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Practical Relevance: Lower urinary tract signs (LUTS) such as dysuria, haematuria, periuria, pollakiuria and stranguria can occur as the result of a variety of underlying conditions and diagnostic investigation is required to uncover the underlying cause and select appropriate treatment., Aim: The '2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats' provide an overview of the common presenting signs caused by underlying feline lower urinary tract (LUT) diseases in cats, which often are indistinguishable between different underlying causes. The Guidelines set out a diagnostic approach to affected cats before focusing on the most common causes of LUTS: feline idiopathic cystitis (FIC), urolithiasis, urinary tract infection and urethral obstruction. The aim is to provide practitioners with practical information on these problematic conditions., Clinical Challenges: The fact that LUTS are similar despite different underlying causes creates a diagnostic challenge. The most common cause of LUTS, FIC, is challenging to manage due to a complex pathogenesis involving organs outside the LUT. Urethral obstruction is a life-threatening complication of various underlying LUT diseases and recurrent LUTS can lead to relinquishment or euthanasia of affected cats., Evidence Base: These Guidelines have been created by a panel of experts brought together by International Cat Care (iCatCare) Veterinary Society (formerly the International Society of Feline Medicine [ISFM]). Information is based on the available literature, expert opinion and the panel members' experience., Competing Interests: Conflict of interestMembers of the panel have received financial remuneration for providing educational material, speaking at conferences

Objective: To document differences in the microbiota of healthy cats versus cats with urethral obstruction (UO); compare the urinary microbiota with the oral, preputial, and rectal microbiota; and demonstrate that 16S rRNA gene sequencing will reveal rich and diverse urinary microbiota., Methods: 15 client-owned cats with UO and 15 age-matched healthy cats were included from July 2020 through April 2021. Exclusion criteria were evidence of urinary tract infection, urolithiasis, antimicrobial administration, urinary catheterization in the past 30 days, or a comorbidity. This study was a prospective, observational study. Both groups had a baseline CBC, chemistry panel, urinalysis, urine culture, and focal bladder ultrasound. Swabs of the cystocentesis site, buccal mucosa, rectum, prepuce, and urinary samples were collected, and 16S rRNA gene sequencing was used to compare the groups and sites., Results: Differences in the microbiota richness and diversity were found in the urine of cats with UO (n = 15) compared to healthy cats (15), along with differences in the preputial and oral samples, supporting the presence of a urinary dysbiosis in cats with UO., Conclusions: Our preliminary data demonstrates a dramatic change in the urinary microbiota of cats with UO along with changes in microbiota in other sites compared to healthy cats., Clinical Relevance: A urinary dysbiosis in cats with UO has been minimally supported in prior studies using 16S rRNA gene sequencing. Although these are preliminary results, documenting this dysbiosis in cats with UO provides a potential avenue for novel therapeutics.

Background: Functional outflow tract obstruction (FOO) remains a challenging disease to manage in male dogs. Cystostomy tubes have been used to relieve urethral obstruction while allowing time to achieve effective medical management, avoiding the need for emergency visits and repeat urinary catheterizations., Objectives: To describe a series of dogs with FOO and categorize the most successful management strategies including medical management alone or with the support of cystostomy tubes for urinary diversion., Animals: Twelve client-owned dogs with FOO were included., Methods: Medical records of dogs presented from August 2012 to September 2021 with a presumptive diagnosis of FOO were retrospectively reviewed and findings recorded., Results: Seven dogs were managed with a cystostomy tube and 5/7 (71%) had a good-excellent outcome. Five dogs were managed without a tube and 1/5 (20%) had a good outcome. Eight dogs were refractory to medical management; 5 managed with a cystostomy tube and 3/5 (60%) had a good-excellent outcome; 3 managed without a cystostomy tube and 0/3 had a good or excellent outcome. Overall, dogs with cystostomy tubes had better outcomes but also had mild, moderate, and severe complications (100%, 71%, and 71%, respectively) reported., Conclusions and Clinical Importance: Most dogs that received a percutaneous cystostomy tube as part of their management plan had a good to excellent outcome, particularly when compared to those that did not, despite the high rate of tube-related complications. Percutaneous cystostomy tubes could be considered early during management for FOO to improve overall outcomes., (© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Background: Urethral obstruction is a common and life-threatening condition in male small ruminants., Case Presentation: This case report describes a 3-year old 103 kg Zwartbles breeding ram, presented with the complaint of straining, suspected to have an urethral obstruction. The work-up included clinical examination, laboratory analyses, ultrasound imaging, (contrast) radiography and urine examination. At presentation, blood analysis revealed a respiratory alkalosis, hyperkalaemia and mild azotaemia. On transabdominal ultrasound an enlarged bladder (diameter 11 cm) and free fluid surrounding the right kidney were observed. Treatment of the animal included tube cystostomy, intravenous perfusion, antimicrobial treatment, ammonium chloride and NSAIDs. No indications for urolithiasis were found on ultrasound, radiography, or urine examination. As no improvement was seen despite 16 days of therapy, a contrast radiograph of the urinary tract, as well as reproductive exam were conducted. Positive anterograde urethrogram showed a contrast filled cavitary lesion at the caudal aspect of the pelvic urethra. The reproductive ultrasonography revealed the same large urethral distention or abscess compressing the pelvic urethra, as well as severe testicular degeneration in both testis. The results of the contrast radiograph and the reproductive exam lead to the decision to euthanize the animal, as the animal would not be capable of breeding. Computed tomography was performed post-mortem, which showed close relation between the cavitary lesion and the left bulbourethral gland. Pathology revealed a lymphoplasmacytic to suppurative infection at the level of the urogenital tract, chronic interstitial nephritis and a perirenal to cortical abscess of the right kidney as well as a periurethral abscess. As for the reproductive system, multifocal interstitial inflammatory infiltrates were seen on the entire system. Marked fibrosis and atrophy was seen at the level of the testes and both epididymides., Conclusions: A periurethral abscess should be included in the differential diagnosis for an urethral obstruction in small ruminants. The extensive medical imaging, together with the ante-mortem and post-mortem findings, makes this a good reference case for diagnosticians confronted with urethral problems in a ram., (© 2024. The Author(s).)

Background: Urinary retention in obstructed male cats leads to changes in blood and urine compounds, which, combined with the time of obstruction, are linked to the worsening of the animal's clinical status., Aim: This study aimed to describe the primary laboratory changes in male cats with urethral obstruction (UO)., Methods: Medical records of 386 male cats diagnosed with UO and treated at the Veterinary Teaching Hospital of the Faculty of Veterinary Medicine and Zootechnics (FMVZ), UNESP-Botucatu, between 2010 and 2020 were reviewed. Data on sex, age, breed, body weight, and reproductive status were evaluated., Results: Over the years, complete blood count, renal and hepatic biochemistry, blood gas analysis, electrolytes, urinalysis, and urine culture were performed upon request. Anaemia was not representative in obstructed cats. Thrombocytopenia was identified in 65.5% (169/258) of patients, and neutrophilic leukocytosis was identified in 52.4% (170/326) of patients. High urea and creatinine values were detected in 82.9% (273/329) and 77.1% (256/331) of the patients, respectively. Acidemia, increased PO 2 , metabolic acidosis, hypochloremia, hyperkalemia, hypernatremia, and hypocalcemia were observed in 37.6% (90/239), 51.5% (120/233), 69.3% (160/231), 50.2% (115/229), 58.5% (138/239), 40.2% (93/231), and 85.7% (84/98) of the cats, respectively. Urinalysis revealed an acidic pH, isosthenuria, a low proportion of proteins, and a high presence of occult blood and erythrocytes per field (> 1,000). Finally, 19.49% had positive cultures. Escherichia coli and Staphylococcus spp. are commonly isolated., Conclusion: This study provides a description of laboratory changes and those most prevalent in the population under study. UO may result mainly in isolated or combined laboratory changes such as azotemia, acidemia, metabolic acidosis, hyperkalemia, hypocalcemia, acidic pH, and occult blood in the urine. Additional laboratory changes may be present; however, they must be deeply investigated as comorbidities might be associated with them. Therefore, the description of laboratory changes in large populations, such as in male cats with UO, provides a reference for veterinarians regarding the hematological and urinary changes expected in obstructed male cats and instigates the search for further studies in the field., Competing Interests: The authors declare no conflict of interest.

