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Background: Urocystolithiasis is a common problem in dogs; many canine uroliths are resistant to medical dissolution. Novel management options would expand, and in some cases improve, current urolith retrieval strategies., Hypothesis/objectives: To describe a previously unreported technique by the Ellik bladder evacuator (EE) to assist in minimally invasive, cystoscopic retrieval of canine cystoliths., Animals: Twelve client-owned dogs presented with urocystolithiasis., Methods: In this retrospective study, dog demographics, procedure type and duration, and clinical outcomes of dogs undergoing cystoscopic cystolith retrieval utilizing the EE are described., Results: Twelve dogs underwent 13 cystoscopic procedures utilizing EE for cystolith retrieval. The EE was used in accordance with previously described techniques via a custom-made adaptor. Ten dogs were spayed females; 8 different breeds were represented. In 8 of 13 procedures, transurethral cystoscopy alone by EE with or without wire basket or grasping forceps was performed with a median procedure duration of 36 minutes (range, 16-52). In the other 5 procedures, additional interventions (ie, laser lithotripsy, percutaneous perineal approach, urethral stricture ballooning, ethanol parathyroid ablation) were performed as indicated with a median procedure duration 110 minutes (range, 42-144). No complications were noted in association with the use of the EE; retrieval of cystoliths was complete in 12 of 13 procedures., Conclusions and Clinical Importance: Use of the EE during cystoscopy might aid in minimally-invasive retrieval of cystoliths. This work provides a starting point for additional discussion regarding its benefit relative to current interventions., (© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Radiotherapy (RT) is increasingly utilised for definitive-intent treatment of canine genitourinary carcinomas (CGUC). At our institution, the standard approach is to irradiate tomographically abnormal tissues gross tumour volume (GTV) plus a clinical target volume (CTV) expansion of 2 cm. Cystourethroscopy is often incorporated into the treatment planning workflow, though an optimal approach has yet to be defined. This observational study evaluated cystourethroscopy as a tool for identifying gross lesions that can be targeted with RT. We hypothesised that in most cases, addition of cystourethroscopy would result in a larger GTV than would be drawn with computed tomography (CT) alone. Medical records from 54 dogs diagnosed with CGUC between 2013 and 2023 were reviewed; each had been evaluated before RT using CT and cystourethroscopy. The GTV was initially defined as the tomographically evident disease on a post-contrast sagittal plane CT scan, and then lesions visualised with cystourethroscopy (suspected or confirmed to be tumour) were added. Beyond what was visible on CT, cystourethroscopy extended the GTV by a median of 6.5 cm distally into the urethra (range: 1.5-31.8 cm) and therefore resulted in GTV enlargement in 26 of 54 (48%) cases. Addition of our standard 2 cm CTV expansion to a CT-defined GTV (without use of data from cystourethroscopy) would have underestimated the extent of grossly abnormal tissue in 35% (19/54) of cases. These results suggest that incorporating cystourethroscopy into treatment planning workflows may improve local tumour control by reducing the risk of a geographic miss., (© 2024 John Wiley & Sons Ltd.)

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., (© 2024 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

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., (© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

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.

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., (© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

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., (© 2022 by American Animal Hospital Association.)

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., (© 2021 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.)

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.

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., (Copyright © 2020 Elsevier Inc. All rights reserved.)

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., (© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

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., (© Veterinary Emergency and Critical Care Society 2019.)

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.

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.

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., (© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

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., (© 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

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., (© 2018 British Small Animal Veterinary Association.)

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.

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.

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.

