Receiver operating characteristics of computed tomography (CT) compared to cystoscopy in diagnosis of canine ectopic ureters: Thirty-five cases.

OBJECTIVE: The aim of the study was to determine receiver operating characteristics (ROC) of computed tomographic excretory urography (CTEU) in predicting cystoscopic findings of ureteral anatomy. STUDY DESIGN: Retrospective cohort study. ANIMALS: Thirty-five client-owned dogs. METHODS: The medical records of dogs referred for suspected ectopic ureters were reviewed. Inclusion criteria included CTEU findings reported by board-certified radiologists, followed by rigid cystoscopy with or without ureteral cystoscopic laser ablation (CLA). Data included signalment, urinary incontinence degree, body condition score, weight, degree of colon distension, CTEU and cystoscopy findings. ROC analysis was used to compare CT-predicted ureteral orthotopia/ectopia to cystoscopy findings. Additionally, ROC of CT predicted ureteral orifice locations was analyzed. Regression covariate analysis was performed to identify factors that may have influenced accuracy of diagnosis. RESULTS: The ability of CT to identify a normal and intra-or extramural ectopic ureters conclusively and correctly was 13/26 (50%) and 32/41(78%), respectively. Sensitivity and specificity of identifying extramural versus intramural ureters was 2/7 versus 30/46 (29 vs. 65%) and 61/63 versus 17/24 (97 vs. 71%), respectively. Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively. Covariate analysis failed to identify interfering factors. CONCLUSIONS: CT did not accurately predict anatomy of ureters; CT findings may need confirmation by cystoscopy and possibly intraoperative fluoroscopy prior to determining if CLA is indicated or not. CLINICAL SIGNIFICANCE: Our results may be of importance for surgeons interpreting the CTEU findings. CTEU prediction of the location of the ureteral orifice shows low sensitivity especially in or close to the urethral sphincter area.

Sex identification in juvenile and adult Indonesian blue-tongued skinks (Tiliqua gigas) through cystoscopy and accuracy of contrast radiography.

OBJECTIVE: To describe a nonsurgical endoscopic technique for sex identification in Indonesian blue-tongued skinks (Tiliqua gigas) and to assess accuracy of contrast radiography of the hemipenile/hemiclitoral pouches. ANIMALS: 42 clinically healthy Indonesian blue-tongued skinks between 6 months and 3 years old and weighing between 22 and 550 g. METHODS: Cystoscopy was performed under general anesthesia. Gonads were visualized through the transparency of the urinary bladder, and their gross morphology was described. Contrast was applied in the tail pouches before obtaining full-body radiographs. Two radiologists, blinded to the sex of the skink, evaluated the radiographs. RESULTS: Cystoscopy was achieved in all 42 skinks. Visualization of the gonads through the urinary bladder was possible in 41 (98%; 95% CI, 87% to 99%) of the skinks, with 18 of them identified as males and 23 identified as females. Median procedure time was 60 seconds (range, 25 to 180 seconds) and was not associated with procedure order (-0.69; 95% CI, -1.83 to 0.45) or with the weight (0.02 g; 95% CI, -0.07 to 1.0) or the identified sex (11.7; 95% CI, -15.07 to 38.45) of the skink. Radiographs had a sensitivity of 69.6% (95% CI, 47.1% to 86.8%) and a specificity of 75.0% (47.6% to 92.7%) to identify female skinks. All the skinks recovered uneventfully. CLINICAL RELEVANCE: Cystoscopic sex identification is feasible in Indonesian blue-tongued skinks of various age and size. Considering the difficulty in identifying their sex otherwise, this technique could provide a significant improvement in the veterinary care of this species. In this population, contrast radiographs showed limited accuracy for sex identification.

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.

Diagnostic yield of uroendoscopy compared to ultrasonography for evaluating lower urinary tract disorders in dogs.