Objectives: The aim of this study was to describe the technical success and outcomes of ureteral and urethral decompression using the subcutaneous ureteral bypass (SUB) device and transurethral self-expanding metallic stents (SEMS) as a palliative treatment option for feline malignant urinary outflow tract obstructions., Methods: A retrospective study was conducted of 14 cats with ureteral and/or urethral obstructions secondary to diagnosed or suspected transitional cell carcinoma (TCC). In all cats, a SUB device and/or a SEMS was placed to relieve the obstruction(s). Group 1 consisted of cats with ureteral obstructions, with or without concurrent urethral obstructions, and group 2 consisted of cats with only urethral obstructions., Results: Eight cats were included in group 1 (seven with concurrent urethral obstructions) and six cats were included in group 2. TCC was confirmed in 8/14 cats. Repeat urethral obstruction due to tumor in growth occurred in 6/13 (46%) cats with a SEMS, and no cats developed recurrent ureteral obstructions after placement of the SUB device. Three cats had additional covered stents placed after urethral re-obstruction. The median survival time (MST) from the time of device placement was 52 days in group 1 (mean 92; range 14-349) and 80 days in group 2 (mean 96; range 7-209). The MST from the time of mass identification of the cats that did and did not receive adjunctive therapy was 349 days (mean 358; range 124-602) and 43 days (mean 113; range 14-423), respectively., Conclusions and Relevance: The use of bypass devices for feline malignant urinary outflow tract obstructions is a viable option to provide immediate renal and urinary bladder decompression. TCC in cats is locally aggressive and can result in urethral re-obstruction, prompting consideration for placing a covered urethral stent. The use of adjunctive therapies for malignant neoplasia should be considered to improve overall survival once the obstruction has been relieved., Competing Interests: Conflict of interestAllyson Berent and Chick Weisse are consultants for Norfolk Vet and Infiniti Medical, which are the companies that supply the SUB device and urethral stents for veterinary patients.

Objective: To evaluate the prevalence of red blood cell (RBC) transfusions and factors associated with the need for transfusion in cases of feline urethral obstruction (FUO). Secondarily, to compare survival to discharge in cats receiving an RBC transfusion versus those that did not., Design: Retrospective, multi-institutional study from 2009 to 2019., Setting: Four university teaching hospitals., Animals: Six hundred twenty-two total occurrences of FUO in 575 cats., Interventions: None., Measurements and Main Results: Medical records were retrospectively reviewed for pertinent information. The overall prevalence of severe anemia (PCV < 0.20 L/L [<20%]) at presentation was 1.0% (6/622). The prevalence of RBC transfusions during hospitalization was 2.1% (13/622). Cats that received an RBC transfusion weighed significantly less than those that did not (4.9 vs 5.8 kg; P = 0.034) and had a lower PCV at presentation (0.30 L/L [30%] vs 0.41 L/L [41%]; P < 0.001). Hospitalization time (240 vs 72 h) and indwelling urinary catheter time (168 vs 48 h) were significantly longer in cats receiving a transfusion compared with those that did not (P < 0.001). Creatinine concentrations were not significantly associated with transfusion administration, while BUN was higher in cats receiving a transfusion (15.35 mmol/L [43 mg/dL] vs. 11.78 mmol/L [33 mg/dL]; P = 0.043). Transfusion rates were significantly higher in cats undergoing perineal urethrostomy (5.5%) compared with those that did not undergo surgery (0.97%; P < 0.001). The overall survival to discharge rate was 96%. Cats not receiving an RBC transfusion were significantly more likely to survive to discharge than those that did (odds ratio: 14.7, 95% confidence interval: 1.8-37; P < 0.001)., Conclusions: FUO is rarely associated with severe anemia and the need for RBC transfusions. In this study, cats receiving an RBC transfusion were less likely to survive to discharge; therefore, requiring a blood transfusion may be associated with a worse prognosis. In addition, the need for surgical intervention was associated with a higher prevalence of RBC transfusions., (© Veterinary Emergency and Critical Care Society 2024.)

Background: This study aimed to investigate variations of the oxidative status in cats affected by urethral obstruction (UO) under Feline Idiopathic Cystitis (FIC) and Bacterial Cystitis (BC), in comparison with a group of healthy subjects. In both groups, the levels of several markers (either direct or indirect) indicative of the oxidative attack and of the antioxidant response were analyzed on plasma and urine samples. In particular, the plasma samples were evaluated for nitric oxide (NO), hydroperoxides derived by reactive oxygen activity (d-ROMs test), superoxide anion (O 2 - ), glutathione peroxidase activity (GPx), superoxide dismutase activity (SOD), and ferric reducing antioxidant power (FRAP test); while on urine the levels of NO, d-ROMs, FRAP, SOD, malondialdehyde (MDA) and 8-hydroxydeoxyguanosine (8-OHdG) were measured. Urine of UO patients was also subjected to urine-culture test., Results: The analytical data on plasma showed that UO, independently of the FIC or BC etiology, induced the insurgence of oxidative stress conditions at the systemic level. In the urine of the UO patients, except for SOD that increased, the markers of redox status were markedly decreased due probably their compromised filtration, thus suggesting involvement of renal function (assessed also by the high levels of plasma creatinine and proteinuria) with no oxidative damage of the lower urinary tract. Moreover, the adoption of a novel oxidative stress index' (OSI) allowed to establish, by means of a numerical value, the different degrees of oxidative stress conditions for single UO patients, both in terms of oxidative attack and antioxidant response., Conclusions: Feline urethral obstruction, induced by Idiopathic Cystitis and Bacterial Cystitis, causes oxidative stress conditions at the systemic level that do not interest the lower urinary tract. Despite to the high variability of the profiles of oxidative stress indexes both in healthy and UO patients, the determination of OSI made possible the evaluation of their single degrees of oxidative stress. Possibly the results of this investigation can be compared with those of correspondent pathologies both in humans and in other animal species., (© 2024. The Author(s).)

Background: Swelling of the perineal region in male dogs is most commonly caused by a perineal hernia. Clinical signs associated with perineal hernia are constipation, tenesmus or stranguria. This case report documents a rare cause of perineal swelling created by the growth of a malignant tumour leading to urethral obstruction and subsequent stranguria., Case Presentation: An 11-year-old neutered male German Shepherd was presented for swelling in the perineal region and stranguria for three days. Complete blood count and serum biochemistry were unremarkable. Ultrasound revealed a heterogeneous mass in the perineal region. Retrograde urethrography showed a severe narrowing of the urethra caudal to the pelvis. A fine-needle aspirate of the mass was highly suspicious for liposarcoma. Staging was performed by computed tomography (CT) of the thorax and abdomen. Total penile amputation in combination with pubic-ischial pelvic osteotomy, transposition of the remaining urethra through the inguinal canal, V-Y-plasty cranial to the prepuce and preputial urethrostomy were performed to remove the tumour. Histopathology confirmed a well-differentiated liposarcoma with complete histological margins. Six months after the surgery the dog was doing well and there were no signs indicating local tumour recurrence., Conclusions: Wide surgical excision is generally recommended for soft tissue sarcomas, however this is sometimes not feasible for large tumours. In the case reported here, tumour resection was achieved by a combination of several surgical techniques with a good clinical outcome., (© 2024. The Author(s).)

