Gastric conduit urinary diversion in normal dogs. Part II, Hypochloremic metabolic alkalosis

Laparoscopic-assisted cutaneous ureterostomy in a canine patient with prostatic carcinoma

A 9‐year‐old neutered male Dachshund dog was assessed for stranguria. An enlarged prostate was identified on physical examination, and a diagnosis of prostatic carcinoma confirmed by cytology. Due to a neoplastic lower urinary tract obstruction, palliative surgical urinary diversion treatment was performed with laparoscopic assisted cutaneous ureterostomy (LACU). The dog recovered well without any major complications. Adjuvant chemotherapy was maintained and continued for post‐surgical medical therapy. This report describes a novel minimally invasive assisted technique in canine patients for palliative treatment of prostatic neoplasia.

Animal models in urinary diversion

We set out to critically assess the value of animal experimentation in urinary diversion through intestinal segments, as some authors question the effectiveness of animal research, criticising the methodological quality, lack of standardization, inadequate reporting and the few systematic reviews in this field. Based on a comprehensive MEDLINE literature search (MeSH database; search terms: urinary diversion, urinary reservoirs, continent, rat, dog, animal models) we retrieved and evaluated all full-length papers published in English, German, French, and Spanish languages from 1966 to 2011 reporting the use of animal models in the setting of urinary diversion. Studies were stratified according to the addressed research question. Within each category species, gender, number of animals, age at procedure, type of diversion, mortality, length of follow-up, experimental procedure and outcome were recorded and tabulated. In all, 159 articles were judged to be relevant and while there are numerous animal models only a few have been used in more than one study. Animals were used for the systematic study of new surgical techniques (93 articles) or metabolic and functional consequences of urinary reconstruction (66 articles). For the latter purpose, the most often used animal is the rat, whereas the dog model is preferred for technical experimentation. In many studies, the validity of the model is at least questionable. Animal experiments have repeatedly been conducted addressing the same question, often with striking discrepancies in outcome. Animal studies were even performed after a surgical technique had been pioneered in humans. The use of animal models in urinary diversion is far from standardized rendering the results less than ideal for comparison across studies. Due to differences in anatomy and physiology, the applicability of findings in animal experiments to clinical urology is limited. Continued effort is needed to optimise the use of animal models in experimental urology.

Transurethral Resection in the Management of Urethral and Prostatic Neoplasia in 6 Dogs

OBJECTIVE

To assess cystoscopic transurethral resection (TUR) for the palliative management of dogs with neoplastic infiltration of the urethra.

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Six client-owned dogs.

METHODS

Cystoscopic examination and electrosurgical TUR were performed in dogs with urination difficulties caused by prostatic or urethral neoplasia. TUR was performed in a retrograde manner in female dogs and antegrade in male dogs via exploratory celiotomy and ventral cystotomy. Cystoscopic examination was used to determine the extent of neoplastic involvement of the urethra. TUR involved piecemeal removal of neoplastic tissue from the urethral lumen using an electrocautery cutting loop. Hemorrhage was controlled with a cystoscopic cauterized roller-ball. In 2 male dogs, intraoperative radiation therapy (IORT) was used to treat both prostatic neoplasia and the sublumbar lymph node bed. Surgical technique, complications, adjuvant treatment, and outcome were recorded.

RESULTS

TUR was performed in 3 male dogs with prostatic carcinoma and 2 female dogs with urethral transitional cell carcinoma (TCC). In 1 female dog, TUR was attempted but not successful because of cystoscope diameter. Iatrogenic urethral perforation occurred during TUR in 3 dogs. In 2 dogs, prolonged exposure to lavage fluid resulted in clinical and biochemical abnormalities consistent with TUR syndrome. Dysuria resolved in 5 dogs within 10 days of TUR. Treatment-related complications included urinary tract infection and tumor seeding. Local tumor progression and metastasis occurred in all dogs.

CONCLUSIONS

TUR (in combination with chemotherapy+/-IORT) resulted in rapid palliation of urination difficulties in male dogs with prostatic carcinoma. In female dogs with urethral TCC, however, electrosurgical TUR cannot be recommended because of a high intra- and postoperative complication rate with no improvement in postoperative management compared with historical reports of tube cystostomy.

CLINICAL RELEVANCE

TUR is a novel alternative for the palliation of male dogs with prostatic carcinoma. In female dogs with urethral TCC, electrosurgical TUR does not provide any advantages compared with tube cystostomy.

Oncologic surgical emergencies

Surgical oncologic emergencies are relatively common and pose a clinical and therapeutic challenge for the emergency clinician. This article provides a clear clinical reference for assessment and management of some common surgical emergencies in cancer patients.

Gastric conduit urinary diversion in normal dogs. Part I, Upper urinary tract structure, function, and sepsis

The urinary bladder of 10 clinically normal dogs was excised and the ureters were implanted into an isolated, vagotomized gastric segment derived from the fundic region of the stomach. The gastric segment was closed to form a conduit. Continence was maintained with a modified Kock "nipple valve" created from an isolated segment of ileum. Four dogs were euthanatized by day 30 because of complications related to the early onset of renal failure and electrolyte alterations. Six dogs were euthanatized on day 150. Ureteral dilatation, hydronephrosis, and decreased endogenous creatinine clearance rates were measured in all dogs at the end of the survival period. Pyelonephritis was diagnosed histologically in seven dogs. Positive renal cultures were obtained from seven dogs at necropsy. It was concluded that gastric conduit urinary diversion is unsatisfactory for long-term or short-term clinical use in dogs.