BACKGROUND: Cystourethroscopy and vaginoscopy (uroendoscopy) is often used in the diagnostic evaluation of dogs with lower urinary tract disorders (LUTD). OBJECTIVE/HYPOTHESIS: To evaluate if uroendoscopy is warranted in dogs with various LUTD, the agreement between uroendoscopic and ultrasonographic diagnoses were compared. Dogs with recurrent urinary tract infections (rUTI) will have the highest diagnostic agreement between uroendoscopy and ultrasonography (US) compared to dogs presenting for other LUTD. ANIMALS: Two hundred thirty-seven dogs presenting between 2014 and 2019 with lower urinary tract signs (LUTS) that had US within 60 days preceding uroendoscopy. METHODS: Retrospective study. Dogs were categorized by primary indication for ultrasound. Pertinent uroendoscopic findings were recorded and agreements (κ analysis) between the final uroendoscopic diagnosis were compared with the final ultrasonographic diagnosis. RESULTS: Pertinent uroendoscopic findings were recorded for 69/237 (29%) cases. For dogs presenting primarily for urinary incontinence (UI), agreement between uroendoscopy and US was 71% (46/65; κ = 0.47, 95% CI 0.28-0.66), for dogs with stranguria, 58% (29/50; κ = 0.47, 95% CI 0.31-0.62) and for dogs with rUTI the agreement was substantial at 87% (26/30; κ = 0.70, 95% CI 0.43-0.98). Urethral strictures were the majority (14/21; 67%) of pertinent uroendoscopic findings for dogs with stranguria, of which 12 were male dogs. CONCLUSIONS AND CLINICAL IMPORTANCE: Agreement between uroendoscopy and US was moderate for all dogs. Based on these data, recommendation for uroendoscopy should be tailored to individual clinical presentation and signalment; transabdominal US is not the preferred modality for urethral lesions.

Cystoscopic Abnormalities in Dogs Presented for Episioplasty.

A recessed vulva is a conformational abnormality that predisposes affected dogs to urinary tract infections. An episioplasty can be recommended for correction of this abnormality when medical management of recurrent urinary tract infection fails. The objective of this study was to investigate the type and incidence of urogenital abnormalities visualized by cystoscopy in dogs presenting for episioplasty. Medical records of 29 dogs that presented for an episioplasty and had a concurrent or prior cystoscopy were reviewed. Eleven of the 29 dogs had urogenital abnormalities diagnosed on cystoscopic evaluation, and 1 dog was diagnosed with a urogenital abnormality during vaginal examination while under general anesthesia. Ten of the dogs with urogenital abnormalities had a corrective procedure performed, 8 of which were cystoscopically assisted. Cystoscopy provides the ability to directly visualize the urinary tract and obtain samples for biopsy and culture and facilitates correction of some anatomic abnormalities that may predispose the patient to developing recurrent urinary tract infections. Cystoscopy should be considered as a routine part of a thorough evaluation of the urinary tract in cases presenting for episioplasty.

Short-term efficacy of epidural pain management in dogs undergoing cystoscopy.

BACKGROUND: The effects of epidural anesthesia in dogs undergoing cystoscopy are unknown. OBJECTIVE: To investigate the effect of epidural analgesia on postcystoscopy pain in dogs. ANIMALS: Twenty-six dogs undergoing routine cystoscopy for lower urinary tract disease. METHODS: Prospective, randomized, blinded observational study. Dogs were assigned either to a treatment group that received epidural anesthesia (preservative free morphine sulfate, 0.09 mg/kg; 1% ropivacaine, 0.2 mg/kg; total volume delivered, 1 mL/4.5 kg of body weight to a maximum of 10 mL; n = 9) or to a nonepidural control group (n = 13). Vital signs were monitored for 24 hours, and sedation and pain scores, behavioral assessments, and presence or absence of complications was evaluated for 5 days postprocedure. RESULTS: All dogs tolerated the epidural without complications. Four dogs were removed from the study because of status unblinding, lack of patient cooperation, or incomplete follow-up. No significant differences were noted in postprocedural pain scores in dogs that received epidural analgesia. Significant differences in postprocedural pain scores were noted in the nonepidural control group. No significant differences were noted in vital signs, behavioral assessments, or the proportion of dogs with a 50% increase in pain scores between the epidural and nonepidural groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Epidural anesthesia was well-tolerated. Dogs not receiving the epidural had poor postprocedural pain control. A consistent benefit for the epidural vs nonepidural group could not be identified. Additional studies are required to better assess the impact and efficacy of epidural anesthesia for cystoscopic procedures.

A case of congenital ureteral atresia causing rare upper and lower urinary tract manifestations in a puppy: a case report.

