Ch 116 Bladder

Question 1

anatomy

Answer 1

• ventral median ligament (contained the urachus in foetus)
• lateral ligaments: distal portion of the ureter and umbilical artery on each side
• Each ureter tunnels obliquely through the dorsolateral bladder wall before opening into the bladder
• urothelium of the bladder consists of mucosa composed of transitional epithelial cells, and submucosa, which contains connective tissue
• The urothelium is covered by a layer of smooth muscle (detrusor muscle)
• there is no anatomically distinct internal sphincter at the vesicourethral junction
• The serosa is the outermost layer of the bladder

Question 2

Where is the trigone?

Answer 2

Internal region of the bladder between the ureteral opening and the urethral opening at the bladder neck

Question 3

micturition

Answer 3

Urinary control is regulated by sympathetic, parasympathetic, and somatic innervation.
- The internal urethral sphincter remains contracted via sympathetic α-adrenergic stimulation from the hypogastric nerves (L1-L4), while β-adrenergic stimulation relaxes the detrusor muscle, allowing urine storage.
- Bladder distention activates stretch receptors, triggering parasympathetic pelvic nerve stimulation (S1-S3), leading to detrusor contraction and urination.
- This activation also inhibits sympathetic control and signals the brainstem to relax urethral musculature.
- The pudendal nerve (S1-S3) provides somatic control over the external urethral sphincter, which maintains urethral resistance during storage and relaxes during reflex urination.
- Voluntary control occurs via pudendal nerve innervation and direct cortical influence on the pontine micturition center.

Question 4

micturition - filling and storage

Answer 4

During filling and storage, stretch receptors in the bladder wall send afferent signals
along the pelvic nerve, which activate a reflex arc through the hypogastric nerve to the urethra (Fig. 2). Norepinephrine is released by postganglionic neurons to activate
beta3-adrenergic receptors in the bladder wall, allowing relaxation and continued filling.
Norepinephrine also stimulates alpha1-adrenergic receptors in the urethra and causes
contraction of the urethral smooth muscle, thus preventing urine leakage

Question 5

micturition- voiding

Answer 5

During initiation
of micturition, stretch receptors send afferent signals along myelinated fibers of
the pelvic nerve to the lumbar spinal cord and cranial to the pontine micturition center
in the brain. Signals from the cerebral cortex and the hypothalamus are processed to
determine whether the situation is appropriate for urination. If so, signals are sent
down the pelvic nerve, which leads to acetylcholine release at the postganglionic parasympathetic
neurons. Acetylcholine binds to M3 receptors and stimulates bladder
smooth muscle contraction. At the same time, inhibitory signals are sent to the sympathetic
reflexes and the urethra relaxes, allowing normal emptying.

Question 6

management - meds etc

Answer 6

-

Question 7

Functional Obstruction: Detrusor Urethral Dyssynergy

Answer 7

Functional urethral obstruction, or detrusor urethral dyssynergy (DUD), arises from an
abnormality in the reflex arc that allows the urethral sphincter to relax at the initiation
of detrusor contraction and urination. The lesion is thought to be in the reticulospinal
tract, Onuf nucleus, or the caudal mesenteric ganglion, and it is possible that the lesion
involves the loss of inhibitory signals to the pudendal and hypogastric nerves

Question 8

Not all detrusor muscle cells have direct innervation: transmission of neuromuscular impulses also occurs between one innervated detrusor muscle cell and many adjacent muscle cells. Prolonged bladder distention or bladder fibrosis results in loss of this excitation-contraction coupling; subsequent atony of the detrusor muscle results in urine retention and overflow

Answer 8

In addition to normal neurologic mechanisms, several other factors are important for
the normal function of the micturition cycle in dogs and cats. The integrity of the
smooth muscle of the urethra, normal urethral mucosa that creates a watertight
seal, associated vasculature, and the support of connective tissues are also key.1,2
In females, estrogen seems to have a significant impact on these tissues.3,4 Its decline
after neutering seems to play a role in the urethral sphincter mechanism incompetence
(USMI) seen in neutered female dogs.5,6 Alternatively, prostatic hyperplasia in intact
male dogs can lead to functional urethral obstruction and urinary retention.

