Recurrent Urethral Obstruction Research Articles

Obstrução uretral em um felino macho Pelo Curto Brasileiro sem intervenção cirúrgica

This study aimed to report a clinical case of a male feline diagnosed with urethral obstruction that underwent conservative treatment without surgical intervention. In the present report, the three-year-old, male, orchiectomized feline was diagnosed with urethral obstruction, also called urinary tract disease, which is a urological disease in the emergency veterinary clinical routine of small animals, being more common in felines, and either partial or total. This pathology can be caused by crystals, uroliths, neoplasms and granulomas, but it can also be related to inadequate food management, lack of environmental enrichment, or simply be an idiopathic disease. Symptoms are non-specific, which makes diagnosis difficult, and possible clinical signs may include hematuria, dysuria, pruriria, urinary frequency, acute stranguria, which may become chronic or intermittent. However, the animal usually presents excessive vocalization, pain and discomfort during micturition. The diagnosis is carried with radiographic examination to assess cardiopulmonary parameters and ultrasound examination to assess real-time information on the architecture of the abdominal organs and laboratory tests that describe all changes in the erythrogram, global leucometry, platelets and parameters of substances that assess renal function. Treatment depends on the frequency of obstruction and the animal's response to conservative treatment. Surgical intervention, which consists of perineal urethrostomy associated with penectomy, is indicated for cases of recurrent urethral obstruction or when conservative treatment fails. Conservative treatment, which includes environmental enrichment and dietary management, is an option for non-recurrent urethral obstructions. Environmental enrichment (water sources, wet food offered several times a day, frequently replenishing water sources to encourage an increase in water intake, litter boxes around the house - always double the number of cats - scratching posts that allow the cat to deposit its scent through the glands present in its paw, pheromones to reduce anxiety), that is, everything aimed solely at the well-being of the domiciled feline, tends to improve their quality of life, interactions with household members, and reduce recurrent relapses of the obstructive condition, obesity, and comorbidities associated with this pathology.

Effect of tamsulosin on urethral tone in healthy male cats.

Alpha-adrenergic antagonists are commonly used to prevent recurrent urethral obstruction in cats with mixed reports of efficacy. No published data on tamsulosin use in cats are available. The objective of this study was to measure changes in urodynamic parameters and blood pressure in five healthy male cats before and after administration of tamsulosin orally for 4 and 10 days. Five young healthy adult male cats from a research colony were administered tamsulosin at 0.1 mg/cat PO q24h for 10 days. Urethral pressure profile and blood pressure measurements were performed before treatment and approximately 6 h after treatment on days 4 and 10. Maximum urethral closure pressure (MUCP) for the prostatic and penile urethra, functional urethral length (FPL), functional area (FA) and systolic blood pressures were recorded and compared between the time points. Significant changes in blood pressure on day 4 (121.1 mmHg ± 20.2 mmHg) and on day 10 (112.6 mmHg ± 14.9 mmHg) compared with day 0 (141.1 mmHg± 33.4 mmHg) were not detected (P = 0.18) in anesthetized cats. No significant difference in MUCP, FA or FPL measurements were detected among baseline, day 4 and day 10 of treatment. Hematuria and transient pollakiuria were induced in two cats with 3.5 Fr urethral catheters. Tamsulosin at 0.1 mg/cat PO q24h did not induce hypotension in healthy cats. Urodynamic testing performed 6 h after the tamsulosin pill was administered did not detect consistent decreases in urodynamic functions induced by tamsulosin. Repeated catheterization of tom cats with 3.5 Fr catheters may induce significant urethral trauma.