BACKGROUND: Ureteral atresia is the congenital absence of a ureteral opening, resulting in a blind-ended ureter that fails to terminate at the urinary bladder. Consequently, severe hydroureter and hydronephrosis occur ipsilateral to the atresic ureter. However, hydronephrosis contralateral to severe hydroureter, although reported in humans, is not documented in the dog. Additionally, ureteral atresia has not been reported as a cause for lower urinary tract signs directly related to extramural urinary bladder compression. This report aims to describe these unique manifestations of this congenital urinary tract disease, as well as follow-up findings after successful treatment. CASE PRESENTATION: A 4-month-old male Husky puppy was evaluated for pollakiuria, stranguria, and urine dribbling of 1-month duration. During the physical examination, a mass was palpated in the mid-abdomen. Diagnostic imaging and cystoscopy findings were diagnostic for right-sided ureteral atresia with secondary hydroureter and hydronephrosis. The severe right hydroureter caused lower urinary tract signs and contralateral hydronephrosis secondary to regional compression of the left distal ureter and urinary bladder. A right-sided ureteronephrectomy was performed, resolving the stranguria and pollakiuria. Significant reduction in the contralateral (left) hydronephrosis also occurred. CLINICAL RELEVANCE: Ureteral atresia should be considered as a differential diagnosis for lower urinary tract signs and/or bilateral hydronephrosis in a young dog. Reporting this case expands our knowledge of congenital lower urinary tract disease and the etiology of their manifestations in dogs. Surgical resolution of the congenital ureteral abnormality can result in preservation of renal function in the contralaterally obstructed kidney.

The Use of Pneumatic Impact Lithotripsy in a Laparoscopic Retrieval Pouch for Removal of Large Cystoliths in Two Female Horses.

Two mares, aged 15 and 21 years, were examined because of urinary incontinence, intermittent hematuria, and urine scalding. On admission of both horses, physical parameters were within normal limits and urine scalding of the skin at the ventral perineum was noted. Transrectal palpation and cystoscopy revealed a large type I cystolith (>10 cm) with associated hyperemia and focal ulceration of the bladder mucosa. In horse 1, hemogram, serum biochemical analysis, and renal ultrasound were not performed because of owner finances. In horse 2, results from hematological and serum biochemical analysis were unremarkable and renal ultrasonography did not reveal any abnormalities. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch was performed under cystoscopic guidance after caudal epidural anesthesia, with the horses standing and under sedation. A laparoscopic retrieval device was passed alongside a flexible endoscope into the urinary bladder and the cystolith was manipulated into the pouch. A customized single stainless-steel rod scaler attached to an air compressor was used for fragmentation of the cystolith contained within the retrieval pouch. Lithotripsy time was 42 minutes for horse 1 and 31 minutes for horse 2. Both horses were released from hospital the day of surgery. Both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 27 and 19 months for horse 1 and horse 2, respectively. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch provided a time-efficient and minimally invasive surgical treatment option for removal of large cystoliths in mares.

Transurethral cystoscopy in dogs with recurrent urinary tract infections: Retrospective study (2011-2018).

BACKGROUND: Urinary tract infections (UTIs) are common in female dogs and recurrent infections often require investigation by transurethral cystoscopy. HYPOTHESIS/OBJECTIVES: Describe the findings of transurethral cystoscopy in dogs presented for recurrent urinary tract infections (RUTI). ANIMALS: Fifty-three client-owned dogs with RUTI were included in the study. METHODS: Retrospective study. Data collected from medical records included signalment, clinical findings, bladder wall culture, cystoscopic, and histopathologic findings. UTI was defined as: presence of compatible clinical signs and at least 2 out of 3 of the following criteria: (1) pyuria, (2) positive urine culture, (3) resolution of clinical signs with antibiotic treatment. Recurrence of UTI was defined as at least 2 episodes of UTI within 6 months or at least 3 or more in 1 year. RESULTS: The mean age at presentation was 3.8 years with a majority of female dogs (48/53), 40/48 of which were spayed. Main breeds were Labrador (10/53), Australian Shepherd (4/53), and Miniature Schnauzer (3/53). A hooded vulva was noted in 33/48 of females. Transurethral cystoscopy showed anomalies in 45/53 of cases: mucosal edema (19/53), vestibulovaginal septal remnant (15/48), lymphoid follicles (8/53), short urethra (6/53), and ectopic ureter (5/53). Urine culture at the time of cystoscopy was positive in 13/49. Bladder wall edema and ulceration were the most common findings on histopathology (25/39). CONCLUSION AND CLINICAL IMPORTANCE: RUTI occurred more frequently in spayed female dogs. Transurethral cystoscopy is useful in the diagnosis and treatment of anomalies in dogs with RUTIs.