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., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Cloacoscopy and cystoscopy are simple, noninvasive to minimally invasive techniques that provide excellent visualization, and result in fast recovery. General or intrathecal anesthesia is sufficient. They can be performed in free-ranging turtles under field conditions. Cloacoscopic gender identification of external genitalia is not reliable because of the high degree of misinterpretation between phallus and clitoris, especially in juveniles. However, saline-infusion or air insufflation cystoscopy through the urinary bladder (or accessory vesicles/bladders) is often effective for the visualization of gonads and to identify the sex. Visualization of gonads is feasible through the urinary bladder or accessory vesicle wall in many species., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Urinary diseases are commonly found in guinea pigs. Diagnostic workup includes clinical examination, blood testing, imaging studies, urine culture, and urinalysis. This article describes the use of transurethral cystoscopy in female guinea pigs as an ancillary tool to diagnose abnormalities within the bladder and urethra. In addition, the transurethral cystoscopic removal of uroliths measuring up to 5 mm and situated within the urinary bladder is described., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Cystoscopy has become an important and widely available component of the diagnostic evaluation of diseases of the lower urinary tract in dogs and cats. In addition, a large number of cystoscopic guided procedures have been described that can be used to treat disease processes that were previously treatable only with invasive surgical procedures. This article reviews the indications and contraindications for cystoscopy, cystoscopy equipment and techniques for male and female dogs and cats, potential complications associated with cystoscopy, and management options for these complications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To characterize the duration of urinary catheterization, length of hospitalization, complications and clinical outcome in cats with urethral obstruction managed with decompressive cystocentesis and subsequent urinary catheterization., Design: Retrospective, observational, descriptive study., Setting: University teaching hospital., Animals: Forty-seven client-owned male cats diagnosed with urethral obstruction., Measurements and Main Results: The medical records of 47 cats diagnosed with urethral obstruction were reviewed. Treatment of all cats included decompressive cystocentesis, placement of an indwelling urinary catheter and hospitalization for a minimum of 6 hours. Collected data included signalment, body weight, body condition score, owner-reported clinical signs, duration of clinical signs, vital signs, and venous blood gas or chemistry values. Mean duration of urinary catheterization was 27.9 hours, median length of hospitalization was 40 hours, and survival to discharge was 91%. Of 34 cats that had survey abdominal radiographs, 56% (19/34) had loss of peritoneal detail consistent with abdominal effusion. No cat was diagnosed with a ruptured bladder during hospitalization., Conclusions: Decompressive cystocentesis, in cats with urethral obstruction, followed by placement of an indwelling urinary catheter, did not result in a diagnosis of bladder rupture in any cat. The source of and clinical significance of the reported abdominal effusion is not known. Survival to discharge, duration of catheterization, and length of hospitalization were similar to previously reported populations., (© Veterinary Emergency and Critical Care Society 2014.)

Objectives: To compare aerobic bacterial culture of urine to cystoscopically obtained mucosal biopsies of the lower urinary tract in dogs., Methods: Retrospective review of case records from dogs that had transurethral cystoscopy at a veterinary teaching hospital between 2002 and 2011. Dogs that had culture results from cystocentesis obtained urine and transurethral cystoscopically obtained mucosal samples were included in the study. Pathogens identified were compared between sampling methods., Results: Forty dogs underwent transurethral cystoscopy for lower urinary tract disease on 41 occasions. There was significant (P = 0 · 0003) agreement between urine and mucosal biopsy cultures. Both cultures were negative in 66% and positive in 17% of dogs. There was a 17% disagreement between the sampling methods. Although not statistically significant, more mucosal samples than urine cultures were positive for Escherichia coli., Clinical Significance: There was a good agreement between pathogen identification from urine and lower urinary tract mucosal cultures. These results do not support the utilisation of transurethral cystoscopy to obtain biopsy samples for culture in dogs with urinary tract infection and positive urine culture. Individual cases with possible chronic urinary tract infection and negative urine culture may benefit from transurethral cystoscopy to obtain biopsies for culture., (© 2014 British Small Animal Veterinary Association.)