Question 9

Blood Supply and Lymphatic Drainage

Answer 9

• the vascular supply also enters the bladder dorsally.
• The caudal vesical artery is the major arterial supply to the bladder. It arises from the vaginal (females) or prostatic (males) branch of the internal pudendal artery.
• Bladder venous drainage is into the internal pudendal veins, and lymphatic drainage is via the hypogastric and sublumbar lymph nodes.

Question 10

How long does it take for bladder mucosa to heal?
How long for full-thickness defects to reach full strength?

Answer 10

Mucosa fully heads in 5 days
Full thickness strength in 14-21 days

Question 11

Suture Material, and Suture Patterns

Answer 11

• absorbable, synthetic suture suitable choices for closure.
• Monofilament suture recommended > less tissue drag than multifilament and fewer bacteria adhere
• Nonabsorbable sutures or staples are not required and could predispose to cystic calculi formation.
• Hickey 2020 found calculi associated with PDS/maxon
• polydioxanone and polyglyconate are acceptable in sterile and E.coli–contaminated urine but that poliglecaprone 25 may not have sufficient tensile strength during the critical phase of bladder healing
• suture size ranges from (3-0 to 5-0)

closure pattern
- there is no consistent evidence as to which performs best overall
- - accurate needle placement through the strength-holding submucosal layer
- A single-layer, full-thickness, simple, continuous, or interrupted appositional closure is quick, provides accurate apposition of the strength-holding submucosal layer, and has not been shown to be inferior to a two-layer, inverting, continuous suture pattern
- compromised bladder > omentalise, serosal patch

barbed suture may be appropriate for cystotomy closure but in vivo studies are needed to support this finding (used in laparoscopy, no knot required)

Question 12

What suture materials are most appropriate for use in the bladder?
What organism disintegrated all tested sutures by day 7?

Answer 12

Polydioxanone and polyglyconate
Proteus mirabilis

Question 13

What ABx are a reasonable choice for periop antibiosis in the face of a UTI?

Answer 13

Amoxiclav
3rd gen cephalosporin
Enrofloxacin

Question 14

antibiosis

Answer 14

• absence of infected urine is classified as clean contaminated.
• The infection rate for this class is approximately 5%
• E.coli, Proteus, Staph
• • there does not appear to be a significant risk for affecting an intraoperative positive urine culture result by administering prophylactic antibiotics at induction before surgery

Question 15

What effects does azotaemia have on anaesthesia and surgery?

Answer 15

• Significant impact on animals ability to tolerate anaesthesia due to alterations of pharmacokinetics of, and sensitivty to, drugs
• Interferes with platelet function

Question 16

What are the effects of hyperkalaemia?

Answer 16

Bradycardia
Arrhythmias
Potentiates the cardiodepressant effects of anaesthetic drugs

Question 17

hyperK Tx

Answer 17

• Fluid therapy and bladder decompression or urinary diversion (depending on the cause of the hyperkalemia) are often all that are required to correct hyperkalemia
• severe hyperkalemia, intravenous calcium gluconate, glucose and insulin

Question 18

diagnostics

Answer 18

cystocentesis
- (C&S, urinalysis, decompress)

catheter biopsy
- applying suction using a syringe via a urinary catheter
- histologic diagnosis in 10 of the 12 dogs

Bladder ultrasonography
- most sensitive
- ultraosund guided biopsy

Positive-contrast cystogram
- reveal the presence of bladder rupture,
- identify radiolucent calculi,
- outline any bladder masses

retrograde urethrocystogram
- lower rupture location is not known.

double-contrast cystogram
- enhanced mucosal detail (lesions, masses, calculi)

intravenous urogram
- Computed tomography (CT) excretory urography

cystoscopy
- direct, magnified view of the mucosal surfaces of the bladder and urethra.
- allows retrieval of calculi or biopsy of bladder tissue, lithotripsy of bladder calculi, laser ablation of ectopic ureters, submucosal injection of collagen

Question 19

List the options for contrast radiographs for the work-up of suspected urolithiasis