Association of abdominal effusion with a single decompressive cystocentesis prior to catheterization in male cats with urethral obstruction.

OBJECTIVE: To evaluate the occurrence of abdominal effusion and its association with decompressive cystocentesis in male cats with urethral obstruction. DESIGN: Prospective observational clinical study. ANIMALS: Forty-five male neutered, client-owned cats with naturally occurring urethral obstruction. PROCEDURES: Laboratory testing and point-of-care ultrasonography were performed. Presence of abdominal effusion was evaluated using the Focused Assessment with Sonography for Trauma (FAST) technique at presentation. Decompressive cystocentesis was then performed prior to catheterization by a standardized technique. Repeat FAST examination was performed 15 minutes after cystocentesis and the following day to further assess for the presence of abdominal effusion. RESULTS: A mean volume of 92.3 ± 35.2 mL of urine was removed from each cat via cystocentesis prior to catheterization. At presentation, 15 of 45 (33%) had abdominal effusion (13/15 with scant effusion, 2/15 with mild), with an additional 7 cats developing scant effusion 15 minutes post-cystocentesis. By the following day, 4 cats still had scant effusion present. No significant complications secondary to cystocentesis were reported. No association was found between severity of azotemia, or volume removed by cystocentesis, and the presence of effusion at presentation or after decompressive cystocentesis was performed. CONCLUSIONS AND CLINICAL RELEVANCE: A single decompressive cystocentesis prior to catheterization did not lead to development of clinically significant abdominal effusion or other discernable complications and appears to be a safe procedure in this population of patients. Abdominal effusion may be found at presentation in cats with urethral obstruction. The significance of this effusion remains to be determined.

Endoscopic-guided laser lithotripsy for removal of an encrusted ureteral stent in a dog.

CASE DESCRIPTION: An 8-year-old spayed female Dalmatian was evaluated because of recurrent urinary tract infections following ureteral stent placement 3 years earlier. CLINICAL FINDINGS: Polyuria, pollakiuria, and hematuria were reported by the owner. Abdominal radiography revealed well-defined, faintly mineralized material superimposed over the distal portion of the previously placed ureteral stent. Abdominal ultrasonography revealed thickening of the bladder wall, right hydroureter, and right pyelectasia; the ureteral stent appeared to extend into a region containing cystic calculi. Cystoscopy revealed small uroliths and mineralized encrustation of the distal portion of the ureteral stent. TREATMENT AND OUTCOME: A holmium:yttrium-aluminum-garnet laser was used to fragment mineralized material from the distal end of the stent and allow endoscopic transurethral removal. Stone analysis revealed ammonium urate as the major component of the mineralized material. The owner was instructed to feed the dog a diet formulated to decrease the likelihood of urate stone recurrence and to administer marbofloxacin for 6 weeks because of suspected pyelonephritis. Follow-up bacterial culture of a urine sample and abdominal ultrasonography revealed resolution of urinary tract infection, pyelectasia, hydroureter, and associated clinical signs. CLINICAL RELEVANCE: Results suggested that endoscopic-guided laser lithotripsy can be used as a minimally invasive alternative to surgery for removal of severely encrusted ureteral stents in dogs.

Use of cystoscopy or cystourethroscopy in treating benign macroscopic hematuria caused by lower urinary tract hemorrhage in three dogs.