The aim of this study was to investigate the short- and long-term morbidity and mortality associated with urethral rupture in cats. Medical records were reviewed from four veterinary hospitals. Diagnosis was made from retrograde urethrography or direct visualisation during surgery. Location of rupture was categorised as pre-, intra- or post-pelvic. Follow-up data were collected from referring veterinarians. Sixty-three cats were included in the study of which, males predominated (88.9%). Trauma was the most common cause (n = 35; 55.6%) with the remainder due to iatrogenic injury. Forty-eight cats (88.9%) were treated surgically and six (11.1%) managed conservatively. Significant differences between cats suffering traumatic versus iatrogenic injury included the presence of musculoskeletal injuries (P <0.001); the location of rupture (P <0.001); the degree of rupture (P <0.001); definitive management (P <0.001) and short-term complications (P = 0.026). Short-term complications were significantly associated with the following: musculoskeletal injuries (P = 0.012); uroabdomen/uroretroperitoneum (P = 0.004); azotaemia (P = 0.021); postoperative urinary diversion (P = 0.036) and >1 surgery performed (P = 0.006). Forty-seven cats (74.6%) survived to discharge. Prognostic factors associated with survival to discharge included the presence of musculoskeletal injuries (P = 0.017); cause of rupture (P = 0.017); location of rupture (P = 0.039) and definitive management (P = 0.020). Twenty-four cats (57.1%) suffered short-term complications and 10 (27.0%) suffered long-term complications. Of those cats surviving to discharge 30 (71.4%) had a good outcome. Median follow-up was 16 months. Outcome was significantly associated with cause of rupture (P = 0.04); short-term complications (P = 0.03) and long-term complications (P <0.001). In conclusion, a significantly greater proportion of cats with iatrogenic injuries survived to discharge and had a good outcome compared with those that suffered trauma.

Voiding urohydropropulsion and cystoscopy are routine procedures performed in the dog for diagnostic and therapeutic purposes. These procedures are typically performed under general anesthesia. The purpose of this study was to describe the use of medetomidine-based sedation protocols to perform voiding urohydropropulsion and cystoscopy in cardiovascularly healthy, non-diabetic dogs without evidence of urinary obstruction, renal disease, or hepatic disease. Results of this study revealed significantly shorter procedure times and decreased cost in sedated dogs, with diagnostic and therapeutic outcomes equivalent to those of patients that underwent general anesthesia. Based on the results of this retrospective study, the authors recommend medetomidine-based sedation protocols for voiding urohydropropulsion and cystoscopy in appropriately selected patients.

Practical Relevance: Diagnostic and therapeutic cystourethroscopy has become very popular in the diagnosis and treatment of canine lower and upper urinary tract disease in the past 5-7 years. As expertise is expanding, the use of similar techniques in feline patients is growing., Outline: This is a brief overview of the indications, equipment needed and procedure for performing cystourethroscopy in feline patients. The principal focus is normal feline lower urinary tract anatomy. Some examples of abnormalities that might be seen are also provided, and therapeutic cystourethroscopy is touched upon.

Objective: To describe a noninvasive technique for sex identification of posthatchling chelonians and to assess its safety in Hermann's tortoises (Testudo hermanni)., Design: Validation study and clinical trial., Animals: 15 recently dead posthachling chelonians and 25 healthy posthatchling Hermann's tortoises., Procedures: Cystoscopy was performed on both dead and anesthetized live chelonians. Dead chelonians ranged in body weight from 32.4 to 75.1 g (0.07 to 0.17 lb; median, 45.7 g [0.10 lb]). Dead chelonians were dissected immediately after cystoscopy, and gonads were collected for histologic examination. Urinary bladder was macroscopically evaluated in situ to assess its integrity after retrograde injection of saline (0.9% NaCl) solution. Hermann's tortoises ranged in body weight from 27.3 to 57.8 g (0.06 to 0.13 lb; median, 37.0 g [0.08 lb]). Cystoscopic examination of live tortoises was performed following induction of general anesthesia with a mixture of morphine, dexmedetomidine, and ketamine administered IM. The Pearson coefficient was used to assess the consistency between procedure time and body weight; κ statistic was used to evaluate agreement between sex identified by cystoscopy and histologic examination beyond that expected by mere chance., Results: Visualization of gonads was feasible through the thin, transparent urinary bladder wall in all the animals evaluated in this study. Blinded histologic examination confirmed the results of cystoscopic gonad identification in all dead chelonians (κ = 1.0). The urinary bladder did not have evidence of macroscopic leakage or microscopic alterations of normal tissue architecture within the representative sections chosen for histologic examination. In live tortoises, median procedure time (range) was 90 (39 to 345) seconds. No significant correlations were found between procedure time and body weight., Conclusions and Clinical Relevance: Cystoscopy performed by means of rigid endoscopy with fluid instillation was found to be an effective method for sex identification of immature chelonians. Furthermore, no complications were observed when this procedure was performed in vivo.