Answer 19

Cystogram
Retrograde cystourethrogram
Double contract cystogram
Intravenous urogram

Question 20

Cystotomy

Answer 20

• • There is no difference urine leakage, adhesions, or calculi formation between dorsal or ventral cystotomy approaches
• cystotomy vs LAC: - Results suggested that LAC may be an acceptable minimally invasive technique for treatment of cystic calculi in dogs. Surgery times were similar to those for dogs undergoing OC; however, surgical and total procedural costs were higher. Further investigation is suggested to determine which patients may benefit from LAC versus traditional OC

Question 21

What is the reported rate or uroabdomen after cystotomy?

Answer 21

less than 1.5%

Haematuria and dysuria in 37-50%

Question 22

Cystectomy

Answer 22

• a temporary cystostomy tube or an indwelling urethral catheter may be placed to maintain bladder decompression
• ureteral orifices, then the ureter can be transected and reimplanted
• neurovascular supply to the bladder enters dorsally in the trigone region

Question 23

What cause bladder regeneration after cystectomy?

Answer 23

• Mucosal regeneration, synthesis and remodelling of scar tissue
• Hypertrophy and proliferation of smooth muscle
• Distention of remaining bladder wall

Regenerating cells arise from the epithelium of the terminal ureters and urethra (trigone)

Question 24

How much bladder can be removed in dogs?

Answer 24

30-40% - all dogs regained baseline bladder capacity by 10m
More than 90% - Still had 72% decrease in capacity by 9m
40-70% excised in 11 dogs, 2 had persistant pollakiuria

Question 25

List options for reconstructions when most or all of the bladder required excision

Answer 25

* Seromuscular colonic augmentation (the external wall of the colon became the cranial wall of bladder) * Ileocystoplasty * Total cystectomy with urinary diversion to colon (not recommended, high morbidity) * TOtal cystectomy with diversion to prepuce or vagina * Porcine SIS (experimental, successful for 40%)

Question 26

Cystostomy

Answer 26

- traditionally placed surgically via a ventral midline laparotomy. A Foley or mushroom-tipped catheter (8 to 14 Fr) is placed for short-term use. Foley not recommended for long-term use because the balloon may deflate over time > bladder is pexied to abdo wall - alternative for long-term use is a low-profile silicone human gastrostomy tube - a minimally invasive inguinal approach is simple and effective for cystostomy tube placement and can usually be performed in under 15 minutes (Bray 2009) - tube must remain in place for at least 7 days to allow time for a secure adhesion to form between the bladder and body wall. - Ultrasound-guided placement of a pigtail cystostomy tube may be beneficial as it is not technically challenging, can be performed rapidly, and may avoid the need for general anesthesia (Culler 2019)

Question 27

What approaches can be used for cystostomy tube placement?

Answer 27

Ventral midline Minimally invasive inguinal approach Laparoscopic

Question 28

What % of patients with cystostomy tubes develop complications?

Answer 28

49% Inadvertnent removal, displacement, chewing, breakage of mushroom tip on removal, fistula formation, urine leakage, rectal prolapse etc

Question 29

List the 2 broad options for cystopexy

Answer 29

Tube cystostomy Incisional cystopexy (3 rows of 6 simple interrupted sutures with 3-0 polypropylene)

Question 30

Congenital Bladder Abnormalities

Answer 30

vesicourachal diverticula, patent urachus, bladder hypoplasia, genitourinary dysplasia

Question 31

What is a patent urachus?

Answer 31

Foetal communication between urinary bladder and allantoic cas persists, resulting in urine being discharged through urachal tube and exiting abdomen at the umbilicus

Question 32

What is a congenital vesicourachal diverticulum?

Answer 32

the external opening of the urachus closes but a blind-ending diverticulum remains at the bladder apex

Question 33

What are the physiologic effects of uroabdomen?

Answer 33

* Azotaemia * Dehydration * Metabolic acidosis * Hyperkalaemia * Death within 47-90hr *Fluid therapy, combined with urine drainage if necessary, is often successful in normalizing electrolyte levels, improving hydration, and decreasing azotemia sufficiently to substantially decrease the anesthetic risk*

Question 34

How can you perform peritoneal dialysis in a patient with uroabdomen?