Objectives: 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., Methods: 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., Results: 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., Conclusions and Relevance: 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., Competing Interests: Conflict of interestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Cardiovascular dysfunction associated with acute kidney injury has been recently described in veterinary medicine, but limited information is available for cats with urinary tract obstruction (UTO)., Objective: This retrospective study aimed to describe the type, frequency, timeline, and risk factors for cardiovascular events (CVEs) in cats treated for acute UTO., Animals and Procedures: Medical records of cats admitted to the intensive care unit for either upper (ureteral: UUTO) or lower (urethral: LUTO) UTO from 2016 to 2021 were reviewed. Cardiovascular events were defined as development of arrhythmia, heart murmur or gallop sound, clinical signs consistent with fluid overload (CRFO), or decreased tissue perfusion (DTP)., Results: One hundred and sixty-eight cats with UTO were recruited (56 with UUTO and 112 with LUTO). Cardiovascular events were reported in 61.9% of cases, including arrhythmia (33.6%), gallop rhythm (28.1%), heart murmur (15.3%), CRFO (14.4%), and DTP (8.6%). Potassium concentration, preexisting chronic kidney disease, and renal pelvic dilation at abdominal ultrasonography were associated with CVE occurrence in multivariate analysis., Conclusions: This study highlighted frequent CVEs in cats treated for UTO, with a potential strong impact on outcome. Therefore, cardiovascular parameters of cats with preexisting chronic kidney disease or those admitted with hyperkalemia or renal pelvic dilation should be closely monitored., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

A 4-year-old, entire, male, domestic long-haired cat was presented with an acute history of stranguria and dysuria and diagnosed with urolithiasis causing urethral obstruction. The patient was induced to general anaesthesia and several unsuccessful attempts to flush the uroliths retrogradely towards the bladder were made. An intraurethral administration of the neuromuscular blocking agent atracurium was performed as it has been reported to facilitate urethral catheterisation without any side effects. Respiratory arrest developed after 15 minutes from atracurium administration, which was promptly recognized and treated with mechanical ventilation. The absence of muscle contraction in response to a nerve stimulation confirmed a generalised muscle blockade. Approximately 35 minutes after, a muscle response to nerve stimulation appeared. Neostigmine combined with glycopyrrolate was administered resulting in complete recovery from neuromuscular blockade. In conclusion, the use of intraurethral atracurium can result in systemic absorption of the drug with subsequent generalised neuromuscular blockade., (© 2023 British Small Animal Veterinary Association.)

Objectives: Feline idiopathic cystitis (FIC) and urethral obstruction (UO) are commonly linked to increased stress. The influence of human movement restrictions on their incidence remains undetermined. FIC with or without UO is associated with environmental stress factors. The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic restricted human movement and working behaviours. It is unknown if these restrictions increased the risk of FIC or UO in cats., Methods: Total cat emergency accessions and transfers between 8 February 2019 and 8 February 2021 at two private hospitals were retrospectively reviewed. Cats were included in the FIC group if they presented with lower urinary tract signs and supporting urinalysis, and were included in the UO group if they presented with UO. Cats with current urinary tract infection, or previous FIC or UO, were excluded. Groups were considered 'pre-COVID-19' between February 2019 and 2020 and 'COVID-19' between February 2020 and 2021. Cases of FIC and UO were compared between COVID-19 and pre-COVID-19 using Fisher's exact test and relative risk (RR) calculations., Results: The pre-COVID-19 incidence of FIC was 4.3% (63/1477, 95% confidence interval [CI] 0.0332-0.053), non-obstructive FIC was 1.4% (20/1477, 95% CI 0.008-0.020) and UO was 2.9% (43/1477, 95% CI 0.020-0.038). One cat was excluded as obstruction occurred during hospitalisation. The COVID-19 incidence of FIC was 5.4% (113/2081, 95% CI 0.044-0.64), non-obstructive FIC was 2.1% (70/2081, 95% CI 0.014-0.027) and UO was 3.4% (70/2081, 95% CI 0.026-0.042). The risk of non-obstructive FIC ( P  = 0.122; RR 0.652, 95% CI 0.387-1.096), UO ( P  = 0.382; RR 0.839, 95% CI 0.577-1.22) or either ( P  = 0.098; RR 0.773, 95% CI 0.572-1.044) was not significantly higher in the COVID-19 period than the pre-COVID-19 period., Conclusions and Relevance: No clear association between COVID-19 movement restrictions and the incidence of UO or non-obstructive FIC was found within this retrospective population., Competing Interests: Conflict of interestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To describe the surgical technique and clinical outcome of small ruminants treated for obstructive urolithiasis using a modified tube cystostomy (MTC) technique., Animals: 15 goats and 2 sheep treated with an MTC between March 2018 and February 2023., Clinical Presentation: Animals were diagnosed with obstructive urolithiasis on the basis of history, physical examination, and ultrasonographic examination. An MTC was performed with sedation and a local block. Postoperative medical management was instituted to help reestablish urethral patency, and Foley catheters were removed after successful urination., Results: Animals were hospitalized an average of 3 nights (range, 0 to 14 nights). Complications included urine spillage in the abdomen and accidental deflation of the Foley balloon. Six animals were euthanized due to poor prognosis or failure to regain urethral patency. Foley catheters were removed an average of 15.7 days postoperatively in animals that regained urethral patency. Long-term (> 1-month) follow-up was available for 8 animals, with an average postoperative survival time of 19.4 months (range, 1 to 58 months). Four animals were lost to long-term follow-up., Clinical Relevance: This MTC technique is an effective means of catheterizing the urinary bladder in small ruminants. It can be performed under field conditions and serve as a standalone procedure for providing temporary urine egress. Patient size is limited by the length of the introducer, and an intact, distended urinary bladder and plan for reestablishing urethral patency are important considerations.

Objective: To retrospectively assess the hospital prevalence and risk factors associated with iatrogenic lower urinary tear in cats with urethral obstruction (UO)., Animals: 15 client-owned cats diagnosed with concurrent UO and lower urinary tears and year-matched control population of 45 cats diagnosed with UO., Methods: University teaching hospital records were reviewed for cats presenting with UO between January 2010 and December 2022. Signalment, anatomic location of tear, experience of the individual passing the urinary catheter, difficulty level of catheter passage, history of previous UO, blood work parameters on presentation, presence of visible grit in urine, and survival to discharge were recorded. In addition, prevalence of lower urinary tears in cats presenting with UO was calculated., Results: The prevalence of lower urinary tears was 0.92% in UO cats. Cats with lower urinary tears were significantly less likely to survive to discharge and had a longer period of hospitalization than cats without tears. In addition, cats with tears were more likely to have a history of previous UO and had more difficult urinary catheter passage than cats in the control group. Cats with tears also had a higher Hct than the control UO cats., Clinical Relevance: Cats that develop lower urinary tears are more likely to have a history of previous UO and difficult catheter passage. This group of cats is also more likely to have a longer hospitalization period and lower survival to discharge rates.

This case report describes the hematological and radiological examination of urinary bladder rupture and complete urethral obstruction. associated with urolithiasis in Hanwoo. Hyponatremia, hypochloremia, azotemia, and hyperglycemia were observed in both urethral obstruction and urinary bladder rupture. However, cattle with urethral obstruction showed hyperkalemia and mild hyperglycemia, whereas cattle with bladder rupture showed marked hyperglycemia and normal potassium levels. In ultrasonography, the urethral obstruction showed a dilated bladder with a thick bladder wall. In contrast to previous literature, in this study, severe electrolyte changes such as severe hyponatremia, hypochloremia, and hyperkalemia occurred in a case of complete urethral obstruction., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Korean Society of Veterinary Science.)

Background: Pseudomembranous cystitis (PMC) in cats is a recognized disease, but concurrent mineralization is reported rarely and its outcome is poorly described., Hypothesis and Objectives: Describe a population of cats with PMC and the prevalence of concurrent mineralization., Animals: Twenty-six cats with PMC., Methods: Medical records were retrospectively reviewed (January 2016 to December 2021). Cats with an ultrasound diagnosis of PMC were included. Clinicopathologic results, imaging, treatment, and outcome were reviewed., Results: All cats were male and 21 (80%) were diagnosed with urethral obstruction (UO). Five cats (23.8%) had positive urine culture (Staphylococcus felis, 3/5; Proteus mirabilis, 2/5) with a median urine pH of 8 (range, 6-9). All cats had ultrasonographic changes suggestive of mineralization. On ultrasound examination, 10 cats (38.5%) had pseudomembranes with acoustic shadowing suggestive of mineralization, 15 (57.7%) had changes indicative of ulceration, and 8 (31%) had changes compatible with of a urachal anomaly. Twenty-two cats received medical treatment, 4 underwent surgery (3 percutaneous cystolithotomy, 1 cystotomy). Twenty cats (77%) survived to discharge. Follow-up ultrasound examination indicated resolution of PMC in 6/7 cats, 4 had persistent hyperechoic bladder lining. Five of 12 cats with follow-up had a relapse of lower urinary tract signs., Conclusions and Clinical Importance: Pseudomembranous cystitis was diagnosed mainly in male cats with UO and imaging findings suggestive of mineralization were present in all cases. Frequent negative urine culture suggests a different etiology than encrusting cystitis related to urease-positive bacteria. Good outcomes can be achieved with medical management., (© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.)