The efficacy of administration of prazosin in reducing the risk of recurrent urethral obstruction in male cats

PICO Question In male cats presenting with urethral obstruction, does administration of prazosin compared with no administration of prazosin reduce the incidence of recurrent urethral obstruction within the first month of initial presentation? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed A total of three studies were included in this appraisal. Two of which were prospective double-blind clinical studies and one retrospective study. Strength of evidence Weak. Outcomes reported Both double-blind studies found no significant difference between prazosin administration and the development of recurrent urethral obstruction (rUO) when compared with a placebo. Both studies, however, did report that cats had a shorter urinary catheterisation time with prazosin administration. The retrospective study found no association between prazosin administration and the risk of rUO and found that after 14 days post discharge, significantly more 73/302 (24%) cats that received prazosin had experienced rUO compared to 11/86 (13%) of cats that did not. One study found side effects to the administration of prazosin which may be detrimental to the overall recovery. Conclusion Administration of prazosin does not reduce the risk of rUO within 30 days of presentation. However, the strength of evidence is weak and would benefit from further clinical studies. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Recurrent urethral obstruction secondary to large vulval inclusion cyst: a remote complication of female genital mutilation: a case report

BackgroundFemale genital mutilation/cutting (FGM/C) is a major public health problem, particularly in developing countries.Case presentationThe authors reported a case of 48-year old multiparous woman presented to Kassala Hospital, east Sudan, with recurrent urine retention resulting from urethral obstruction, which was caused by large vulval inclusion cyst. A traditional birth attendant circumcised her when she was 5 year old. Five years before her presentation the patient observed a painless swelling in her vulva, which was gradually increasing in size. She presented to the hospital with urine retention seeking medical care. Local examination showed a large cystic swelling originating in the circumcision line and covering the introitus. A diagnosis of inclusion cyst at the site of circumcision was made. The cyst was large enough causing bladder outlet obstruction and when the patient advised to tilt it away from the urethral orifice she passed urine without difficulties. The cyst was surgically removed by dissection along the lines of cleavage, which measured 10 × 9.2 cm and weighed 1.2 kg.ConclusionThis case report indicates that FGM is a serious public health problem and there should an urgent intervention such as planned health education campaigns to end FGM practice.

Retrospective evaluation of the effect of inhalant anesthesia on complications and recurrence rates in feline urethral obstruction.

The aim of this study was to evaluate the use of inhalant anesthesia vs sedation for urinary catheter placement in male cats with urethral obstruction. The primary outcome measures were the incidence of complications related to catheterization, the incidence of recurrent urethral obstruction (rUO; both during hospitalization and within 1 year) and survival. The secondary aim of this study was to evaluate the association between baseline serum biochemical concentrations and antispasmodic medications with complications and short-term rUO. We carried out a retrospective review of records from a university teaching hospital from 2009 to 2020. Cats were included if diagnosed with a urinary obstruction, based on the presence of a large, painful and non-expressible bladder, a urinary catheter was placed and hospitalization occurred for a minimum of 24 h. Collected baseline data included age, breed, weight, serum biochemical concentrations and if cats underwent sedation or inhalant anesthesia for urethral catheterization. For the comparison of inhalant anesthesia or sedation, univariate logistic regression was used. There was no statistically significant difference in complications or the recurrence of obstruction in cats with urethral obstruction that underwent inhalant anesthesia compared with sedation. All serum biochemical concentrations were significantly associated with survival. Decreased serum ionized calcium was found to be statistically significantly associated with higher complication rates (P = 0.0086), as well as short-term recurrence of obstruction (P = 0.004). Increased serum potassium concentrations were found to be statistically significantly associated with the risk of short-term recurrent urethral obstruction (P = 0.0345). No significant difference was found between the use of antispasmodic medications with short-term recurrence. No significant difference was found between complications or recurrence rates when comparing the use of inhalant anesthesia to sedation protocols. Baseline serum biochemical data were significantly associated with complications, survival and short-term recurrence rates.

Prazosin administration increases the rate of recurrent urethral obstruction in cats: 388 cases.