Answer 34

Place an indwelling abdominal drain Instill 20ml/kg warmed isotonic fluid Leave in situ for 45 minutes and then drain Can be repeated hourly

Question 35

Bladder Rupture

Answer 35

- bladder is the most common site of rupture after trauma - likely to have concurrent injuries - Animals with a ruptured bladder may still appear to urinate normally and may have a palpable bladder - positive-contrast retrograde urethrocystogram - negative resuslt > repeat or intravenous urogram is performed to assess the ureters and kidneys - Diversion of urine may be achieved via an indwelling urethral catheter, an abdominal drain, or both. Alternatively, a cystostomy tube - All unviable bladder tissue must be resected and the bladder closure is omentalized prognosis for urinary tract rupture after trauma is more likely to be governed by the extent and severity

Question 36

uroperitoneum

Answer 36

fluid should be submitted for urea and creatinine measurements, hematocrit, total protein estimation, and cytology - If the abdominal creatinine content is higher than in a serum sample taken at the same time, then the abdominal fluid is highly likely to be urine. - - Urea is a small molecule that rapidly equilibrates across the peritoneum. Therefore, if the abdominal fluid is negative for urea, it is definitely not urine - Potassium concentrations in abdominal fluid are also higher than those in peripheral blood when uroabdomen is present

Question 37

What are the most common calculi in dogs and cats?

Answer 37

* Struvite (magnesium ammonium phosphate) * Calcium oxalate * **both radiopaque** urate, calcium phosphate, silica, xanthine, cystine, mixed. Dried, solidified blood (cats) | hematuria, pollakiuria, stranguria, and dysuria

Question 38

What % of dogs with a negative urine culture will have a positive culture from the urolith, mucosal biopsy or both?

Answer 38

24%

Question 39

Which uroliths are not amenable to dissolution and therefore requir removal?

Answer 39

Calcium oxalate Silicate

Question 40

List methods for retrieval of uroliths (6)

Answer 40

* Catheter-assisted retrieval * Transurethral cystoscopic retrieval * Voiding hydropulsion ( fully voided in 15/21) * Lithotripsy (Ho:YAG) - retrieved by basket extraction / cystoscope or by hydropropulsion * Laparoscopic assisted or percutaneous cystotomy * Surgical cystotomy

Question 41

What is the rate of incomplete removal of cystoliths at cystotomy?

Answer 41

20%

Question 42

What minimised urine spillage during a minimally invasive laparoscope-assisted cystotomy?

Answer 42

Packing swabs around the bladder Using a purse string suture Trochar with a diaphragm

Question 43

What recommendations can be made to reduce recurrence?

Answer 43

Increased water intake Elimination of obesity Appropriate diet or medical therapy urate/calcium: high-moisture, protein-restricted, alkalinizing diet

Question 44

What are the recurrence rates of various uroliths? | Urolithiasis is likely to recur

Answer 44

Struvite - 21% dogs - 2.7% cats - UTI management, acidifying diet Calcium oxalate - 50% in dogs within 3 yr - 7% cats Urate - 33% dogs - 13% cats Cysteine - 47% dogs - diet, 2-MPG Silicate - 12% dogs Recurrence rates not differ widely among methods (medical dissolution, minimally invasive, or surgical retrieval) | No controlled studies have looked at recurrence rates

Question 45

Bladder Calculi

Answer 45

- rads: false-negative findingsfor certain types - Pneumocystography, double-contrast cystography and ultrasonography are the most sensitive techniques for detection of calculi > false-negative rates 3.4% to 6.5% for all calculi. - entire urinary tract must be imaged (consider CT) - Medical therapy for the dissolution of struvite, urate, and cystine cystoliths - medial trial: If no reduction in urolith size or number occurs by 1 month, a nonstruvite composition is likely, and alternative interventions should be considered (urethral obstructions possible) - inspection and palpation of the entire mucosal lining > sterile rigid scope can be passed through the cystotomy incision to examine - essential to repeatedly flush the urethra in a retrograde manner - repeat appropriate imaging after sx