Objective: To investigate the influence of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of urethral obstruction (UO) in male cats., Design: Retrospective study., Setting: One veterinary university teaching hospital and 6 private practice veterinary specialty and emergency centers., Animals: A total of 24,937 total feline cases presenting to the emergency room (ER) between March 2019 and March 2021., Measurements and Main Results: Out of 24,937 total cases, 1793 male cats met the inclusion criteria for diagnosis of UO. Of those, 327 cases were identified in which an additional diagnosis of either urolithiasis or neoplasia was made and were therefore excluded. The remaining 1466 UO cases were presumed to be idiopathic urethral obstruction (iUO) caused by feline interstitial cystitis (FIC) alone. Of those, 637 cats presented during the prepandemic year and 829 cats presented during the pandemic year., Key Findings: Incidence of presumptive iUO increased by 30% during the COVID-19 pandemic. Total feline emergency caseload increased by 38%. iUO accounted for 6.08% and 5.73% of total feline emergency cases during the prepandemic and pandemic years, respectively., Clinical Significance: The reported increase in incidence of feline UO is likely due to the increase in overall emergency feline caseload., (© Veterinary Emergency and Critical Care Society 2023.)

A 5-year-old wether was presented for an acute onset of loss of appetite and inability to urinate. Urethral urolithiasis causing urethral obstruction was diagnosed and a cystostomy catheter was placed. The wether continued to be unable to urinate through the urethra and further developed a perineal pseudodiverticulum. Diverticulectomy followed by a urethroplasty using porcine small intestinal submucosa was performed to relieve the obstruction. The wether developed a urethral stricture following urethroplasty and the owners refused a perineal urethroplasty. Cystourethrography, fluoroscopic-guided balloon dilations, and urethral stent placement were done to establish urethral patency. The wether developed tissue ingrowth through the stent, resulting in recurrent obstruction that necessitated placement of covered urethral stents. Key clinical message: Although obstructive uroliths usually carry a guarded prognosis in small ruminants, the use of novel interventional radiology techniques along with urethroplasty using a xenograft allowed a wether to achieve urethral patency and normal urinations., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Objective: To describe the successful management of pelvic urethral strictures in 3 young cats (1 after perineal urethrostomy, 1 after a third-time urethral obstruction, and 1 with prolonged lower urinary tract signs post-urethral obstruction) using balloon dilation and a short-term, indwelling urethral catheter., Case Summaries: A 9-month-old neutered male domestic longhair cat with a urethral obstruction and a suspected congenitally narrowed urethra was treated via perineal urethrostomy. The cat later developed acute kidney injury, multidrug-resistant urinary tract infections, and a pelvic urethral stricture. A second case, a 2.3-year-old neutered male domestic shorthair cat, developed a stricture of the pelvic urethra after multiple obstructions and catheterizations. A third case, a 1.2-year-old neutered male domestic shorthair cat, had persistent and prolonged lower urinary tract signs after treatment for a urinary obstruction. The cat also had an abnormally small urethral opening and was ultimately found to have a proximal urethral stricture. The strictures in all 3 cases were successfully treated with a combination of fluoroscopic-guided balloon dilation and short-term indwelling urethral catheterization while managing any present infection., New or Unique Information Provided: To the authors' knowledge, this is the first published case series of successful balloon dilations paired with the use of a short-term indwelling urethral catheter in cats that developed urethral strictures after catheterization due to urinary obstructions. This procedure appears safe and well tolerated and appears to offer a long-term, cost-effective solution to urethral strictures at the level of the pelvis., (© Veterinary Emergency and Critical Care Society 2023.)

Practical Relevance: Traumatic injury of the urinary tract may be caused by external accidental trauma or due to iatrogenic injury (typically as a result of catheterisation procedures). Thorough patient assessment and careful attention to patient stabilisation are essential, with diagnosis and surgical repair delayed until the patient is stable, if necessary. Treatment depends on the location and severity of the trauma. If diagnosed and treated promptly, the chance of survival of a patient without other concurrent injuries is good., Clinical Challenges: Following accidental trauma, at the initial presentation urinary tract injury can be overshadowed by other injuries, but if left undiagnosed or untreated it can lead to serious morbidity and potentially mortality. Many of the surgical techniques described for management of urinary tract trauma can be associated with complications, and so comprehensive communication with the owners is necessary., Patient Group: The main population affected by urinary tract trauma is young, adult male cats, owing to their roaming behaviour, as well as their anatomy and the resulting increased risk of urethral obstruction and its associated management., Aims: This article aims to serve as a guide to all veterinarians who treat cats for the diagnosis and management of urinary tract trauma in cats., Evidence Base: This review summarises the current knowledge available from a number of original articles and textbook chapters in the literature that cover all aspects of feline urinary tract trauma, and is supported by the authors' own clinical experience.

Objectives: 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., Methods: 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., Results: 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., Conclusions and Relevance: 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.

Objectives: The aim of this study was to investigate a potential association between the COVID-19 pandemic stay-at-home orders and the prevalence of emergency room presentations for urethral obstruction (UO) in feline patients., Methods: Medical records and hospital census were retrospectively searched to identify the total number of cats and total number of male cats with UO presenting to two academic veterinary medical centers from 22 March to 10 August in the years 2018 (123), 2019 (137) and 2020 (175). Cats were grouped based on the year of presentation and the proportions of UO cases relative to all cats presenting to the emergency rooms during the same time frame. Absolute (year of interest - reference year) and relative ([year of interest - reference year]/[reference year]) change in prevalence was determined. These were compared for each year using a two-sample z -test., Results: The absolute and relative prevalence of UO presentations across the combined population increased significantly during the COVID-19 pandemic in comparison with 2018 (2.2% and 59%, respectively; P  = 0.0003) and 2019 (1.9% and 48%, respectively; P  = 0.0021). For the individual institutions, a significant increase in UO presentations was found for institution A when comparing 2020 with both 2018 ( P  = 0.0072) and 2019 ( P  = 0.0073), but not for institution B ( P  = 0.057 and P  = 0.18, respectively). No significant differences were found when 2018 and 2019 were compared across the combined population or within institutions., Conclusions and Relevance: The results of this study demonstrate an increased prevalence of UO during the initial months of the COVID-19 pandemic, which may be related to environmental change and stress imposed by stay-at-home orders.

Objectives: Stenosis is a postoperative complication reported in 12-17% of male cats that undergo perineal urethrostomy (PU). This study compared two different revision techniques for failed perineal urethrostomies. The first objective was to evaluate the feasibility of performing a transpelvic urethrostomy (TPU) after a previous, correctly performed PU in male cats. The second objective was to determine the residual urethral length, orifice diameter, and the position of the orifice relative to the pubic brim and anus after PU, TPU and subpubic urethrostomy (SPU)., Methods: Twenty male cat cadavers were randomly divided into two groups: TPU and SPU. In group TPU, PU was followed by TPU; in group SPU, PU was followed by SPU. After each procedure, the urethral orifice cross-section size was estimated by inserting the largest possible urinary catheter without resistance. Residual urethral length was measured both on contrast radiographs and after anatomical dissection., Results: In all cats, TPU could be performed following a technically correct PU. The TPU resulted in a 1.5-times longer residual urethral length than SPU, based on contrast radiographs ( P  = 0.001) and confirmed by anatomical dissection ( P <0.001). Relative to the initial urethral length, PU, TPU and SPU resulted in a reduction of 24%, 36% and 56%, respectively. The urethral orifice diameter after TPU did not differ from SPU ( P  = 1.000), and it was not statistically significantly different between TPU and PU ( P  = 0.317) or between SPU and PU ( P  = 0.655). The urethral orifice was located further away from the pubis ( P <0.001) and closer to the anus ( P <0.001) after TPU than after SPU., Conclusions and Relevance: Both TPU and SPU are possible revision surgeries following PU. As TPU preserves a significantly longer urethral length and requires less tissue dissection, the risk of urinary tract infections, urinary dermatitis and urinary incontinence might be less following TPU than SPU.