Objective: To (1) investigate the tissue response to a novel urethral bulking agent, polyethylene glycol carboxymethyl cellulose hydrogel (PEG-CMC) injected submucosally in the canine urethra and (2) compare PEG-CMC with bovine collagen (BC), the current standard for urethral bulking., Study Design: Experimental study., Animals: Purpose-bred female hound dogs (n = 8)., Methods: Standardized submucosal urethral injections of BC and PEG-CMC were performed in 8 female dogs. Injection sites were evaluated by cystoscopy on days 0 (n = 8), 30 (n = 4), and 90 (n = 4), magnetic resonance imaging on days 0 (n = 8), 30 (n = 8), and 90 (n = 4) and by histopathology on days 30 (n = 4) and 90 (n = 4)., Results: Both PEG-CMC and BC were detectable on MRI as hyperintense foci on T2-weighted images. Grossly, PEG-CMC formed more prominent blebs than BC. On follow-up cystoscopic examination, 6/8 PEG-CMC injection needle tracts were visible, and 3 of these sites had mucosal erosions. Histopathologic scores for foreign body reaction and inflammation were significantly higher for PEG-CMC compared with BC (P < 0.005). BC elicited a lymphoplasmacytic reaction whereas PEG-CMC incited a granulomatous response., Conclusions: The overall physical characteristics and histologic response associated with PEG-CMC support its use as a urethral bulking agent; however, the current formulation needs to be adjusted for clinical use., (© Copyright 2012 by The American College of Veterinary Surgeons.)

Objective: To describe and evaluate the short- and long-term outcomes in female dogs after cystoscopic-guided laser ablation of ectopic ureters (CLA-EU)., Design: Prospective case series., Animals: 32 incontinent female dogs with intramural ectopic ureters., Procedures: A diagnosis of intramural ectopic ureters was made via cystoscopy and fluoroscopy in all patients. Transurethral CLA-EU (via diode laser [n = 27] or Holmium:yttrium aluminum garnet laser [3]) was performed to relocate the ectopic ureteral orifice cranially into the urinary bladder. All vaginal anomalies were treated with the laser concurrently. Follow-up evaluation was standardized and included urinary continence scoring, serial bacteriologic culture of urine samples, and a follow-up cystoscopy 6 to 8 weeks after CLA-EU., Results: Ectopic ureteral orifices of all dogs were initially located in the urethra. Eighteen of 30 dogs had bilateral ectopic ureters, and 12 had unilateral ectopic ureters. All dogs had other concurrent urinary anomalies. At the time of last follow-up (median, 2.7 years after CLA-EU, [range, 12 to 62 months]), 14 of 30 (47%) dogs did not require any additional treatments following CLA-EU to maintain urinary continence. For the 16 residually incontinent dogs, the addition of medical management, transurethral bulking-agent injection, or placement of a hydraulic occluder was effective in 3, 2, and 4 dogs, respectively, improving the overall urinary continence rate to 77% (23/30 dogs). One dog had evidence of polypoid cystitis at the neoureteral orifice 6 weeks after CLA-EU that was resolved at 3 months., Conclusions and Clinical Relevance: CLA-EU provided an effective, safe, and minimally invasive alternative to surgery for intramural ectopic ureters in female dogs.