To determine if prazosin administration decreased the rate of recurrent urethral obstruction (rUO) before hospital discharge and within 14 days. 388 cats with urethral obstruction. Veterinarians who either always or never prescribed prazosin (generally, 0.5 to 1 mg, PO, q 12 h for 14 days) were recruited to complete observational surveys. Patient data and characteristics of relieving the obstruction, including perception of a gritty feel within urethra or difficulty unobstructing the cat, were recorded. The rate of development of rUO before hospital discharge and by day 14 was compared between cats that received or did not receive prazosin with the Fisher exact test. Other variables were similarly compared between cats with and without rUO. 302 (78%) cats received prazosin, while 86 (22%) did not. There was no association between prazosin administration and risk of rUO prior to discharge, with 34 of 302 (11.3%) cats receiving prazosin and 5 or 86 (5.8%) not receiving prazosin developing rUO. Within 14 days, a significantly higher proportion of prazosin-treated cats (73/302 [24%]) developed an rUO, compared with the proportion of non-prazosin-treated cats (and 11/86 [13%]). The perception of a "gritty feeling urethra" or difficulty of performing the catheterization was associated with increased risk of rUO. Prazosin administration increased the likelihood of rUO by 14 days; ongoing investigation of other therapies to decrease rUO in cats is warranted. Without specific indications, the use of prazosin for the prevention of rUO should be discouraged.

Effect of prazosin on feline recurrent urethral obstruction.

The aim of this study was to determine if male cats treated with 7 days of prazosin following relief of urethral obstruction (UO) experienced decreased rates of recurrent urethral obstruction (rUO) within 30 days vs those treated with 7 days of placebo. All castrated male cats presenting for the first time with UO from May 2014 to August 2017 were eligible for enrollment. Exclusion criteria included the administration of medications or passage of a urinary catheter prior to referral, the presence of heart disease or hypertension requiring medication, prior treatment with glucocorticoids, non-steroidal anti-inflammatory medications, prazosin or phenoxybenzamine, or radiographic identification of cystoliths. Cats were treated with standardized anesthetic and analgesic protocols, standardized indwelling urinary catheter management, and were hospitalized for care. A random numbers table was generated prior to study initiation and cats were randomized to receive either prazosin (0.5 mg PO q12h for 7 days) or placebo in a blinded fashion. A 30-day follow-up with owners via telephone was performed to identify the rate of rUO. Cats that did not receive the full course of study medication were removed from the analysis. The study was unblinded at the end of data collection. Eighty cats were enrolled and 65 cats completed the study; 12 were excluded because they did not receive the study medication. Sixteen of 65 cats experienced rUO (25%). Of the 16 cats experiencing rUO, five received placebo (n = 5/28 [18%]) and 11 received prazosin (n = 11/37 [30%]). Ten of the cats that experienced rUO reblocked while still hospitalized. There was no significant difference in frequency of rUO in cats treated with prazosin vs placebo (P = 0.27). Prazosin administered at 0.5 mg PO q12h did not decrease the rate of rUO in this population of obstructed male cats vs placebo. These results further support evidence suggesting that prazosin may not be beneficial in prevention of feline rUO.