CASE DESCRIPTION: A 5-year-old 11.5-kg (25.3-lb) castrated male Boston Terrier (dog 1), an 8-year-old 27.8-kg (61.2-lb) castrated male Boxer (dog 2), and a 10.5-year-old 15.9-kg (35.0-lb) spayed female Pembroke Welsh Corgi (dog 3) were evaluated because of severe, gross hematuria and suspected idiopathic renal hematuria. CLINICAL FINDINGS: All 3 dogs had hematuria, anemia, blood clots in their urinary bladders, and unremarkable findings on coagulation and mucosal bleeding time assessments. With cystourethroscopy, lower urinary tract hemorrhage originating from a small lesion in the urinary bladder (n = 2) or urethra (1) and normal-appearing yellow urine jetting from both ureterovesicular junctions were visualized in each dog. TREATMENT AND OUTCOME: Cystoscopically guided surgical resection of a hemorrhagic lesion of the urinary bladder was performed on dog 1, and histologic evaluation of the resected tissue confirmed urinary bladder telangiectasia. Dogs 2 and 3 each underwent cystourethroscopically guided laser ablation of a hemorrhagic lesion (presumptively diagnosed as hemangioma, angioma, or telangiectasia) in the urinary bladder (dog 2) or urethra (dog 3). The longest follow-up duration was 7 years, and none of the 3 dogs had subsequent recurrence of gross hematuria. CLINICAL RELEVANCE: Findings suggested that cystourethroscopy should be considered part of the diagnostic plan for hematuria in dogs before pursuing major surgical treatment or when results of conventional diagnostic procedures do not indicate the underlying cause. In addition, histologic results for dog 1 indicated urinary bladder telangiectasia, previously an unreported cause of severe, chronic lower urinary tract hematuria in dogs.

Endoscopic laser-ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008-2017).

BACKGROUND: Ureteroceles are a rare condition in dogs in which conventional treatments can result in substantial morbidity. Cystoscopic and fluoroscopic-guided laser ablation (CLA) of ureteroceles can successfully relieve obstruction. OBJECTIVES: To describe the technique and outcomes of attempting CLA for treatment of ureteroceles in dogs. ANIMALS: Thirteen client-owned dogs that underwent CLA for treatment of ureteroceles. METHODS: Retrospective multicentered study. Medical records were reviewed in all dogs that underwent CLA for ureterocele(s). A laser was used to extend the opening of the ureteral orifice (UO) unless surgical conversion was necessary. Data collected included signalment, clinicopathologic data, imaging, procedural findings, complications, and short- and long-term outcome. RESULTS: Thirteen dogs with 13 ureteroceles associated with 14 UOs resulting in ureteral obstruction were included. One ureterocele extended bilaterally. Treatment was initiated via retrograde cystoscopy (7 females), percutaneous perineal urethrocystoscopy (4 males), or percutaneous antegrade cystoscopy (2 males). Surgical conversion was necessary in 2 males. Ten of 14 (71%) UOs associated with the ureteroceles were ectopic. Thirteen of 14 had stenotic or imperforate UOs. No postoperative complications were noted. Preoperative incontinence or pollakiuria was present in 9 of 13 and 3 of 13 dogs and resolved in 8 of 9 and 3 of 3 dogs, respectively. Follow-up imaging showed resolution of all ureteroceles and improved ureteral/renal pelvic dilatation. Median follow-up time was 27 months (range, 3-96 months). CONCLUSIONS AND CLINICAL IMPORTANCE: Cystoscopic-guided laser ablation was effective for the treatment of ureteroceles(s) in 11 of 13 dogs.

Clinical, histopathologic, cystoscopic, and fluorescence in situ hybridization analysis of proliferative urethritis in 22 dogs.

BACKGROUND: Proliferative urethritis (PU) is a lower urinary tract disease of dogs characterized by frond-like lesions in the urethra. The etiology of PU is unknown, although an association with bacterial cystitis is reported. OBJECTIVES: Deep-seated bacterial cystitis is associated with PU, particularly in dogs with neutrophilic or granulomatous inflammation. ANIMALS: Twenty-two client-owned dogs with PU and 5 control dogs euthanized for non-urinary disease. METHODS: In retrospective analysis, medical records of dogs with PU from 1986 to 2016 were reviewed. Signalment, clinical signs, cystoscopic findings, antimicrobial use, and results of urine, bladder, or urethral tissue cultures, if available, were recorded. Histopathology was reviewed and classified as lymphocytic-plasmacytic (LP), neutrophilic, LP-neutrophilic (LPN), granulomatous, or pleocellular. Eubacterial fluorescence in situ hybridization (FISH) was performed on 18 tissue samples (13 cases, 5 controls), with subsequent evaluation of bacterial species. RESULTS: Of the 22 dogs, 9 had LP urethritis, 6 had LPN, 4 had pleocellular, and 3 had neutrophilic urethritis. Of note, 7 of 13 PU samples were FISH+ for adherent or invasive bacteria; 1 of 5 controls were FISH+ for adherent bacteria. Five dogs had negative urine and tissue cultures when FISH was positive. There was no association detected between the type of urethral inflammation and the results of urine and tissue culture or FISH. CONCLUSIONS AND CLINICAL IMPORTANCE: The type of inflammation varied widely in these 22 PU cases. Deep-seated bacterial urethritis could be contributing to the inflammatory process in some dogs, regardless of the inflammation type. Urine and tissue cultures likely underestimate bacterial colonization of the urethra in dogs.