Objective: To assess gene expressions of cyclooxygenase-1 and -2 in oral, glandular gastric, and urinary bladder mucosae and determine the effect of oral administration of phenylbutazone on those gene expressions in horses., Animals: 12 healthy horses., Procedures: Horses were allocated to receive phenylbutazone or placebo (6 horses/group); 1 placebo-treated horse with a cystic calculus was subsequently removed from the study, and those data were not analyzed. In each horse, the stomach and urinary bladder were evaluated for ulceration via endoscopy before and after experimental treatment. Oral, glandular gastric, and urinary bladder mucosa biopsy specimens were collected by use of a skin punch biopsy instrument (oral) or transendoscopically (stomach and bladder) before and after administration of phenylbutazone (4.4 mg/kg, p.o., q 12 h) in corn syrup or placebo (corn syrup alone) for 7 days. Cyclooxygenase-1 and -2 gene expressions were determined (via quantitative PCR techniques) in specimens collected before and after the 7-day treatment period and compared within and between groups. Prior to commencement of treatment, biopsy specimens from 7 horses were used to compare gene expressions among tissues., Results: The cyclooxygenase-1 gene was expressed in all tissues collected. The cyclooxygenase-2 gene was expressed in the glandular gastric and bladder mucosae but not in the oral mucosa. Cyclooxygenase gene expressions were unaffected by phenylbutazone administration., Conclusions and Clinical Relevance: Cyclooxygenase-2 was constitutively expressed in glandular gastric and bladder mucosae but not in the oral mucosa of healthy horses. Oral administration of phenylbutazone at the maximum recommended dosage daily for 7 days did not affect cyclooxygenase-1 or -2 gene expression.

Objective: To assess the diagnostic utility of transurethral cystoscopic biopsy in dogs with histologically confirmed transitional cell carcinoma (TCC) of the urinary bladder and urethra., Design: Retrospective case series., Animals: 92 dogs with histologically confirmed TCC., Procedures: Information on sex, breed, neuter status, body weight, tumor location, biopsy method, number of biopsy procedures, experience level of clinician performing biopsy, and quality of biopsy sample was obtained from medical records. The association of variables with likelihood of achieving a diagnostic-quality biopsy sample was evaluated by use of logistic regression., Results: If used as the initial biopsy method, cystoscopic biopsy samples were of diagnostic quality in 65% of male dogs and 96% of female dogs with histologically confirmed TCC. Cystoscopic biopsy samples were significantly more likely to be of diagnostic quality in female dogs than in male dogs., Conclusions and Clinical Relevance: Cystoscopic biopsy is an effective method to obtain biopsy samples in dogs with TCC of the bladder and urethra. Cystoscopy is more likely to produce a diagnostic-quality biopsy sample in female dogs with TCC than in male dogs with TCC. Cystoscopy should be considered as a primary means of biopsy in male and female dogs with masses of the urinary bladder or urethra.

Objectives: To describe a minimally invasive technique for treating urethral obstructions in male dogs and to review the postoperative results., Methods: All dogs (n=9) had urethral obstruction due to calculi. Obstructions were verified by radiographic and ultrasonographic examinations. Dogs with impaired kidney function were not included in the study. A 5-mm diameter trocar and cannula were placed in the ventral midline, 2 cm cranial to the umbilicus, allowing placement of a 10-mm diameter cannula under visual guidance, adjacent to the apex of the bladder. The bladder was then partially exteriorised and sutured to the skin. A 5-mm diameter cystoscopy sheath was introduced into the bladder lumen and advanced into the urethra. Continuous retrograde flushing was used to dislodge the calculi from the site of obstruction and collect them upstream., Results: The nine dogs were followed up for a minimum of 6 months. No major postoperative complications were identified. One dog exhibited transient macroscopic haematuria (for 3 weeks postoperatively). All urethral calculi were removed in the nine dogs. No recurrence was found during the follow-up period., Clinical Significance: A minimally invasive approach is used to treat urethral obstructions resulting from calculi in the male dogs., (© 2011 British Small Animal Veterinary Association.)