Question 46

lithotripsy

Answer 46

- smooth and smaller than the urethral diameter. GA recommended. - - Removal of all cystoliths using this technique was achieved in 15 of 21 animals ~70% - crushing or fragmenting of uroliths using shockwaves or laser energy. Laser lithotripsy is the most efficient - Depending on their size, urolith fragments can then be retrieved by basket extraction with the aid of the cystoscope or by voiding hydropropulsion - Small male dogs with large numbers of uroliths may be poor candidates for laser lithotripsy. - Short-term complications of laser lithotripsy include urethral swelling or obstruction, perforation of the bladder or urethra, and hematuria - Lithotripsy takes longer than cystotomy > no difference in their outcome, same number required subsequent sx

Question 47

laparoscopic or cystoscopic assisted

Answer 47

- Percutaneous cystolithotomy allowed removal of bladder and urethral stones with rapid postoperative recovery and few major perioperative or short-term postoperative complications (Cruciani 2020) - eliminates the need for a pneumoperitoneum and only requires one laparotomy incision. For percutaneous cystolithotomy the bladder is located by palpation following distention with saline via a urethral catheter, and an abdominal incision is made directly over the apex of the bladder - LAC may be an acceptable minimally invasive technique for treatment of cystic calculi in dogs. Surgery times were similar to those for dogs undergoing OC; however, surgical and total procedural costs were higher - - recommended that a negative urine culture be obtained before sx

Question 48

What is polypoid cystitis? What disease can it resemble?

Answer 48

An uncommon nonneoplastic inflammatory disease Can resemble TCC but is typically located in cranioventral aspect of bladder

Question 49

List surgical options for polypoid cystitis

Answer 49

Partial cystectomy Submucosal resection Excisional mucosal biopsy using a clamp placed across the base Resection using laparoscope-assisted cystoscopy

Question 50

What is the most common bladder neoplasia in dogs and cats? What breeds are overrepresented?

Answer 50

TCC malignant, highly invasive, and has a predilection for the trigone region. The vast majority (>90% of cases) consists of intermediate- to high-grade InvUC, papillary (50%) or non-papillary (50%) tumors and infiltrating (≥90%) or non-infiltrating (≤10%) tumors. - Airedale terriers - Beagles - Shelties - Collies - Scottish terriers

Question 51

ddx

Answer 51

- lymphoma, - embryonal rhabdomyosarcoma, - adenocarcinoma, - squamous cell carcinoma, - hemangioma, hemangiosarcoma, - fibroma, fibrosarcoma, - leiomyoma, and leiomyosarcoma

Question 52

In what % of cases does it effect both the bladder and urethra? Prostate?

Answer 52

Bladder and urethra in 56% Prostate in 29% of male dogs

Question 53

List factors which may be associated with the development of TCC

Answer 53

Female Obesity Older topical insecticides Phenoxy herbicides Nitrosamine exposure Cyclophosphamide Living in highly industrial area

Question 54

TCC

Answer 54

- high risk for developing secondary urinary tract infections - Ultrasonography is a very sensitive method of imaging bladder masses and can determine the degree of invasion into the bladder wall and any extension into the ureters and urethra + check the entire abdomen - Bone mets and sternal l.n. enlargement correlated with survival - Definitive diagnosis > catheter biopsy technique or cystoscopy (Percuraneous FNA not recommended dt seeding) - - Staging of bladder neoplasia is important to guide therapy and provide an accurate prognosis - the animal is likely to die as a consequence of this disease. In a study in which the cause of death was known for 85 dogs with transitional cell carcinoma, 61% died because of the primary tumor, 14% died of metastatic disease, and 25% died of non–tumor-related causes

Question 55

What % of TCC will have metastatised to the LNs and to the lungs?

Answer 55

LN 16% at diagnosis, 40% at necropsy Thoracic: 14% at diagnosis, 49% at necropsy

Question 56

What Tx is associated with the best results for TCC?