Objective: To evaluate the effect of intermittent bladder flushing on recurrent urethral obstruction (rUO) at 7 d and 30 d after discharge and the risk of bacteriuria as a result of indwelling urethral catheterization., Animals: There were 72 cats with suspected obstructive feline idiopathic cystitis admitted to the hospital., Procedures: Cats were randomly assigned to either intermittent bladder flushing ( n = 34) or no-flush (control) groups ( n = 38). Bladder flushing was performed with 5 mL/kg of sterile 0.9% saline, q8h during indwelling urinary catheterization. Urine was tested for bacteriuria by a point-of-care test at the time of urinary catheterization and via cystocentesis following catheter removal before discharge. Risk of rUO by groups and its association with other variables were evaluated., Results: The age (median: 3.0 years) in the flush group was younger ( P = 0.01), and the length of hospitalization (> 24 hours) was longer ( P < 0.01) than that of the control group. Overall rUO was 6.6% on Day 7 and 21.8% on Day 30 after discharge, but there was no significant difference between groups. A shorter duration of catheterization (< 24 hours) was associated with higher risk of rUO (odds ratio: 6.0). The incidence of catheter-related bacteriuria was 14.5% and was not significantly different between groups (13.8% and 15.2% in the flush and control, respectively)., Conclusion and Clinical Relevance: Intermittent bladder flushing during hospitalization appears safe but did not decrease the incidence of rUO. The incidence of bacteriuria following catheterization was not affected by intermittent bladder flushing., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Objectives: The purpose of this study was to evaluate the correlation between clinical aspects and urethral lesions with reproductive status and age at neutering in obstructed male cats., Methods: All cats with compatible signs of urethral obstruction (UO) treated at the Veterinary Hospital of the Federal Rural University of Pernambuco from 2019 to 2021 were divided into three groups according to their reproductive status: intact; prepubertal neutered; and post-pubertal neutered. Cats with compatible signs of UO were selected for further analysis. Age, clinical signs, age at neutering and age of the first obstructive event were documented. Cats with recurrent obstructive urinary signs or urethral trauma that made catheterization impossible were referred for perineal urethrostomy. The morphology of the excised penises was assessed by histopathological analysis., Results: Of 84 cats with signs of UO included in this study, 28.6% were classified as intact, 28.6% as prepubertal neutered and 42.8% as post-pubertal neutered. Intact cats had a significantly earlier onset of UO compared with prepubertal and post-pubertal neutered cats, as seen by the age at obstruction (3.6 vs 5.7 and 5.5 years, respectively). Similar clinical signs and histopathological lesions were observed in all groups. The main clinical signs observed were stranguria, hematuria and pollakiuria. All cats had some degree of injury in the penile urethra. The most common lesions were hemorrhage, fibrosis and congestion., Conclusions and Relevance: It appears that intact cats had an earlier onset of UO than neutered cats, regardless of age at neutering. Urethral histopathological lesions and clinical signs were similar in both groups. Pediatric neutering represents a useful tool in the control of abandoned and stray animals and the consequent dissemination of zoonoses, thus having a positive impact on public health.

Objectives: The aims of this study were: to describe the potassium-lowering treatment strategies used to manage moderate-to-severe hyperkalemia in male cats with urethral obstruction (UO); to determine how much dextrose was required per unit of insulin to prevent hypoglycemia; to determine whether early initiation of a dextrose continuous rate infusion (CRI) prevented hypoglycemia; and to determine whether in-hospital mortality was associated with presenting plasma potassium concentration ([K + ])., Methods: The medical records of male cats presenting with a [K + ] ⩾7.0 mEq/l due to UO that had another [K + ] measured within 6 h were reviewed retrospectively. All [K + ] values within the first 6 h, blood glucose concentrations, treatments for hyperkalemia and survival to discharge were recorded. Analyses were performed to test for associations between dextrose:insulin ratios or method of dextrose administration and the development of hypoglycemia; and for presenting [K + ] and mortality. Normally distributed groups of continuous data were compared with a t -test and categorical data were compared with a Fisher's exact test., Results: Fifty cats were included. Mean presenting [K + ] was 8.9 ± 1.0 mEq/l, while the mean final [K + ] within 6 h was 6.6 ± 1.4 mEq/l. Forty-two (84%) cats were treated with intravenous fluids and 40 (80%) were treated with dextrose and insulin. Median dextrose:insulin ratio was 2 g/u (range 0.4-100). No dextrose:insulin ratio was found to protect against hypoglycemia, and 3/8 cats that became hypoglycemic had received ⩾2 g dextrose per unit of insulin. There was no association between the early initiation of a dextrose-containing CRI and avoidance of hypoglycemia. No association was found between presenting [K + ] and mortality., Conclusions and Relevance: While no specific dextrose:insulin ratio was found to protect against hypoglycemia, there is evidence that the commonly recommended dextrose:insulin ratio of 2 g/u may be inadequate in preventing hypoglycemia in every cat. Severity of hyperkalemia was not associated with mortality.

Objective: To describe a novel modified preputial urethrostomy with preservation of the local anatomy in 4 dogs., Study Design: Short case series., Animals: Four client-owned male dogs., Methods: Dogs presented for dysuria and urethral obstruction and underwent a modified preputial urethrostomy as a salvage procedure after the failure of previous treatments. Urethral stenosis or tear was confirmed by cysto-urethrography in all dogs. The preputial urethrostomy involved anastomosis of the pelvic urethra with the preputial mucosa after caudal laparotomy, without dissection of the prepuce or amputation of the penis. Owner follow up was obtained by telephone interview., Results: Urinary obstruction was due to urethral stenosis in 3 dogs and severe complications following perineal urethrostomy in 1 dog. The urinary obstruction was resolved in all dogs by the modified preputial urethrostomy. None of the dogs had signs of dysuria, urinary tract infection, or dermatitis immediately postoperatively. Two dogs showed signs of urinary incontinence from 15 days to 1 month postoperatively, which persisted throughout the follow-up period., Conclusion: A functional urethral stoma was obtained in all dogs. This technique may be an alternative to prepubic urethrostomy in male dogs., (© 2022 American College of Veterinary Surgeons.)

Objectives: The aims of this study were to evaluate serum symmetric dimethylarginine (SDMA) and creatinine concentrations in cats with urethral obstruction pre- and post-decompression of the obstruction, and to determine if pre-decompression values were predictive of post-decompression renal function, as measured by SDMA and creatinine., Methods: This was a prospective observational study. Twenty-five client-owned cats with urethral obstruction were hospitalized for decompression of the obstruction. Serum SDMA and creatinine were prospectively assessed at presentation, 24 h post-decompression and 5-20 days post-decompression. Urinalysis and culture were assessed at presentation and at the final follow-up. Exclusion criteria included positive urine culture, reobstruction or failure to obtain required samples., Results: Mean SDMA concentration dropped by 41.8% from an initial pre-decompression concentration of 17.6 µg/dl to 10.3 µg/dl 24 h post-decompression ( P  <0.001). The mean creatinine value dropped by 38.4% from an initial pre-decompression concentration of 2.5 mg/dl to 1.5 mg/dl 24 h post-decompression ( P  <0.001). There was no association between SDMA concentration at initial presentation and SDMA concentration 5-20 days after urethral catheterization (Spearman's ρ = 0.205, P  = 0.314). Creatinine concentration upon initial presentation was associated with the 5-20 day values after urethral catheterization (Spearman's ρ = 0.583, P  <0.002). Twenty percent of cases were excluded due to bacterial growth on initial urine culture. SDMA and creatinine concentrations were significantly higher in these cases (median 59 µg/dl and 10.9 mg/dl, respectively) compared with those with negative cultures (median 14 µg/dl and 1.6 mg/dl [ P  <0.002 and P  <0.001], respectively)., Conclusions and Relevance: Both SDMA and creatinine decreased significantly after urethral catheterization, suggesting that renal function post-decompression cannot be predicted by the pre-decompression concentrations of these values.