Endoscopy in the field of buiatrics has gained growing importance in recent years. Parts of the upper respiratory and gastrointestinal tract, the urethra and urinary bladder, the abdomen and the teat are all accessible by means of endoscopy. The direct visualisation of inner or outer organ surfaces allows for rapid diagnosis and even prognosis of different pathological conditions. Flexible endoscopes of different dimensions are used for endoscopic examination of the upper respiratory tract. Examining this region, endoscopy is in some cases superior to other imaging techniques because of the direct visualization of surfaces and their pathological conditions and the possibility of collecting biopsies under visual control. The same is documented for diseases of the oesophagus. On the other hand, rumenoscopy is of experimental character so far. Urethrocystoscopy is mainly performed for diagnostic purposes with either flexible or rigid optics. Theloscopy represents the "gold standard" for surgical intervention in cases of disturbance of milk flow, since mucosal tissue can be removed under visual control. Therefore, this indication is one of the most important applications for endoscopy performed by practitioners. Another important field for the application of therapeutic endoscopy is the treatment of left displaced abomasum by repositioning and fixation to the abdominal wall under endoscopic control.

Three gravid, female, wild Florida cooter turtles (Pseudemys floridana floridana) were evaluated and treated by the North Carolina State University College of Veterinary Medicine Turtle Rescue Team as a result of traumatic injuries or infection. As part of medical management, oviposition was induced using oxytocin, which was only partially effective. In all three cases, ectopic eggs were subsequently identified in the urinary bladder by ultrasound and were successfully removed via a minimally invasive cystoscopic-guided technique. One of the three turtles died within several days of the procedure, and necropsy revealed granulomatous bacterial cystitis. It is hypothesized that these complications were likely due to the length of time between induction with oxytocin and the identification and removal of the ectopic egg.

Objective: To determine outcome of cystoscopic-guided transection for treatment of ectopic ureters in dogs., Design: Retrospective case series., Animals: 16 female dogs., Procedures: Medical records of dogs that underwent cystoscopic-guided transection of the membrane separating unilateral or bilateral ectopic ureters from the urethra and bladder between May 2005 and May 2008 were reviewed. Postoperative outcome was determined by use of telephone interviews conducted 1 to 36 months after the procedure., Results: 4 dogs had complete resolution of urinary incontinence with cystoscopic-guided transection alone, an additional 5 dogs had complete resolution with a combination of cystoscopic-guided transection and phenylpropanolamine administration, and an additional 4 dogs had an improvement in urinary control, although urinary incontinence persisted. Outcome could not be assessed in the remaining 3 dogs because of collagen injections in the urethra at the time of ureteral transection (n = 2) or nephrectomy secondary to unilateral hydronephrosis (1)., Conclusions and Clinical Relevance: Results suggested that cystoscopic-guided transection may be an acceptable alternative to traditional surgical correction of ectopic ureter in dogs. Most complications associated with the cystoscopic procedure were minor and easily managed.

Multiple techniques exist to remove uroliths from each section of the urinary tract. Minimally invasive methods for removing lower urinary tract stones include voiding urohydropropulsion, retrograde urohydropropulsion followed by dissolution or removal, catheter retrieval, cystoscopic removal, and cystoscopy-assisted laser lithotripsy and surgery. Laparoscopic cystotomy is less invasive than surgical cystotomy. Extracorporeal shock wave lithotripsy can be used for nephroliths and ureteroliths. Nephrotomy, pyelotomy, or urethrotomy may be recommended in certain situations. This article discusses each technique and gives guidance for selecting the most appropriate technique for an individual patient.