Answer 56

Recieving multiple different treatment protocols over the course of their disease (leads to control of TCC growth in 75% with a MST of 1yr) - Response monitored every 4-8 weeks - Different treatment instituted if cancer progresses or unacceptable toxicity occurs

Question 57

What % of stents will relieve urinary obstruction in the face of TCC? And cause urinary incontinence?

Answer 57

over 95% relieve obstruction 26-39% urinary incontinence MST 78d | stent migration and reobstruction

Question 58

TCC Tx

Answer 58

- Nonsteroidal drugs, classically piroxicam, offer a good option (180d) - chlorambucil (200d) - - Total cystectomy procedures have been associated with high morbidity without substantial long-term benefit, so these procedures are no longer recommended. - Palliative placement of a cystostomy tube (could lead to seeding of the tumor in the abdomen) or stent - addition of intensity-modulated and image-guided radiation therapy appeared to prolong survival compared to historical data employing medical therapy alone. Median survival time from time of initial diagnosis was 179 days Sx - histopathologically tumor-free margins are unlikely >>It is generally accepted that TCC of the bladder is characterized by a ‘field cancerization effect’, where multiple independent foci of neoplasia may be present throughout the bladder - Partial cystectomy may be performed in combination with chemotherapy - partial or cytoreductive surgeries > literature unclear from these studies whether or not surgery provides these dogs with a survival advantage as they either had small case numbers or insufficient information - surgery may provide a survival advantage. Median survival times of dogs undergoing debulking surgery and medical therapy (chemotherapy or piroxicam) was 272 days versus 150 days for those with medical treatment alone - median ST with partial full-thickness cystectomy and daily piroxicam therapy, with or without chemotherapy, was 772 days. Dogs with non-trigonal (marvel 2017) - cats: median progression-free interval was 89 days

Question 59

Marvel 2017: Clinical outcome of partial cystectomy for transitional cell carcinoma of the canine bladder | VCO

Answer 59

Retrospective. Clinical outcome of partial cystectomy for TCC of the canine bladder. 37. overall MST 348 days MST 772 days > partial full-thickness cystectomy and daily piroxicam therapy, +/- chemotherapy (non-trigonal bladder TCC, <75% bladder removal) improved outcome compared to medical therapy Post-operative complications (43%) > urinary incontinence (31%), 11% abdo wall seeding trigonal location > worse outcome following surgery, 80% recurrence

Question 60

Griffin 2020: Lower urinary tract transitional cell carcinoma in cats: Clinical findings, treatments, and outcomes in 118 cases

Answer 60

The trigone was the most common tumor location (32/118; 27.1%) as assessed by ultrasound examination, Metastatic disease was documented in 25 of 118 (21.2%) cats MST 155 days, nsaid and partial cystectomy associated with survival. The median estimated percentage of bladder wall excised during partial cystectomy (reported in 15/28 [53.6%] cats) was 50% (range, 20%-65%) Improvement in clinical signs was reported after surgery in 21 of 28 (75.0%) cats that underwent partial cystectomy,

Question 61

Radical cystectomy

Answer 61

- severe hyperammonemia, metabolic alkalosis, diarrhea, vomiting, and neurologic complications - Total cystectomy is a potential treatment option for the management of transitional carcinoma of the bladder. - remove the source of pain because of the tumor, inflammation and urinary tract obstruction, and to remove the primary tumor, which may limit or prevent metastatic spread of disease. - Further clinical evaluation of this procedure is needed to determine its clinical efficacy with regards to tumor control, complications and patient quality of life

Question 62

Use of the subcutaneous ureteral bypass device and urethral stenting for treatment of malignant urinary outflow tract obstructions in cats Mariel S Covo 2024 | berent

Answer 62

Retrospective. SUB and urethral stenting for TCC urinary outflow tract obstructions in 14 cats recurrence /obstruction 6/13 (46%) cats with a self-expanding metal stent No obstructions @ SUB device. MST from device implant > 52 days ureteral/urethral and 80 days only urethral Overall MST sx with adjunct Tx 349 days vs none 43 days

Question 63

Single-step, non-surgical placement of permanent low-profile cystostomy tubes in dogs: 10 cases (2018-2023) C. Lea1 and D. Kelly 2024

Answer 63

successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low-profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement Lack of cystopexy does not appear to result in complications

Question 64

Cystine and urate cystoliths in dogs are frequently visible on radiographs prior to surgical or nonsurgical removal Camille Andrews 2024

Answer 64

Cystine and urate cystoliths in dogs are frequently visible on radiographs. 331. Of 331 cases > (9%) cystine stones, (15%) urate radiographs > (85%) of urate and (92%) of cystine were visible on radiographs. Radiopacity is commonly used to determine whether a dissolution or prevention diet is an appropriate management technique > need to reconsider this practice.