RETROPERITONEAL FIBROSIS PRESENTING AS URETERAL OBSTRUCTION SECONDARY TO SARCOIDOSIS

SESSION TITLE: Fellows Disorders of the Mediastinum Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sarcoidosis is a multi-organ system granulomatous disease of unknown etiology and, although it commonly affects the lungs, may be highly variable in its presentation. We will describe here a case of retroperitoneal fibrosis and ureteral obstruction secondary to sarcoidosis. CASE PRESENTATION: A 69 year old male with a history of prior episodes of nephrolithiasis presented with recurrent flank pain and nausea. Computed tomography (CT) of the abdomen revealed a new 4 mm stone at the left ureterovesicular junction with periureteral stranding. Cystoscopy was significant for distal left ureteral extramural compression. Subsequent magnetic resonance imaging (MRI) of the abdomen showed infiltrative soft tissue encasing the distal left ureter and iliac vessels. Patient underwent CT guided biopsy with pathology showing inflammatory myofibroblastic tumor. Initially, only observation was advised. The patient later developed recurrent urethral obstruction requiring new cystoscopy and stent placement. Subsequent MRI showed progressive infiltrative soft tissue throughout the retroperitoneum encasing the infrarenal aorta, IVC, and bilateral ureters. Multiple enlarged lymph nodes were also partially visualized in the chest, then dedicated CT chest showed diffuse nonspecific mediastinal and bilateral hilar lymphadenopathy. Endobronchial ultrasound guided fine needle aspiration of the mediastinal lymph nodes, stations 7, 11R, 4R and 4L revealed non-necrotizing granulomas consistent with sarcoidosis, without evidence of infection, malignancy or any additional inflammatory process as an explanation for the pathologic findings. DISCUSSION: Retroperitoneal fibrosis is a rare fibro-inflammatory disorder comprising the periabdominal aorta which expands to involve the retroperitoneum and frequently causes ureteral obstruction. It is an extremely rear manifestation of sarcoidosis, and always other more common etiologies such as immunoglobulin G4-related disease (IgG4-RD), malignancy, connective tissue disease, abdominal aortic aneurysm, and medications such as ergots, beta blockers, and non-steroidal anti-inflammatory drugs need to be ruled out. Symptoms are non-specific and include a dull low back, flank, or abdominal pain as well as constipation, fatigue, and weight loss. The diagnosis can be made with CT or MRI and biopsy is used to exclude malignancy and diagnose IgG4-RD. First line therapy is corticosteroids. CONCLUSIONS: Although experience with retroperitoneal fibrosis as a manifestation of sarcoidosis is lacking, treatment may help to reduce inflammation especially in the case of recurrent ureteral obstruction. Reference #1: Runowska M, Majewski D, Puszczewicz M. Retroperitoneal fibrosis – the state-of-the-art. Reumatologia 2016; 54, 5: 256–263. Reference #2: Spagnolo P, Rossi G, Trisolini R, et al. Pulmonary sarcoidosis. Lancet Respir Med 2018; 6: 389–402. DISCLOSURES: no disclosure on file for David Abia Trujillo; no disclosure on file for Isabel Mira-Avendano; No relevant relationships by Murat Tatari, source=Web Response

Retrospective evaluation of urinary indwelling catheter type in cats with urethral obstruction (January 2014 to December 2014): 91 cases.

To investigate the influence of urinary catheter type on recurrence rate (rUO) in cats with urethral obstruction. Retrospective study. Two private referral hospitals. Ninety-one cats diagnosed with urethral obstruction treated with a 3.5-Fr Argyle (AR) or 3.5-Fr red rubber (RR) indwelling catheter presenting in 2014. One hundred sixty-six cats were identified using diagnostic code search with 91 cats meeting inclusion criteria. All were treated with IV fluids, buprenorphine, prazosin, and an indwelling urethral catheter with a closed collection system. Catheter groups did not differ statistically in baseline characteristics, medication treatment, or catheterization time. Follow-up was available for 91 cats at 24hours, 86 cats at 7 days, and 84 cats at 30 days. There was no statistical difference in rUO between cats with different catheter types at any time in this retrospective study. No difference in rUO was found in cats treated for urethral obstruction with a 3.5-Fr AR or RR catheter, however, due to the retrospective nature of this study the inability to detect a difference may be due to the small sample size of this study. Recurrent urethral obstruction in this study at 30 days was 11%.

A prospective randomized study of efficacy of 2 treatment protocols in preventing recurrence of clinical signs in 51 male cats with obstructive idiopathic cystitis.