Progression of transitional cell carcinoma (TCC) in dogs often leads to urinary obstruction. This observational pilot study aimed to evaluate the safety and efficacy of irreversible electroporation (IRE) balloon therapy for the palliative treatment of TCC with partial urethral obstruction. Three client-owned dogs diagnosed with TCC causing partial urethral obstruction were enrolled. After ultrasonographic and cystoscopic examination, IRE pulse protocols were delivered through a balloon catheter device inflated within the urethral lumen. After the procedure, the patients were kept overnight for monitoring and a recheck was planned 28 days later. No complication was observed during the procedure and postprocedural monitoring. After 28 days, one dog had a complete normalization of the urine stream, one dog had stable stranguria, and one dog was presented with a urethral obstruction secondary to progression of the TCC. On recheck ultrasound, one dog had a 38% diminution of the urethral mass diameter whereas the other two dogs had a mass stable in size. IRE balloon therapy seems to be a feasible and apparently safe minimally invasive novel therapy for the palliative treatment of TCC causing urethral obstruction. Further studies are needed to better characterize the safety, efficacy, and outcome of this therapy., (© 2022 by American Animal Hospital Association.)

Objective: To describe the ureteropyeloscopic removal of a nephrolith in a horse., Animals: A 19 year old Hanoverian gelding with history of urolithiasis requiring surgical intervention., Study Design: Case report METHODS: The horse presented with signs of abdominal straining and stranguria. A proximal urethral calculus was palpable externally within the perineal urethra. Perineal urethrostomy (PU) at the location of the urethral calculi was performed to remove the urethral obstruction. Left nephrolithiasis was then treated by endoscopic retrieval, inserting the endoscope through the PU. The procedures were performed over 2 consecutive days, with the horse standing and sedated. Medical therapy included antimicrobial and anti-inflammatory treatment., Results: The ureteropyeloscopic removal of a nephrolith from the left renal pelvis was completed. No complications were appreciated following the procedure, and the horse was able to return to athletic activity within 2 weeks. The horse had no further clinical signs referable to urinary dysfunction 7 months later., Conclusion: Ureteropyeloscopic removal of a nephrolith from the renal pelvis is technically feasible in the equine patient and preserves function of the affected kidney. The availability of a treatment that maintains renal function is a distinct benefit over unilateral nephrectomy, particularly when treating a condition that frequently involves both kidneys., (© 2022 The American College of Veterinary Surgeons.)

Objectives: The objective of this retrospective study was to describe the feline population presented for urinary incontinence at a veterinary teaching hospital between 2009 and 2019, with a particular focus on cats with a non-neurologic underlying cause., Methods: The medical records of cats diagnosed with urinary incontinence were retrospectively evaluated. Signalment, clinical presentation, results of diagnostic tests, diagnosis of the underlying cause and treatments were recorded. When information was available, outcome was recorded and follow-ups divided into three time frames (0-1 week, 1 week to 3 months and >3 months)., Results: Thirty-five cats were presented with urinary incontinence. Of these, 18 cats with complete medical records presented urinary incontinence of non-neurologic origin. The most common clinical signs at presentation were urine leakage while resting (12/18), urine-soiled perineum (8/18), urine dribbling (8/18) and no spontaneous micturition (5/18). The most common underlying cause was urethral obstruction (67%; 12/18), with a majority due to urethral strictures (58%; 7/12). Other causes were suspected inflammation (2/12), neoplasia (1/12), urolithiasis (1/12) and foreign body (1/12). In 8/10 cats in which it was performed, cystoscopy and contrast cystourethrography were the methods that led to the diagnosis. Twelve cats with urethral obstruction underwent interventional procedures, resulting in complete resolution of incontinence in 7/12 and improvement in 1/12. Urinary tract infection was a common complication after 3 months (4/18)., Conclusions and Relevance: When incontinence of non-neurologic origin is suspected in a cat, urethral obstruction should be considered. Advanced imaging studies (cystoscopy and contrast studies) are useful for diagnosis. A good prognosis was reported in cats undergoing interventional procedures with no long-term treatment.

A 10-year-old castrated, male miniature pig was presented with tenesmus vesicae and anuria accompanied by tachypnea. Radiographs confirmed numerous uroliths within the bladder and urethra. The urethra was not amenable to catheterization, therefore, an emergency tube cystostomy was performed. Despite bladder irrigation the uroliths in the urethra were not removable. Consequently, a prepubic urethrostoma procedure was undertaken. The minipig fully recovered and has since been voiding urine via the urethral fistula uneventfully. Measures to prevent urolithiasis, among others, include an adequate water intake, a balanced feed and diet composition as well as maintaining a physiological urine pH., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: To determine if prazosin administration decreased the rate of recurrent urethral obstruction (rUO) before hospital discharge and within 14 days., Animals: 388 cats with urethral obstruction., Procedures: 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., Results: 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., Clinical Relevance: 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.

Urolithiasis is the most common cause of urinary tract disease in small ruminants and has significant economic and production impacts worldwide. Urolithiasis is multifactorial in origin and generally begins with the formation of cystoliths followed by urethral obstruction. The condition is most common in males. Clinical signs are variable depending on the severity of the obstruction. Uroliths can be calcium, struvite, or silicate based; however, struvite and amorphous magnesium calcium phosphate are the most common urolith types observed in small ruminants. Although urethral process (vermiform appendage) amputation is widely considered the first line of treatment, reobstruction is common within the first 36 hours. Surgical interventions such as temporary tube cystostomy, perineal urethrostomy (PU), modified proximal perineal urethrostomy, vesico-preputial anastomosis (VPA), and urinary bladder marsupialization (BM) are reported to carry an improved prognosis for long-term survival. PU carries a lower proportion of long-term success (> 12-month survival time) when compared with VPA and BM. Stoma stricture and urine scald are the most commonly observed surgical complications. Currently, the literature provides minimal direction for clinician decision-making in managing these cases while accounting for patient history, client financial ability, composition of calculi, and potential treatment complications. Small ruminant urinary obstructions are challenging and complicated conditions to treat, due to their multifactorial etiology, ruminant urogenital anatomy, and the variety of imperfect treatment options available. The purpose of this article this article is to provide veterinary practitioners with decision trees to guide management and treatment of urolithiasis in small ruminants.

Background: Urethral obstruction secondary to artificial urethral sphincter (AUS) implantation is a recognized complication in dogs. However, urethral obstruction secondary to AUS-associated capsule formation has been described rarely., Hypothesis: Describe clinical and diagnostic findings, management, and outcome in 6 dogs with urethral obstruction secondary to AUS-associated capsule formation., Animals: Six client-owned dogs., Methods: Retrospective study. Medical records between January 1, 2010, and June 30, 2021, were reviewed to identify dogs with urethral obstruction associated with the AUS device., Results: The AUS device was implanted a median of 884 days (range, 20-2457 days) before presentation for urethral obstruction. Median age at time of urethral obstruction was 4.7 years (range, 3.1-8.7 years). Clinical signs at the time of urethral obstruction were stranguria (n = 4), pollakiuria (3), weak urine stream (2), and worsened urinary incontinence (1). In all dogs, the urethra was noted to be stenotic during urethroscopy and positive contrast cystourethrography. All dogs underwent surgery, and a fibrous capsule associated with the AUS was found to be causing urethral stenosis. Resolution of urethral obstruction occurred in all dogs after transection or removal of the capsule. Positive bacterial cultures were obtained from the capsule, AUS, or both in all dogs. Recurrence of urethral obstruction had not occurred in any dog at the time of follow-up., Conclusions and Clinical Importance: Urethral obstruction secondary to capsule formation is an uncommon but clinically important complication associated with use of the AUS. Continued investigation is needed to evaluate this complication more thoroughly, and its possible association with infection., (© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Objective: To describe transpelvic urethrostomy (TPU) as a surgical technique for the successful treatment of vestibulovaginal and urethral stenosis in a 7 month old female spayed mixed-breed dog., Study Design: Case report., Sample Population: Female spayed mixed-breed dog with obstructive vaginal tissue present on vaginal examination., Methods: The dog presented with a history of persistent urine dribbling, stranguria, and dysuria since birth. Vaginoscopy and fluoroscopy revealed severe vestibulovaginal and urethral stenosis. An episiotomy and partial vaginectomy were performed to remove stenotic tissue. A perineal urethrostomy was attempted from a blind-ended pouch associated with the stenotic urethral tissue but was unsuccessful. The dog was repositioned in dorsal recumbency and a postpubic urethrostomy was performed., Results: Six days postoperatively, incisional dehiscence occurred at the cranial aspect of the urethrostomy. The site was revised at this location using a TPU to decrease tension at the urethrostomy site. The dog recovered uneventfully with no further complications identified after surgery. Forty-two months after surgical intervention, the dog continued to show no clinical signs., Conclusion: Transpelvic urethrostomy may be a viable surgical alternative for dogs diagnosed with urethral stenosis., (© 2022 American College of Veterinary Surgeons.)