This case report describes the clinical, ultrasonographic and cystoscopic findings and treatment in a two-year-old Swiss Braunvieh heifer with rupture of a patent urachus. The lead signs in the seven-month-pregnant heifer were markedly abnormal general condition and demeanour and a pear-shaped abdomen. The heifer had severe azotaemia, and abdominal ultrasonography revealed ascites, which was diagnosed as uroperitoneum based on an elevated creatinine level in the fluid. A patent urachus was identified during cystoscopy; the endoscope could be advanced beyond the apex of the urinary bladder into the urachus. Based on all the findings, a diagnosis of uroperitoneum attributable to rupture of a patent urachus was made. The urachus was ligated twice via a left-flank laparotomy. The general condition normalised within a few days of surgery, and the patient calved normally and was in good health at follow-up evaluation.

Despite advances in the prevention and management of urinary calculi, calculus removal remains a common need in small animal practice. In fact, changes in calculus management have increased the percentage of calculi that are difficult to manage medically.1 Endoscopic techniques that reduce the need for calculus removal by traditional laparotomy and cystotomy have been developed. In my experience, most cystic and urethral calculi can be removed by transurethral or laparoscopic-assisted cystoscopy. These techniques decrease trauma to and urine contamination of the abdomen. Endoscopy also improves the ability to examine the urinary system for disease and the presence of more calculi.

A 4.5-year-old Swiss Braunvieh cow was presented to the Department of Farm Animals, University of Zurich, because of severe haematuria. All other clinical findings were within normal ranges. Transrectal ultrasonography revealed a 1 cm x 1 cm echogenic, irregularly-shaped, raised mass in the wall of the urinary bladder. Endoscopy identified the mass as a proliferation, approximately 0.5 cm in diameter, which was bleeding continuously. Thermocautery of the bleeding site was carried out twice five days apart via endoscopy. Clinical signs resolved for the remainder of the cow's life; she was slaughtered 15 months later because of infertility. Histological examination of the mass revealed a haemangiosarcoma.

Diagnostic examinations are markedly improved by using rigid endoscopy in the ear, nasal cavity, and urinary tract. This article presents the procedure, equipment, indications, and examples of abnormalities of rigid endoscopy in these areas. Textbooks, "hands-on" courses, and in-hospital training are methods for learning about these techniques and their applications. In addition to improving diagnostics, endoscopy can also be used for therapy in these three body areas.

OBJECTIVE-To evaluate a laparoscopic technique for implantation of a urinary catheter in the right paramedian area in male sheep and to determine feasibility, benefits, and risks for this technique. DESIGN-Evaluation study. ANIMALS-6 Healthy male sheep (mean +/- SD body weight, 42.16 +/- 11.95 kg [92.75 +/- 26.29 lb]). PROCEDURES-Each sheep was anesthetized and positioned in dorsal recumbency. A 10-mm laparoscope was inserted in the right paramedian area between the xiphoid and preputial orifice. After creation of capnoperitoneum, grasping forceps were inserted in the left paramedian area at the level of the teats and used to immobilize the urinary bladder. A pigtail balloon catheter was implanted transcutaneously in the right paramedian area between the preputial orifice and teats and directed into the urinary bladder by use of laparoscopic guidance. The catheter was removed 10 days after implantation. Fourteen days after initial surgery, a second laparoscopy was performed to evaluate pathologic changes. RESULTS-Inadvertent insertion of the first trocar into the rumen of 1 sheep was the only intraoperative complication encountered. Laparoscopic-assisted implantation of the urinary catheter was successfully performed in all sheep. No postoperative complications were detected. CONCLUSIONS AND CLINICAL RELEVANCE-Laparoscopic-assisted implantation of a urinary catheter in the right paramedian area was successfully performed and may be a feasible method for use in sheep. This method can be considered as an alternative to tube cystotomy performed by laparotomy.