Ureteral ectopia and urethral sphincter mechanism incompetence: an update on diagnosis and management options.

The two leading causes of urinary incontinence in dogs are ureteral ectopia in juveniles and urethral sphincter mechanism incompetence in adults. While the accuracy of diagnosis of ectopic ureters has improved due to increased use of CT and/or cystoscopy, the diagnosis of urethral sphincter mechanism incompetence largely remains one of exclusion. New treatment options have been developed for both conditions, which have reduced morbidity and mortality, although the rate of long-term urinary continence has not significantly improved for either and neither has our understanding of the pathophysiology behind these failures. This review provides updates on the management of both of these conditions, with discussion of controversial areas and thoughts for future directions.

Use of cystoscopic-guided laser ablation for treatment of unilateral ureterovesicular stenosis and secondary orthotopic ureterocele in a female dog.

CASE DESCRIPTION A 4-year-old spayed female Beagle was evaluated because of a 2-month history of intermittent pollakiuria, stranguria, dysuria, and abdominal pain. A diagnosis of bacterial cystitis was initially made, but clinical signs persisted despite appropriate antimicrobial treatment, so the dog was referred for further evaluation and treatment. CLINICAL FINDINGS Abdominal ultrasonography revealed a large, thin-walled, cystic structure in the urinary bladder at the level of the expected right ureterovesicular junction that communicated with the uniformly dilated right ureter. Severe right-sided pyelectasia was also detected. A presumptive diagnosis was made of a right-sided orthotopic ureterocele with secondary hydroureter and pyelectasia. TREATMENT AND OUTCOME Cystoscopy revealed a large cystic structure in the region of the right ureterovesicular junction without obvious communication between the ureter and urinary bladder. Portable C-arm fluoroscopy was used to confirm the presence of an intramural orthotopic tract and to measure the diameter of the ureter and renal pelvis via retrograde contrast ureteropyelography. Complete laser ablation of the ureterocele was performed by incising it circumferentially near its base. Clinical signs resolved immediately following the procedure. Six weeks later, the dog remained free of clinical signs and abdominal ultrasonography revealed resolution of hydroureter with persistence of mild right-sided pyelectasia. CLINICAL RELEVANCE Cystoscopic-guided laser ablation of an orthotopic ureterocele secondary to ureterovesicular stenosis was a safe and effective minimally invasive treatment for the dog of this report, resulting in immediate and continued improvement of clinical signs and ultrasonographic changes. Laser ablation should be considered as an alternative to surgery for the treatment of orthotopic ureteroceles in dogs.

Sondagem da pelve renal guiada por cistoscopia em éguas / Catheterization of the renal pelvis guided by cistoscopy in mare

O objetivo deste trabalho foi padronizar a técnica de acesso à pelve renal por meio de sondagem ureteral guiada por cistoscopia em éguas. Foram utilizados oito animais, de raças variadas, com peso médio de 439kg. As éguas foram sedadas e mantidas em tronco de contenção para a realização da cistoscopia com endoscópio flexível. Após identificação do óstio ureteral esquerdo, uma sonda de polietileno foi introduzida em seu lume, até a pelve renal. A localização da sonda no rim foi confirmada por meio de ultrassonografia transcutânea. Foram coletados 3mL de urina, de forma asséptica, para citologia e cultura bacteriana. Todas as amostras obtiveram resultados negativos na cultura e análise do sedimento urinário. Nenhum dos animais apresentou quaisquer complicações após a sondagem. Este estudo demonstrou que a coleta de urina diretamente da pelve renal em éguas, com auxílio da cistoscopia na realização da sondagem ureteral, consiste em um procedimento viável e seguro.(AU)