Question 65

Feasibility of laparoscopic stapled partial cystectomy in canine cadavers Bianca C. Reyes 2024

Answer 65

laparoscopic stapled partial cystectomy in canine cadavers performed with an endoscopic (GIA) stapler successful 10 of 11 cadavers. Further evaluation for application to clinical cases is warranted.

Question 66

Modified Toyoda technique for total cystectomy and cutaneous ureterostomy in a cat Noritaka Maeta 2022

Answer 66

total cystectomy for TCC → complete excision, 16-month survival - obstruction of one ureter at 14-months post-op - urinary incontinence managed with an absorbent diaper

Question 67

Removal of lower urinary tract stones by percutaneous cystolithotomy: 68 cases (2012–2017) Benoît Cruciani 2020

Answer 67

Retrospective. Percutaneous cystolithotomy: 68 cases (1cm incision) Laparoscopic assisted median sx time 95min, lithotripsy required in (3%) - 58/70 (83%) discharged within 24-hours - complications: intra-op: 1/70 procedures, 6% residual stones did not require removal post-op: (24%) minor LUT signs, 1/68 major (sx wound dehisence) * recurrence: (21%) cases with follow-up >1year

Question 68

Partial cystectomy with a bipolar sealing device in seven dogs with naturally occurring bladder tumors Milan Milovancev 2020

Answer 68

Partial cystectomy with a bipolar sealing device in seven dogs successful performed 7/7 dogs – median sx time 69min - all sealed cystectomy sites oversewn with a single-layer suture - prior to suture > no leakage in 3/7, variable leakage in 4/7 - may expose abdomen to tumour-laden urine - 1/7 required revision cystorraphy after uroabdomen > suture placed in BSD peripheral thermal effect zone

Question 69

Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases Dario Floriano 2019

Answer 69

Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy. Clinical significance: The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.

Question 70

Influence of barbed suture on leak pressures after double-layer inverting closure of cystotomy sites in sheep Daniel J. Duffy 2018

Answer 70

* barbed suture with double-layer inverting closure of cystotomy. Experimental sheep * double-layer closure → ~2x initial leak pressure regardless of suture type * both single and double-layer closure → adequate seal/leak pressure * no difference in mean leak pressure for barbed vs non-barbed closure

Question 71

Radical cystectomy and subsequent ureterohysterostomy in a bitch Tiare Delaune 2018

Answer 71

initial bilateral ureterovaginal anastomosis - right-sided dehiscence of anastomosis → right ureterohysterostomy/anastomosis + stent across cervix → intraluminal obstruction of uterine stent, loss of right ureter patency severe right hydronephrosis at 12 months → death at 14m

Question 72

Retrospective comparison of modified percutaneous cystolithotomy (PCCLm) and traditional open cystotomy (OC) in dogs: 218 cases (2010-2019) Adair 2023

Answer 72

- PCCLm → shorter GA time to open, less post-op LUT signs - no difference: incomplete urolith removal, SSI and inflammation rates - incisional infection associated with PCCLm complications The PCCLm may result in reduced lower urinary tract signs postoperatively compared to OC, but other clear advantages of the PCCLm were not identified in this study

Question 73

Intraoperative Nano arthroscopy imaging system enhances complete urolith removal during open cystotomy in 13 dogs García 2025

