemic patients from this region of the United States is warranted.

Adeno-associated virus-vectored erythropoietin gene therapy for anemia in cats with chronic kidney disease.

BACKGROUND: A treatment of chronic kidney disease (CKD)-associated anemia in cats is needed. SB-001 is an adeno-associated virus-vectored (AAV)-based gene therapeutic agent that is administered intramuscularly, causing the expression of feline erythropoietin. HYPOTHESIS/OBJECTIVE: We hypothesized that SB-001 injection would lead to a sustained increase in PCV in cats with CKD-associated anemia. ANIMALS: Twenty-three cats with International Renal Interest Society (IRIS) Stage 2 to 4 CKD-associated anemia were enrolled at 4 veterinary clinics. METHODS: In a prospective clinical trial, cats were treated with 1 of 3 regimens of SB-001 (Lo 1.2 × 109 genome copies [GCs] on Day 0; Lo ± Hi [supplemental 2nd dose of 3.65 × 109 GC on Day 42]; Hi 3.65 × 109 GC IM on Day 0) and followed for 70 days. RESULTS: A response to SB-001 at any time between Day 28 and Day 70 was seen in 86% (95% confidence interval 65, 97%) of all cats. There was a significant (P < .003) increase in PCV from Day 0 to Day 28 (mean increase 6 ± 6 percentage points [pp]; n = 21), Day 42 (8 ± 9 pp; n = 21), Day 56 (10 ± 11 pp; n = 17), and Day 70 (13 ± 14 pp, n = 14). Twelve cats were hypertensive at baseline, 4 of which developed encephalopathy during the study. An additional 6 cats became hypertensive during the study. CONCLUSIONS AND CLINICAL IMPORTANCE: Results of this study suggest that SB-001 therapy represents a suitable single injection treatment that can address nonregenerative anemia in cats with CKD. It was generally well tolerated; however, hypertension and encephalopathy developed in some cats as previously described in association with erythropoiesis-stimulating agent therapy.

Idiopathic functional urinary outflow tract obstruction in dogs, a retrospective case series (2010-2021): 31 cases.

BACKGROUND: Idiopathic functional urinary outflow tract obstruction (iFUOTO) is an uncommon but life-limiting disease whose etiology and clinical course of disease remain poorly understood. OBJECTIVE: Characterize signalment, clinical signs, clinicopathologic findings, treatments, and propose a standardized response score for dogs with iFUOTO. ANIMALS: Thirty-one client-owned dogs diagnosed with iFUOTO. METHODS: Retrospective case series. Medical records from 2010 to 2021 were reviewed and findings recorded. Dogs were categorized based on the presence or absence of overt signs of neurological disease. Response to treatment was scored. RESULTS: Thirty-one dogs were included. All dogs had stranguria and 14 (45%) had overflow urinary incontinence. Mean age of onset for signs was 6.9 years±8 months. Twenty-four dogs (77%) were castrated males, 5 (16%) intact males, and 2 (6%) spayed females. Eight (26%) of dogs had overt neurological deficits. Follow-up data were available for 29 dogs (median 38 days, range: 2-1277). Final outcome scores were not significantly different among dogs with overt signs of neurological disease (median score 2.5; range: 0-3) and those without (median score 1; range; 0-3; P = .35). Treatments included alpha antagonists, skeletal muscle relaxants, parasympathomimetics, anti-inflammatories, castration, temporary placement of a urethral catheter, or a combination of these. CONCLUSIONS AND CLINICAL RELEVANCE: Multimodal treatment was frequently prescribed, but a standard outcome score is needed to evaluate the effectiveness of these therapies. Serial neurological examinations and monitoring of the dogs' dysuria are warranted.

Lesser vestibular periurethral gland-like inflammation associated with lower urinary tract signs in a female dog.