The objective of this study was to standardize the technique of access to the renal pelvis by means of ureteral catheterization guided by cystoscopy in mares. Eight animals of different races were used, with an average weight of 439kg. The mares were sedated and contained in containment trunk for the accomplishment of cystoscopy with flexible endoscope. After the identification of the left ureteral ostium, from where inside a catheter was introduced, which went through the entire extension of the ureter up to the renal pelvis. After identification of the left ureteral ostium, from where inside a catheter was introduced, into its lumen until reaching the renal pelvis. The location of the probe in the kidney was confirmed by transcutaneous ultrasonography. Three ml of urine was aspirated aseptically for cytology and microbiological culture. All the samples obtained negative results in the culture and sedimentation. None of the animals had any complications after catheterization. This study demonstrated that the collection of urine directly from the renal pelvis in mares, with the assistance of cystoscopy in the realization of the ureteral catheter, consists of a viable and safe procedure.(AU)

Cystoscopic diagnosis of polypoid cystitis in two pet rabbits.

CASE DESCRIPTION AS-year-old male Dwarf rabbit and 4-year-old female Mini-Rex rabbit were evaluated because of anorexia and urine scalding of the perineum. CLINICAL FINDINGS Abdominal radiography revealed a diffuse increase in the opacity of the urinary bladder attributable to urinary sludge. In 1 rabbit, abdominal ultrasonography revealed several mass-like lesions protruding from the mucosal surface into the lumen of the urinary bladder. Rabbits were anesthetized, and cystoscopy was performed with a rigid 2.7-mm, 30° endoscope. Histologic analysis of tissue samples obtained through the cystoscope operating channel revealed findings consistent with polypoid cystitis. TREATMENT AND OUTCOME To remove the urinary sludge from each rabbit, the urinary bladder was filled with sterile saline (0.9% NaCl) solution and emptied with a gentle massage several times until the ejected fluid was transparent. Rabbits were treated with NSAIDs, antimicrobials (chosen following microbial culture of urine and antimicrobial susceptibility testing), bathing of the perineum, and a low-calcium diet. The male rabbit died of unrelated causes 18 months later; postmortem examination findings confirmed the polypoid cystitis. The female rabbit remained disease free through to last follow-up (12 months after initial evaluation). CLINICAL RELEVANCE This was the first report of polypoid cystitis in pet rabbits. Although ultrasonographic findings supported this diagnosis, a definitive diagnosis was achieved through cystoscopy and lesion biopsy. Treatments administered were intended to reduce the potential sources of irritation. Research is needed to investigate the effectiveness of the applied interventions and the association between excessive urinary calcium excretion and polyploid cystitis in rabbits.

Use of Cystoscopy to Visualize Morphological Alteration of the Liver in a Posthatchling Turtle ( Cuora trifasciata ).

A 55 g, 7 mo old Chinese three-striped box turtle ( Cuora trifasciata ) was presented with a 2 wk history of lethargy and anorexia. The owner attempted various antibiotic treatments without clinical improvement. A cystoscopic evaluation of the coelom was performed. The liver appeared dark red-to-brown presenting multifocal irregularly shaped white-to-tan and roughly round areas of discoloration on the capsular surface. An adult keeled box turtle (Pyxidea mouhotii), which died in the same facility at the same time, had similar hepatic lesions detected upon necropsy. From hepatic lesions, an antibiotic-resistant Escherichia coli was isolated. Antibiotic treatment based on sensitivity testing led to a rapid resolution of the clinical signs in the Cuora trifasciata , with gain of appetite 4 days after the first antibiotic administration. A recheck cystoscopy demonstrated macroscopic resolution of hepatic lesions. This report demonstrates, to the best of the authors' knowledge, for the first time the clinical usefulness of cystoscopy for the diagnostic evaluation of the coelom of small chelonians. This minimally invasive technique is a valuable clinical tool in the medical approach to posthatchling chelonians.

Clinical Applications of Cystoscopy in Chelonians.

The medical approach to chelonians can be challenging. Cystoscopy may be useful to evaluate morphologic changes in the viscera without the need of celiotomy, and is a valuable diagnostic tool. The size and transparency of the urinary bladder in chelonians allows visualization of most coelomic organs. Through cystoscopy the external aspect of stomach, intestine, heart, lungs, liver, pancreas, spleen, kidneys, testes, and ovaries may be visualized. Although a definitive diagnosis cannot be achieved, rapid identification of the diseased system through cystoscopy may be possible. Furthermore, cystoscopy is fundamental for diagnosis and treatment of lower urogenital disorders.