Answer 73

* Retrospective case series of 13 dogs undergoing open cystotomy with intraoperative Nano arthroscopy imaging (NanoScope). Level 4 * Traditional cystotomy achieved complete removal in 10/13 dogs. * Nano arthroscopy detected residual uroliths in 2/13 * 1/13 dogs still had residual stones detected on postoperative radiographs requiring revision surgery. * No complications associated with Nano arthroscopy use. * Stones commonly lodged in trigone or proximal urethra, where they may evade catheter lavage. * Rigid scope limits evaluation of the entire male urethra, * Study limitations: Small retrospective without comparison to cystoscopy or prospective evaluation of recurrence. Model Exam Conclusion (Concise ANZCVS-Style) Incomplete urolith removal after cystotomy remains clinically important, and intraoperative nano-arthroscopy may improve detection of residual stones in the bladder and urethra, particularly when they are missed by catheter lavage alone, although evidence is currently limited to small case series.

Question 74

Transarterial embolisation in the treatment of persistent haematuria in two dogs with lower urinary tract carcinoma

Answer 74

Transarterial embolisation may be an effective palliative treatment for persistent haematuria associated with lower urinary tract carcinoma, providing rapid symptom control and temporary tumour reduction, although repeat procedures may be required due to recanalisation of embolised vessels Case 1: 193 days survival (euthanised due to pulmonary metastasis). Case 2: alive at 352 days after initial TAE with mild intermittent haematuria Gelatine sponge particles (100–150 µm) used for embolisation to near stasis to reduce risk of bladder ischaemia.

Question 75

Intraoperative urethrocystoscopy reduces operating time and may improve urolith detection during open cystotomy in male dogs over 7 kg Litviakov 2025

Answer 75

* Retrospective matched case–control study of 54 male dogs (>7 kg) undergoing open cystotomy for urolithiasis comparing intraoperative urethrocystoscopy (n=18) with postoperative positive-contrast urethrocystography (n=36). Level 3 * Intraoperative urethrocystoscopy was significantly faster: flexible scope place normo and retrograde * Urethrocystoscopy detected a retained distal urethral urolith in 1 dog, * Completeness of removal Case group: 100% complete removal Control group: 97% (1 suspected retained urolith). * No complications related to urethrocystoscopy. * Median 374 days; no urethral re-obstruction * Allows direct visualization of the urethra and bladder during cystotomy, enabling detection and removal of retained stones in real time. * Study limitations: Retrospective, small sample size, selection bias. Model Exam Conclusion (Concise ANZCVS-Style) In male dogs undergoing cystotomy for urolithiasis, intraoperative urethrocystoscopy is a safe and faster method to confirm complete stone removal than postoperative contrast imaging, and may improve detection of retained urethral uroliths while reducing anesthesia time and the need for revision surgery.

Question 76

Voided urine collection for urine culture in female dogs with lower urinary tract signs is not a substitute for cystocentesis Little

Answer 76

Prospective diagnostic accuracy study of 53 female dogs with lower urinary tract signs Standard voided: 70% Clean voided: 58% Cystocentesis/cystoscopy: 30% Agreement was higher for gram-negative pathogens (e.g., E. coli, Proteus) than for gram-positive organisms, which were more frequently contaminants. In female dogs with lower urinary tract signs, midstream voided urine culture does not reliably agree with cystocentesis culture, and therefore cystocentesis should remain the gold standard method for urine culture, with voided samples reserved only when sterile collection is contraindicated.

Question 77

Cystoscopy-assisted urolith retrieval via a perineal urethrostomy stoma in male cats Cantrall 2025

Answer 77

* Cadaver feasibility study (20 male cat cadavers) followed by a clinical pilot study in 2 cats. Level 4 * Cadaver study: Ureteroscope passage possible in 90% (18/20) of cats, 100% retrieval of 99 stones. * 2 cats underwent PU + CUPU. * Complete urolith removal in both cases. * No perioperative complications. * May not be possible in ~10% of cats due to narrow urethra. * Best suited for small stones (< 3–4 mm). * CUPU may allow minimally invasive removal of bladder stones through the PU stoma Model Exam Conclusion (Concise ANZCVS-Style) Cystoscopy-assisted urolith retrieval via a PU stoma is feasible and may avoid cystotomy in selected male cats undergoing PU, although evidence is currently limited to cadaver studies and very small clinical series.