CASE DESCRIPTION: A 4-year-old female spayed mixed breed dog presented with a 2-year history of painful urination and recurrent hematuria. CLINICAL FINDINGS: The dog had a large sensitive bladder, palpation of which was followed by painful urination. Pollakiuria accompanied by vocalization were noted during observation of voiding. DIAGNOSTICS: Cystoscopy identified a focal, rounded expansion of epithelial tissue in the right lateral aspect of the urethral papilla containing purulent material consistent with an abscess. A sample submitted for culture yielded growth of Staphylococcus pseudintermedius and Proteus mirabilis. TREATMENT AND OUTCOME: Purulent material was expelled by manual pressure during cystourethroscopy. Enrofloxacin (10 mg/kg PO q24h for 42 days) and carprofen (4.4 mg/kg PO q24h for 14 days) were initiated. Clinical signs resolved within 2 days. CLINICAL RELEVANCE: Inflammation in the region of the lesser vestibular paraurethral glands should be considered as a differential for female dogs presenting with chronic dysuria.

Influence of three different closure techniques on leakage pressures and leakage location following partial cystectomies in normal dogs.

BACKGROUND: Transitional cell carcinoma (TCC) is the most common neoplasia affecting the canine urinary bladder. Partial cystectomy, when used adjuctively with medical management, has been shown to meaningfully extend medial survival time. Surgical stapling devices have a wide variety of uses and advantages over traditional closure methods and, to date, investigation into their use in canine partial cystectomies has not been documented. OBJECTIVE: To determine the influence of three closure techniques on ex vivo leakage pressures and leakage location following canine partial cystectomy. METHODS: Specimens were assigned to one of three closure techniques: simple continuous appositional closure with 3-0 suture, closure with a 60 mm gastrointestinal stapler with a 3.5 mm cartridge, and placement of a Cushing suture to augment the stapled closure, with each group containing 12 specimens. Mean initial leakage pressure (ILP), maximum leakage pressure (MLP), and leakage location at the time that ILP was recorded were compared between groups. RESULTS: Oversewn stapled constructs leaked at significantly higher ILP (28.5 mmHg) than those in the sutured (17 mmHg) or stapled (22.8 mmHg) group, respectively. MLP was greater in the oversewn stapled construct group compared to other groups. Leakage was detected in 97% partial cystectomies, with leakage occurring from the needle holes in 100% of the sutured closure group, from the staple holes in 100% of the stapled only group, and from the incisional line in 83% and from bladder wall rupture in 8% of the augmented staple closure group. All closure methods withstood normal physiologic cystic pressures. CONCLUSIONS: Placement of a Cushing suture to augment stapled closures improved the ability of partial cystectomies to sustain higher intravesicular pressures compared with sutured or stapled bladder closures alone. Further in vivo studies are required to determine the clinical significance of these findings and the role of stapling equipment for partial cystectomy, as well as the clinical significance of suture penetration through the urinary bladder mucosa during closure.

Tracheal stenosis following endotracheal intubation in a dog.

A 2-month-old intact female Rottweiler was presented for investigation of coughing and respiratory distress 9 d after an exploratory laparotomy for intestinal foreign body removal. Tracheal stenosis was suspected by radiography and confirmed with computed tomography (CT) and tracheoscopy. After 1 wk of medical management, clinical signs had resolved and the severity of the tracheal narrowing was markedly improved, as confirmed by radiography and tracheoscopy. Tracheal stenosis is a considerable complication of endotracheal intubation in veterinary medicine and may be medically managed, depending on the severity of the tracheal injury. Key clinical message: To our knowledge, this is the first clinical case report of tracheal stenosis resulting from endotracheal intubation in a dog and its resolution after medical management.

Sténose trachéale après intubation endotrachéale chez un chien. Une femelle Rottweiler intacte âgée de deux mois a été présentée pour examen de la toux et de la détresse respiratoire neuf jours après une laparotomie exploratrice pour le retrait d'un corps étranger intestinal. Une sténose trachéale a été suspectée par radiographie et confirmée par tomodensitométrie et trachéoscopie. Après une semaine de prise en charge médicale, les signes cliniques avaient disparu et la sévérité du rétrécissement trachéal s'était nettement améliorée, tel que confirmés par la radiographie et la trachéoscopie. La sténose trachéale est une complication majeure de l'intubation endotrachéale en médecine vétérinaire et peut être prise en charge médicalement, selon la gravité de la lésion trachéale.Message clinique clé:À notre connaissance, il s'agit du premier cas clinique de sténose trachéale résultant d'une intubation endotrachéale chez un chien et de sa résolution après prise en charge médicale.(Traduit par Dr Serge Messier).