Objectives: To evaluate the concentration of kidney injury molecule-1 and activity of urinary gamma-glutamyl transferase in cats with urethral obstruction and healthy cats., Materials and Methods: Blood and urine samples were collected from a group of 15 healthy cats (control group) and a group of 20 cats with urethral obstruction at presentation, and 24 hours and 7 days after unblocking the obstruction. The serum creatinine, urinary creatinine and urinary gamma-glutamyl transferase were measured by spectrophotometry and kidney injury molecule-1 by the sandwich enzyme-linked immunosorbent assay., Results: On presentation, cats with obstruction had serum creatinine concentration and urinary gamma-glutamyl transferase index higher than healthy cats (mean difference 544 μmol/L, 95% confidence intervals 222 to 865 μmol/L, and 0.0022 U/μmol-uCre, 0.00043 to 0.0039 U/μmol-uCre, respectively), urine creatinine concentration lower (mean difference 25,624 µmol/L, 17,329 to 33,919 µmol/L), and no significant difference in the kidney injury molecule-1/urinary creatinine ratio (mean difference 13 pg/μmol-uCre, -33 to 59 pg/μmol-uCre). In the group of cats with urinary obstruction, over time serum creatinine decreased, urine creatinine increased, urinary gamma-glutamyl transferase index did not change significantly, and kidney injury molecule-1/urinary creatinine ratio increased., Clinical Significance: Cats with post-renal obstruction and potential intrinsic renal damage had higher urinary gamma-glutamyl transferase index than healthy cats at the time of presentation and showed increase in kidney injury molecule-1/urinary creatinine ratio over time., (© 2021 British Small Animal Veterinary Association.)

Background: Urethral obstruction (UO) has a negative effect on welfare of cats., Objectives: This study aimed to determine incidence, case management, and outcomes of UO in cats in primary-care practice in the United Kingdom., Animals: All male cats under veterinary care within the VetCompass database in 2016., Methods: A retrospective cohort study was performed. The electronic records of all male cats with a clinical note during the study period were searched for UO cases and were manually reviewed for inclusion. Additional demographic and clinical information were extracted on cases., Results: From the study cohort of 237 825 male cats, there were 1293 incident cases. The estimated UO incidence risk during 2016 was 0.54 (95% CI: 0.51-0.57). Demographic and clinical data were available for 1108 cases. Antibiotics were administered to 641/1108 (57.9%) cases. Overall repeat catheterization rate was 253/854 (29.6%). Repeat catheterization at 48 hours was less frequent in patients with indwelling catheters (10.1%) vs those that had a catheter placed and then immediately removed (14.8%; P = .04). Death during a UO episode was 329/1108 (29.6%), and 285/329 (88.0%) deaths involved euthanasia., Conclusions and Clinical Importance: Antibiotics were commonly prescribed in cats for treatment of UO despite minimal evidence in the clinical records of bacterial cystitis. Repeat catheterization was common and case fatality rate during a UO episode was high. Repeat catheterization within 48 hours of elective removal of a urethral catheter was less common in cats that had previously had indwelling catheters. The majority of cats requiring repeat catheterization survived until the end of the study., (© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Objective: To describe the procedure, complications, and long-term outcome of cats that underwent a modified prepubic urethrostomy (mPPU) technique for the management of proximal urethral obstructions., Animals: Eight male cats., Study Design: Short case series., Methods: Medical records were reviewed for signalment, diagnostic investigation, details of the surgical procedure, and complications of cats that underwent mPPU., Results: mPPU was well tolerated by all patients, and no intraoperative complications were reported. The duration of follow-up ranged from 13 to 84 months (median 19 months). Early postoperative skin scalding around the stoma associated with mild urinary incontinence during recumbency occurred and was self-limiting in all patients. Two cats required surgical revision at 5 and 6 months, respectively, due to a progressive weight gain and accumulation of abdominal fat around the stoma, causing a partial stomal obstruction. Resolution of clinical signs was reported in both patients., Conclusions: mPPU was easy to perform and offered favorable outcomes in this cohort of cats., (© 2021 American College of Veterinary Surgeons.)

A 10-year-old, male intact, mixed breed dog was admitted with a history of intermittent lower urinary tract signs of 18-months duration. Dysuria, stranguria, pollakiuria and overflow incontinence developed 2 weeks prior to presentation, while vomiting, polydipsia and anorexia were seen a few days prior to admission. Physical examination revealed prostatomegaly. Biochemistry results were compatible with postrenal azotemia. Abdominal imaging confirmed prostatomegaly with consequent urethral obstruction, and ultrasound-guided fine needle aspiration cytology of the prostate gland was consistent with granulomatous inflammation. The dog was hospitalized, urethral patency was preserved and upon laparotomy a cystostomy tube was placed, and prostatic biopsy was obtained. Orchiectomy was also performed. Urine culture performed 2 days prior to the surgery was negative. Prostatic histopathology revealed mild to moderate lymphoplasmacytic prostatitis. Three months postoperatively, clinical signs had resolved completely and urinations remained normal while the dog is still in good health 3 years after diagnosis. This is the first case of canine lymphoplasmacytic prostatitis in which clinical signs, diagnostic evaluation, management and long-term follow up are available., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: 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., Methods: 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., Results: 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)., Conclusions and Relevance: 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.

Background: This paper presents the first described case of laparoscopy-assisted prepubic urethrostomy and laparoscopic resection of a tumor of the distal part of the urethra in a female dog as a palliative treatment., Case Presentation: An intact, 11 -year-old, mixed breed female dog, weighing 15 kg, was admitted with signs of urinary obstruction and difficulty with catheterization. Vaginal, rectal, and endoscopic examinations revealed a firm mass in the pelvic cavity at the level of the pelvic urethra. Ultrasound and computed tomography examination showed enlargement of the urethral wall (5.5 cm width and 3 cm thick), which was significantly restricting the patency of the urethra. The lesion affected only the distal part of the urethra without the presence of local or distant metastatic changes. The affected portion of the urethra was laparoscopically removed while performing pre-pubic urethrostomy with laparoscopy. The patient regained full consciousness immediately after the end of anesthesia, without signs of urinary incontinence. Histopathological examination of the removed urethra revealed an oncological margin only from the side of the bladder. In the period of 2.5 months after the procedure, the owner did not notice any symptoms that could indicate a postoperative recurrence, which was diagnosed three months after the procedure., Conclusions: Pre-pubic urethrostomy can be successfully performed with the assistance of laparoscopy. The use of minimally invasive surgery will allow, in selected cases, removal of the urethral tumor, and in inoperable cases, to perform a minimally invasive palliative pre-pubic urethrostomy., (© 2021. The Author(s).)