BackgroundUrethral obstruction (UO) is a common complication of feline idiopathic cystitis (FIC). Robust treatment recommendations to prevent its recurrence are scarce.ObjectivesTo evaluate meloxicam treatment for prevention of clinical recrudescence in male cats with obstructive FIC.AnimalsFifty‐one client‐owned cats.MethodsProspective, randomized clinical trial. Every male cat with FIC‐associated UO was deemed eligible for the study and was recruited during hospitalization. After discharge, cats were treated with phenoxybenzamine and alprazolam for 2 weeks, with (24 cats) or without (27 cats) low‐dose meloxicam (0.025 mg/kg/day PO) and monitored for 6 months.ResultsCumulative number (%) of cats with recurrent UO at 10 days, 1‐, 2‐, and 6‐months after discharge was 1 (2%), 2 (4%), 4 (8%), and 8 (16%), respectively. Overall, 12 (24%) cats experienced signs of recurrent FIC within 6 months, with (8 cats) or without (4 cats) concurrent UO. No difference in the cumulative incidence of UO within 6 months was detected with addition of meloxicam (odds ratio [95% confidence interval], 0.63 [0.13‐2.97]; P = .70). All cats were alive at 6 months.Conclusions and Clinical ImportanceNo clinical benefit was detected with the addition of low‐dose meloxicam to phenoxybenzamine and alprazolam treatment for 2 weeks after discharge. Nevertheless, this study was underpowered to identify potential differences, and its findings must be corroborated in larger studies.

Evaluation for association between indwelling urethral catheter placement and risk of recurrent urethral obstruction in cats.

OBJECTIVE To test for an association between indwelling urethral catheter placement in cats with urethral obstruction (UO) and the short-term (30-day) risk of recurrent urethral obstruction (RUO). DESIGN Prospective cohort study. ANIMALS 107 client-owned male cats with UO. PROCEDURES Owners were offered standard care for their cats, including hospitalization, placement of an indwelling urethral catheter, IV fluid therapy, and other supportive treatments (inpatient group). One-time catheterization and outpatient care were offered (outpatient group) if standard care was declined. Data regarding signalment, measures of metabolic compromise and urinalysis findings at enrollment, catheterization-related variables, and supportive treatments of interest were collected. Risk of RUO ≤ 30 days after urethral catheter removal was determined for the outpatient vs inpatient group by OR and 95% confidence interval calculation. Other variables were compared between cats that did and did not develop RUO with Fisher exact and trend tests. RESULTS 91 cats completed the study; 19 (5/46 [11%] inpatients and 14/45 [31%] outpatients) developed RUO. Risk of RUO was significantly greater for cats of the outpatient group (OR, 3.7; 95% confidence interval, 1.2 to 11.4). Among inpatients, increasingly abnormal urine color at the time of catheter removal was significantly associated with RUO. No other significant associations were identified. CONCLUSIONS AND CLINICAL RELEVANCE Hospitalization and indwelling catheterization significantly reduced the risk for RUO ≤ 30 days after treatment for the population studied. Results suggested that removal of an indwelling catheter before urine appears grossly normal may be associated with development of RUO. One-time catheterization with outpatient care was inferior to the standard care protocol but was successful in many cats and may be a reasonable alternative when clients cannot pursue standard care.

Perineal urethrostomy in the cat. Technique and complications

Perineal urethrostomy (PU) is the surgical procedure performed in the male cat in order to create a permanent stoma of the pelvic urethra to the skin of the perineal region. The first urehrostomy was devised on early sixties and since then many urethrostomy techniques were invented. On 1971 Wilson and Harrison invented a technique of PU that is currently used by the majority of surgeons, because of the better results and fewer complications compared to the other urethrostomy techniques. Indications for performing PU in the male cat include recurrent urethral obstruction associated with lower urinary tract disease, as an emergency procedure for the restoration of the patency of the obstructed urethra when all other conservative measures failed, priapism, strictures, trauma and urethral neoplasms. For a successful PU: 1) the pelvic urethra should be incised and anastomosed in the perineum cranial to the bulbourethral glands, 2) the urethra should be completely freed from its attachments to the ishium so as to decrease tension to the stoma, and 3) accurate apposition of the urethra to the skin should be performed to achieve first intention healing of the stoma site and avoid stricture formation. Complications following PU may include urethral stricture, ascending urinary tract infection, haemorrhage, subcutaneous urine extravasation resulting in sloughing and dehiscence of the stoma, skin fold dermatitis, urinary and fecal incontinence, bladder atony, iatrogenic perineal hernia and rectourethral fistula. Prepubic, subpubic or transpelvic urethrostomy may be used to salvage postoperative urethral stricture. Pepubic urethrostomy is the only salvage technique that has been evaluated long-term, but is associated with serious complications such as urine scalding, urinary incontinence and urinary tract infection. Perineal urethrostomy aims at relieving urethral obstruction and is part of the medical management of cats with recurrent or persistent urethral plug formation.