Three-dimensional bladder ultrasound to measure daily urinary bladder volume in hospitalized dogs.

BACKGROUND: Urinary bladder volume (UBV) and urine residual volume (URV) provide important information for hospitalized dogs and might allow recognition of urine retention. OBJECTIVE: Using 3-dimensional (3D) ultrasound to monitor daily URV is a safe and effective way to recognize urinary retention. ANIMALS: Twenty-five client-owned hospitalized dogs. METHODS: Prospective, observational study. UBV and URV were measured using 3D ultrasound daily at approximately the same time. UBV was measured, the dog was taken for a 5-minute controlled leash walk, then URV was estimated. Concurrent use of opioids, anesthetics, and fluids administered IV were recorded. RESULTS: Daily URVs were >0.4 mL/kg in 22 of 25 dogs on at least 1 day of hospitalization. Seventeen of 25 dogs had an abnormal URV at the time of discharge. Of 18 dogs that were anesthetized while hospitalized, 16 had a URV >0.4 mL/kg with a mean of 4.34 mL/kg (range, 0.5-13.4 mL/kg). No statistical difference in degree of URV was found based on the use of anesthesia, administration of fluids IV, or opioids. Weight was significantly associated with URV; dogs <10 kg had a higher URV per unit mass than dogs >10 kg (P = .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Use of a 3D ultrasound device to measure daily UBV and URV in hospitalized dogs provides a safe estimate of bladder volume in real-time. Monitoring daily URV might help in early identification of patients that are retaining urine, thereby preventing potential adverse effects of urethral catheterization or prolonged urinary retention.

Investigation of the use of microwave ablation with and without cooling urethral perfusion for thermal ablation of the prostate gland in canine cadavers.

OBJECTIVE: To investigate the use of microwave ablation (MWA) with cooling urethral perfusion and with no perfusion (MWA-UP and MWA-NP, respectively) for prostate gland ablation in canine cadavers. ANIMALS: Cadavers of 18 sexually intact male dogs. PROCEDURES: After technique refinement in 2 cadavers, laparotomy with ultrasound-guided MWA-UP (n = 8) or MWA-NP (8) of the prostate gland was performed in 16 cadavers. Normograde cystourethroscopy was performed before and after treatment; recorded images were reviewed in a blinded manner for scoring of urethral mucosal discoloration and loss of integrity. Difficulty with cystoscope insertion was recorded if present. Excised prostate glands were fixed for serial sectioning, gross measurements, and calculation of percentage ablation. Percentages of prostate tissue necrosis from MWA, denuded urethral mucosa, and depth of epithelial surface loss in an adjacent section of the colon were estimated histologically. Variables of interest were statistically analyzed. RESULTS: Difficulty with cystoscope insertion after treatment was significantly more common and scores for urethral mucosal discoloration and loss of integrity were significantly higher (indicating more severe lesions) for the MWA-NP group than for the MWA-UP group. The histologically assessed percentage of denuded urethral mucosa was also greater for the MWA-NP group. Overall median percentage prostate gland ablation was 73%; this result was not associated with prostate gland volume or chronological order of treatment. CONCLUSIONS AND CLINICAL RELEVANCE: MWA-UP induced subtotal thermal necrosis of prostate glands in canine cadavers while limiting urethral mucosal injury. Further study is required to optimize the technique and evaluate its safety and efficacy in vivo as a future curative-intent treatment for prostatic tumors in dogs.

Reversible myelosuppression suspected to be secondary to linezolid in a cat with infected subcutaneous ureteral bypass systems.