Objective: To describe and evaluate the outcome of cystoscopic-guided laser ablation of intramural ureteral ectopia in male dogs., Design: Retrospective case series., Animals: 4 incontinent male dogs with intramural ureteral ectopia., Procedures: Intramural ectopic ureters were diagnosed via preoperative computed tomography-IV urography and subsequent cystoscopy. Transurethral cystoscopic-guided laser ablation (diode laser [n = 3 dogs] and holmium:yttrium aluminum garnet laser [1]) was performed to proximally relocate the ectopic ureteral orifice to the urinary bladder. Fluoroscopy was used during the procedures to confirm that the ureteral tract was intramural and the ureteral orifice was intravesicular after the procedure. In 1 dog with bilateral ureteral ectopia, staged laser ablation was performed at 6-week intervals because of difficulty viewing the second ureter on the first attempt. All ureteral orifices were initially located in the middle to proximal portion of the prostatic portion of the urethra. Six weeks after surgery, imaging was repeated in 3 of 4 dogs., Results: Postoperative dysuria or hematuria did not develop. All dogs were immediately continent after laser treatment and remained so at a median follow-up period of 18 months (range, 15 to 20 months) without medical management., Conclusions and Clinical Relevance: Ureteral ectopia can cause urinary incontinence in male dogs and is usually associated with other urinary tract abnormalities. Cystoscopic-guided laser ablation provided an effective and minimally invasive alternative to surgical management of intramural ureteral ectopia.

Objective: To assess the management of traumatic urethral ruptures using a systematic attempt at urethral catheterisation., Methods: Eleven cats that had been diagnosed with a traumatic urethral rupture over a five-year period were included in this study. Rupture was assessed by positive-contrast retrograde urethrography. An attempt was made to manage these ruptures by placing an indwelling urethral catheter., Results: The placement of an indwelling urethral catheter, could be performed in 10 out of 11 cats, which indicated a partial rupture. In one cat, catheterisation was not possible because of complete urethral rupture. A urethral catheter was placed into the urinary bladder via the urethra in five animals. In the other five animals, urethral catheterization required cystotomy using a modified 'inside to outside' technique. Urethral catheter removal occurred between five and 14 days after placement. Urethral healing was accomplished in all cases of catheterisation with a good outcome in eight of the 10 cats. Two cats showed clinical signs related to stricture formation during the follow-up period (seven to 72 months). Retrograde urethrography provided a definitive diagnosis of partial rupture in only six of the 10 cases of partial rupture., Clinical Significance: Results suggested that primary alignment with the placement of a urethral catheter should be attempted for the management of traumatic urethral ruptures in cats. Gentle urethral catheterisation seems to be an effective procedure for diagnosing and dealing with partial urethral rupture in cats. Clinical stricture formation can occur, but the risk does not seem to be high. Further studies are warranted in order to define the ideal duration for maintenance of an indwelling urethral catheter in cases of traumatic partial urethral rupture.

Inflammatory polyps in the urinary bladder of two dogs were removed via laparoscopic-assisted cystoscopy. In addition, one dog had a calculus removed and liver biopsies taken using the same two trocar sites. The laparoscopic-assisted cystoscopic technique provided clear surgical margins and permitted a thorough examination of the inside of the bladder and urethra. The technique was minimally invasive, produced little abdominal injury, and limited urine contamination of the abdomen.

Vaginoscopy is a useful diagnostic procedure for evaluating the nature and extent of disease in the vestibule and vagina of female dogs. Using flexible or rigid endoscopes improves the operator's capability to detect disease because of improved illumination and magnification while facilitating vaginal distension. The size of the scope should be appropriate for the size of the patient. Although a variety of positions are suitable, we place anesthetized dogs in dorsal recumbency to minimize inadvertent contamination of the operative field with feces. If the urinary tract will also be examined, evaluate the urethra and urinary bladder first and then the vagina. After the reproductive tract is examined, tissue biopsies can be obtained for microscopic evaluation.