Evaluation of meloxicam for the treatment of obstructive feline idiopathic cystitis.

Objectives The aim of the study was to investigate the effect of the non-steroidal anti-inflammatory drug meloxicam on the clinical course of obstructive idiopathic cystitis in cats in a placebo-controlled clinical study. Methods Thirty-seven cats with obstructive idiopathic cystitis were enrolled. Cats received supportive treatment and an indwelling transurethral catheter for 48 h. On days 0 and 1, all cats received buprenorphine 0.01 mg/kg subcutaneously every 8 h. On day 1, cats were randomly assigned to the meloxicam (n = 18) or placebo group (n = 19) and received meloxicam (0.1 mg/kg on day 1, 0.05 mg/kg on days 2-5) or placebo orally for five consecutive days. Cats were monitored by repeated physical examinations and urinalysis, and with a 5 day questionnaire filled in by the owners after discharge and a telephone interview 3 months after presentation. Parameters for evaluation of treatment success were the occurrence of recurrent urethral obstruction, results of physical examinations and questionnaires. Results Recurrent urethral obstruction occurred in 4/18 cats (22%) in the meloxicam group and 5/19 cats (26%) in the placebo group ( P = 1.000). General demeanour and pain on abdominal palpation during hospitalisation improved significantly in both groups ( P <0.001). After discharge, with regard to general demeanour, food intake and voiding behaviour, there were no significant differences within or between groups at different time points. Conclusions and relevance Orally administered meloxicam for 5 days did not influence the incidence of recurrent urethral obstruction and the recovery from clinical signs in cats with obstructive feline idiopathic cystitis. The persistence of clinical signs in most of the cats 1 week after initial presentation indicates that symptomatic treatment for a longer period of time is warranted.

Efficacy of intravesical pentosan polysulfate sodium in cats with obstructive feline idiopathic cystitis.

Obstructive feline idiopathic cystitis is a common emergency in small animal practice. There is evidence for a defective glycosaminoglycan layer in the urinary bladder of affected cats. The aim of this study was to investigate the effect of intravesical pentosan polysulfate sodium (PPS) in cats with obstructive feline idiopathic cystitis in a randomised, placebo-controlled, blinded clinical study. Thirty-five cats with obstructive feline idiopathic cystitis were enrolled into the study. On day 0, cats were randomised to receive either 30 mg PPS in saline (18 cats) or saline alone as placebo (17 cats) at the time of indwelling urinary catheter placement and then after 24 and 48 h. The catheter was clamped for 30 mins after administration before connecting it to a sterile urine collection system. The procedure was repeated after 24 and 48 h, and then the indwelling catheter was removed. Treatment success was assessed via the incidence of recurrent urethral obstruction, results of a scoring system for physical examination and daily urinalysis from day 0 to 5. Recurrent urethral obstruction occurred in 3/18 cats of the verum group and 3/17 of the placebo group (P = 1.000). The verum group showed a significantly lower degree of microscopic haematuria between day 5 and day 0 (P ⩽0.05). The placebo group showed a significantly lower degree of dipstick haematuria between day 5 and day 0 (P ⩽0.05). There was no difference in the clinical score between the groups in the investigated time period. Intravesical instillation of PPS three times within 48 h in the chosen dose had no influence on the incidence of recurrent urethral obstruction and clinical signs in cats with obstructive feline idiopathic cystitis.