Objectives: The aim of this study was to compare indications, complications and mortality rates for perineal urethrostomy (PU), transpelvic urethrostomy (TPU) and prepubic urethrostomy (PPU)., Methods: A retrospective review of, and follow-up owner questionnaire for, cats undergoing urethrostomy between 2008 and 2018, at a single referral hospital, were performed., Results: Fifty-six cats underwent urethrostomy (PU, n = 37; TPU, n = 8; PPU, n = 11). The presenting problem was significantly associated with urethrostomy technique ( P <0.001). For PU cats, feline idiopathic cystitis (FIC; n = 21 [56.7%]) was the most common problem, whereas for PPU cats, trauma (n = 9 [81.8%]) was most common ( P <0.001). Urethrostomy technique was associated with imaging diagnosis ( P <0.001) of the urethral lesion. Most PU cats had no diagnostic imaging lesion (n = 15 [40.5%]) or obstructive calculi or clots (n = 10 [27.0%]), and all PPU cats had urethral rupture. Ten (90.9%) PPU cats had a pelvic lesion, while 21 (56.7%) PU cats had a penile lesion. TPU cats had a range of presenting problems and imaging diagnoses. Short- and long-term complications were reported in 33/55 (60.0%) and 11/30 (36.7%) cats, respectively. The number of cats with long-term complications was greater among PPU cats ( P  = 0.02). Short-term dermatitis ( P  = 0.019) and long-term incontinence ( P  = 0.01) were associated with PPU. Short-term mortality was 5.6% and long-term mortality was 13.3%; both were independent of urethrostomy technique. Quality of life post-urethrostomy, across all techniques, was graded as good by 93% of owners., Conclusions and Relevance: In this study, PU was the most common feline urethrostomy technique indicated for FIC. Short-term urethrostomy complications are common, irrespective of urethrostomy technique. Long-term complications are less frequent but more common with PPU.

Objective: To describe penile urethral augmentation anastomosis (PURAA) for resection anastomosis (RA) of the canine penile urethra by using autogenous tissue in two dogs and to determine the mechanical properties of the augmentation technique in cadaveric specimens., Study Design: Cadaveric study and two case reports., Animals: Sixteen canine cadavers and two dogs with urethral obstruction., Methods: The lower urogenital system was harvested from cadavers and randomized into two groups: simple (S) and augmented (AUG) RA of the urethra. Tensile strength and peak load were compared between the two groups. Two dogs were treated with PURAA for urethral obstruction secondary to juxtaurethral neoplasms., Results: Minimal tensile strength (MITS) and maximal tensile strength (MATS) were greater in the AUG group (MITS, 54.36 ± 24.0 N; MATS, 75.37 ± 34.79 N) compared with the S group (MITS, 11.78 ± 4.93 N, P = .0014; MATS, 13.74 ± 3.89 N, P = .0015). Both dogs recovered without complications. Histopathological examinations were consistent with a lipomatous mass in both cases. Both dogs had good medium-to-long-term outcomes., Conclusion: The augmentation technique improved the tensile properties of penile RA in normal cadavers and was associated with successful outcomes in two dogs., Clinical Significance: Penile urethral augmentation anastomosis may help prevent stricture or leakage secondary to tension at the surgical site after penile urethral RA., (© 2021 American College of Veterinary Surgeons.)

Objective: The aim of this study was to investigate causes for feline urethral obstruction and determine whether the frequency of radiographic diagnoses differs between cats radiographed before or after unobstruction of the urethra., Materials and Methods: A retrospective cross-sectional study of cats with naturally occurring urethral obstruction was performed. Only cats presenting for their first urethral obstruction in which radiography was integrated in the initial evaluation were included. The diagnosis frequency (overall and for each disease type) was compared between cats radiographed before or after unobstruction of the urethra., Results: Eighty cats (52%) had radiographs obtained before unobstructing the urethra and 73 cats (48%) had radiographs taken after unobstructing the urethra. Cats radiographed before unobstruction had a greater frequency of radiographic diagnoses than those radiographed after unobstruction (61% versus 45%). This difference was largely due to a greater frequency of urethral plugs detected before unobstruction versus after unobstruction (45% versus 5.5%)., Clinical Significance: Radiographs obtained before unobstructing the urethra provided a diagnostic advantage for detecting a cause for urethral obstruction compared to radiographs obtained after unobstructing the urethra. Urethral plugs were the most common diagnosis., (© 2020 British Small Animal Veterinary Association.)

An 8-year-old female spayed dog was presented due to simultaneous inability to defecate and urinate. During digital rectal examination a smooth, rounded, firm-elastic mass was detected. Laboratory results showed a 6-fold elevation of serum lactate dehydrogenase activity. Ultrasonographic, radiographic and computed tomography findings raised the suspicion of a leiomyoma. An ultrasound-guided fine needle aspiration biopsy was performed under mild sedation but cytologic evaluation was inconclusive. During laparotomy the mass was located at the colorectal transition. It was completely removed while keeping the intestinal wall intact. The results of the histopathological examination and immunohistochemistry confirmed the initial tentative diagnosis of a leiomyoma. Postoperatively the patient was able to pass urine and feces spontaneously. Six months later the dog presented clinically unremarkable. Abdominal ultrasound and rectal examination exhibited no signs of recurrence. Lactate dehydrogenase activity was only marginally increased., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: To investigate whether decompressive cystocentesis (DC) safely facilitates urethral catheterization (UC) in cats with urethral obstruction (UO)., Animals: 88 male cats with UO., Procedures: Cats were randomly assigned to receive DC prior to UC (ie, DC group cats; n = 44) or UC only (ie, UC group cats; 44). Abdominal effusion was monitored by serial ultrasonographic examination of the urinary bladder before DC and UC or before UC (DC and UC group cats, respectively), immediately after UC, and 4 hours after UC. Total abdominal effusion score at each time point ranged from 0 (no effusion) to 16 (extensive effusion). Ease of UC (score, 0 [easy passage] to 4 [unable to pass]), time to place urinary catheter, and adverse events were recorded., Results: No significant difference was found in median time to place the urinary catheter in UC group cats (132 seconds), compared with DC group cats (120 seconds). Median score for ease of UC was not significantly different between UC group cats (score, 1; range, 0 to 3) and DC group cats (score, 1; range, 0 to 4). Median change in total abdominal effusion score from before UC and DC to immediately after UC was 0 and nonsignificant in UC group cats (range, -5 to 12) and DC group cats (range, -4 to 8). Median change in effusion score from immediately after UC to 4 hours after UC was not significantly different between UC group cats (score, -1; range, -9 to 5) and DC group cats (score, -1; range, -7 to 5)., Conclusions and Clinical Relevance: DC did not improve time to place the urinary catheter or ease of UC in cats with UO.

Background: Proliferative urethritis (PU) is an uncommon inflammatory and infiltrative disease of the urethra in female dogs, often associated with urinary tract infection (UTI). It typically presents with evidence of urethral obstruction (UO)., Objectives: Identify clinical features in dogs with PU and determine outcome after different treatment modalities., Animals: Eleven client-owned dogs., Methods: Medical records of dogs with histopathologic diagnosis of PU from 2011 to 2020 were retrospectively evaluated, including information on clinical pathology, imaging, and histopathology. Outcomes of various treatment modalities were recorded and compared. Long-term urethral patency (>6 months) was considered treatment success., Results: All dogs were female and presented with UO. Eight (73%) had a history of UTI. Ten of 11 survived to discharge and were used for long-term data collection. Seven of 10 (70%) were treated using an effacement procedure (balloon dilatation [BD], stent, or both) and 6/7 (86%) achieved long-term urethral patency (>6 months). Seven of 10 had UO recurrence after their first procedure, including 3/3 (100%) that did not have effacement and 4/7 that did (57%), at a median of 101 days and 687 days, respectively. After effacement, the duration of patency was longer for those treated using a stent than BD alone (median, 843 days and 452 days, respectively)., Conclusions and Clinical Importance: Proliferative urethritis is a recurrent disease often associated with UTI. The best outcome of long-term urethral patency occurred after lesion effacement, either by BD or stenting. Future prospective studies should determine the impact of immunosuppressive treatment., (© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.)