CASE SUMMARY: A 5-year-old castrated male domestic shorthair cat was presented for a multidrug-resistant Enterococcus faecium urinary tract infection within its bilateral subcutaneous ureteral bypass systems. After considerable consultation, the cat was treated with oral linezolid (10 mg/kg q12h) for two separate 2-week courses over 5 weeks. Over this time period, the cat became progressively neutropenic and thrombocytopenic, but was otherwise clinically stable. Upon cessation of the linezolid, the bicytopenia resolved within 12 days. RELEVANCE AND NOVEL INFORMATION: The reversible myelosuppression in this case is suspected to be secondary to linezolid administration. While previously reported in people, this effect has not been reported at therapeutic doses in veterinary species. This report demonstrates the potential for adverse drug reaction development in cats treated with prolonged linezolid therapy and highlights the need for extreme caution when utilizing linezolid in patients with renal insufficiency. Linezolid is the only drug currently approved by the Food and Drug Administration to treat vancomycin-resistant enterococci infections in people; however, resistance to this antibiotic appears to be increasing. Multidrug-resistant organisms continue to be a real global public health threat in both human and veterinary medicine. Third-tier antibiotics should only be considered under extreme circumstances and after considerable consultation with a specialist. Please note that the authors of this manuscript followed American Veterinary Medical Association policies on stewardship and International Society for Companion Animal Infectious Diseases guidelines, and do not promote or encourage the use in daily practice.

Three-dimensional bladder ultrasound for estimation of urine volume in dogs compared with traditional 2-dimensional ultrasound methods.

BACKGROUND: Although point-of-care volumetric assessments of the urinary bladder are not routinely performed in dogs, urine volume quantification can provide important clinical information including noninvasive urine output estimation. HYPOTHESIS/OBJECTIVE: Use of 3-dimensional (3D) ultrasound for determination of urinary bladder volume (UBV) in dogs will be accurate for different bladder volumes and will decrease the need for operator skill in measuring UBV compared to 2-dimensional (2D) ultrasound evaluation. ANIMALS: Ten laboratory-bred Beagle dogs. METHODS: Prospective, experimental study. Urinary bladders were infused with a calculated amount of sterile saline to represent small, medium, and large volumes. Each UBV was estimated and calculated by a board-certified veterinary radiologist using 3 different 2D ultrasound formulas followed by use of a 3D ultrasound device by a novice. Measured UBVs were compared to the instilled UBV for both 2D and 3D ultrasound methods. Time from start to end of examination was recorded for both ultrasound methods in a subset of dogs. RESULTS: The 3D ultrasound device underestimated UBV with a mean difference of -9.8 mL compared with 2D ultrasound that overestimated UBV with a difference of +4.2 to 20.3 mL dependent on the 2D formula used. The 3D ultrasound method took less time to measure UBV (mean of 80 seconds per measurement) compared to the 2D method (165 seconds per measurement; P = .02). CONCLUSIONS AND CLINICAL IMPORTANCE: The tested 3D ultrasound device was found to be an accurate and rapid point-of-care tool for measuring UBV in dogs, providing a noninvasive method to estimate bladder volume in real time.

Clinical findings, diagnostic test results, and treatment outcome in cats with hiatal hernia: 31 cases (1995-2018).

BACKGROUND: Information regarding clinical signs, assessment, treatment, and outcome in cats with hiatal hernia (HH) is limited. OBJECTIVES: To characterize the clinical presentation of HH and medical and surgical outcomes in a cohort of affected cats. ANIMALS: Thirty-one client-owned cats with HH. METHODS: Medical records of cats with HH were retrospectively reviewed for signalment, history, results of diagnostic tests, details of surgical and medical treatments, complications, and outcome. Long-term follow-up data were obtained by telephone communication. Relationships between clinical variables and outcome were evaluated by regression analysis. RESULTS: Type I HH was present in 85.7% (24/28) of cats, and 64.5% (20/31) were >3 years of age at diagnosis. Twenty-one of 31 (67.7%) cats underwent surgical repair including phrenoplasty, esophagopexy, and left-sided gastropexy, and 10 of 31 cats were treated medically without surgery. Concurrent illness was common, and 77.4% cats had comorbidities. All cats survived to discharge, and median time to death or follow-up was 959 days (range, 3-4015 days). Cats treated medically survived longer than cats treated surgically, with median time to death or follow-up of 2559 and 771 days, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Type I HH is the most common type of HH in cats. A congenital etiology is possible, but many cats with HH were >3 years of age at diagnosis and suffered from comorbidities, including upper airway obstruction. Case selection and the presence of comorbidities likely influenced the outcome. Cats with HH may not be diagnosed until disease is advanced or concurrent illness draws attention to clinical signs.