Evaluation of risk factors associated with recurrent obstruction in cats treated medically for urethral obstruction

To determine risk factors for short-term recurrent urethral obstruction in cats after treatment by means of urinary catheterization and hospitalization. Prospective case series. 83 client-owned cats. Physical examination findings, laboratory abnormalities, treatment decisions, and environmental changes were evaluated as risk factors for recurrent urethral obstruction in the 30 days following hospital discharge. Of the 68 cats with completed follow-up surveys, 10 had an episode of recurrent urethral obstruction. Older cats were significantly more likely to have recurrent urethral obstruction. No specific laboratory abnormalities were associated with the risk of recurrent urethral obstruction. Longer duration of catheterization was significantly associated with a decreased risk of recurrent urethral obstruction. Duration of hospitalization and volume of IV fluids delivered were not significantly associated with recurrent urethral obstruction. Increasing water availability after discharge was associated with a decreased risk of recurrent urethral obstruction. There was no association between diet and recurrent urethral obstruction. Results of this study suggested that longer duration of catheterization may be associated with a lower probability of short-term recurrent urethral obstruction in male cats. Older cats were at higher risk for recurrent obstruction. Owners should be encouraged to increase water availability after discharge in cats treated for urethral obstruction to decrease the likelihood of recurrence.

Initial treatment factors associated with feline urethral obstruction recurrence rate: 192 cases (2004–2010)

To evaluate the association of treatment factors during initial urinary catheterization (IUC) of cats with recurrence of urethral obstruction at 24 hours and 30 days after catheter removal. Retrospective case series. 192 male cats with urethral obstruction that were treated at an emergency and specialty center from 2004 through 2010. Data were obtained from the cats' medical records. Duration of indwelling catheterization, catheterization with a 5F versus 3.5F urinary catheter, treatment with phenoxybenzamine versus prazosin, consistent administration of pain medication, and treatment with meloxicam or antimicrobials during IUC were reviewed for association with rate of recurrent urethral obstruction (rUO). Overall rUO rates were 10.94% (21/192 cats) at 24 hours and 23.57% (37/157 cats) at 30 days after IUC. At 24 hours and 30 days after IUC, rUO developed in 10 of 140 (7.14%) and 20 of 110 (18.18%) prazosin-treated cats, respectively, compared with 10 of 46 (21.74%) and 16 of 41 (39.02%) phenoxybenzamine-treated cats, respectively. Reobstruction developed following use of a 5F or 3.5F urinary catheter in 11 of 58 (18.97%) and 7 of 105 (6.67%) cats, respectively, through 24 hours. There was no association between rUO and duration of urinary catheterization, administration of antimicrobials or meloxicam, or consistent administration of pain medication during IUC. At 24 hours and 30 days after IUC, rUO rates in prazosin-treated cats were significantly lower than rates in phenoxybenzamine-treated cats. Reobstruction rate at 24 hours was significantly lower when a 3.5F versus 5F urinary catheter was used.

Laparoscopic-assisted urinary bladder marsupialization in a goat that developed recurrent urethral obstruction following perineal urethrostomy

A 5-year-old castrated male Nigerian Dwarf goat with recurrent urethral obstruction after perineal urethrostomy. The wether goat was referred for evaluation of a perineal urethrostomy site; perineal urethrostomy had been performed 1.5 years earlier. The site was patent, but a moderate stricture was found just cranial to the perineal urethrostomy site. The goat had obstructed urine flow at the stricture site repeatedly in the previous few months. Laparoscopically assisted urinary bladder marsupialization was recommended. The procedure was performed with the patient under general anesthesia in dorsal recumbency; food had been withheld for 36 hours prior to anesthesia. Ventral midline and left caudal paramedian portals were made for the laparoscopic camera and instruments. A larger incision in the right caudal paramedian portion of the abdomen was used to create the marsupialization stoma. Laparoscopic observation of anatomic structures within the abdomen was excellent. The goat recovered well from surgery and was discharged the day following surgery. Follow-up examinations were done every few months after surgery, and dermatitis of the abdominal skin secondary to urine scald was the only postoperative complication. At 9 months of follow-up, the goat continued to pass urine through the marsupialization site comfortably. In the goat of this report, laparoscopic urinary bladder marsupialization was a minimally invasive procedure with minimal signs of postoperative pain. The procedure was simple to perform and should be considered as an alternative to marsupialization via laparotomy.

Evaluation of palliative stenting for management of malignant urethral obstructions in dogs

To evaluate use of balloon-expandable and self-expanding metallic stents in management of malignant urethral obstructions in dogs. Original study. 12 dogs with malignant urethral obstructions. The extent and location of urethral obstructions and the diameter of adjacent unaffected luminal segments were determined by use of fluoroscopically guided wires and measuring catheters. Stents were chosen to extend approximately 1 cm proximal and distal to the obstruction. Stent diameters were chosen to be approximately 10% greater than the diameter of healthy portions of the urethra to prevent displacement. Stents were placed in the urethra under fluoroscopic guidance to restore luminal patency. 3 dogs received balloon-expandable metallic stents, and 9 dogs received self-expanding metallic stents. The placement procedures were rapid, safe, and effective at restoring luminal patency and were not associated with major complications. Complications included recurrent urethral obstruction secondary to blood clot formation and urethral edema in 1 dog and stent dislodgement into the urinary bladder in 1 dog. All dogs were able to urinate immediately after the procedure. Nine dogs (3/4 females and 6/8 males) were continent or mildly incontinent after stent placement. Of the remaining 3 dogs, 2 developed severe incontinence and 1 had an atonic bladder. Seven dogs were considered to have good to excellent outcome, 3 had fair outcome, and 2 had poor outcome. Transurethral placement of metallic stents was a safe and effective palliative treatment option for dogs with malignant urethral obstructions.

Oral glucosamine and the management of feline idiopathic cystitis

Oral glucosamine was compared to a placebo for the management of cats with feline idiopathic cystitis (FIC) in a randomised, double-blinded, placebo-controlled, study. Forty cats with a history of recurrent cystitis due to FIC were divided into two groups and treated daily per os with either 125 mg N-acetyl glucosamine or a placebo for six months. Owners graded their cats' clinical signs at the beginning and end of the study, and kept daily diaries documenting signs of cystitis using visual analogue scales. Further episodes of cystitis were seen in 26 (65%) of the cats during the study. Affected cats experienced a mean of five recurrences (range 1–19) with each recurrence lasting a mean of four days (range 1–64 days). There were no significant differences between the two groups when considering the owners assessments of the mean health score ( P > 0.5), the average monthly clinical score ( P = 0.22) or the average number of days with clinical signs ( P = 0.28). Two cats suffered from such severe recurrent urethral obstruction that they were euthanased; they were both in the placebo group. Compared to the start of the study the majority of cats in both groups improved significantly ( P < 0.001) (mean health score of each group at the start was 0.5 ± SD 0.5, compared to glucosamine 4.4 ± 0.7 and placebo 3.9 ± 1.6 at the end). This is believed to have occurred because the owners of 36 of the 40 cats (90%) started feeding more canned cat food. The urine specific gravity at the start of the trial was significantly higher (mean 1.050 ± SD 1.007) than when reassessed one month later (1.036 ± 1.010, P < 0.01).

Feline Perineal Urethrostomy: A Potential Cause of Feline Lower Urinary Tract Disease

Perineal urethrostomies are associated with complications that may mimic primary causes of feline lower urinary tract disorders. Though postoperative urethral strictures may be minimized by proficiency with an effective surgical technique, removal of the distal urethra may result in bacterial urinary tract infections in 25% to 30% of patients after surgery. Urinary tract infections caused by urease-producing microbes may induce struvite urolith formation. Thus the prophylactic benefits of minimizing recurrent urethral obstruction by urethrostomy must be weighed against a long-term predisposition to recurrent bacterial urinary tract infection and urolith formation.