Retrieval of ureteral calculus using a new method of endoscopic assistance in a cat

A 9-year-old female spayed domestic short-haired cat presented with ureteral obstruction due to a ureteral calculus 4 cm distal to the renal pelvis. Preoperative creatinine was 844 mmol/L. A novel approach to this condition was utilised whereby a flexible endoscope was passed through a hole made in the renal capsule into the renal pelvis and ureter. The calculus was visualised, and the endoscope was removed. A 1.4 mm flexible grasping forceps was introduced into the proximal ureter through the same hole in the renal capsule and the calculus was removed. The creatinine dropped to 282 micromol/L within 2 weeks of surgery. The cat died of apparently unrelated causes several months after surgery.     

Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi: 163 cases (1984-2002)

OBJECTIVE: To determine clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi. DESIGN: Retrospective study. ANIMALS: 163 client-owned cats. PROCEDURE: Medical records were reviewed, and information on signalment, history, clinical signs, and results of clinicopathologic testing and diagnostic imaging was obtained. RESULTS: The number of cats in which ureterolithiasis was diagnosed each year increased progressively during the study period. Clinical signs tended to be non-specific and included inappetence, vomiting, lethargy, and weight loss. A combination of survey radiography and abdominal ultrasonography revealed ureteral calculi in 66 of 73 (90%) cats in which the diagnosis was confirmed at surgery or necropsy. Ultrasonography revealed that ureteral calculi were causing ureteral obstruction in 143 of 155 (92%) cats. One hundred thirty-four of 162 (83%) cats had azotemia, 84 of 156 (54%) had hyperphosphatemia, and 22 of 152 (14%) had hypercalcemia. Urinary tract infection was documented in 10 of 119 (8%). Fifty-eight of 76 (76%) cats with unilateral ureterolithiasis had azotemia and 33 (43%) had hyperphosphatemia, indicating impairment of renal function in the contralateral kidney or prerenal azotemia. Ultrasonographic imaging of the contralateral kidney in cats with unilateral ureteral calculi suggested that preexisting renal parenchymal disease was common in cats with ureterolithiasis. Ninety-one of 93 (98%) ureteral calculi contained calcium oxalate. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that abdominal imaging should be performed in all cats with chronic nonspecific signs or with acute or chronic renal failure to rule out ureterolithiasis. Preexisting renal disease may be common in cats with ureteral calculi.     

Proximal ureteral ectopia causing hydronephrosis in a kitten

A 2-month-old, female cat was presented for abdomen dilation. The patient was undernourished, and severe left hydronephrosis was diagnosed after clinical, ultrasonographical and radiographical examination. Although pyelography was performed in order to visualise the ureteral course, surgery was necessary to reach a final aetiological diagnosis and treatment. At gross examination, the left ureter crossed the renal capsula at the level of the caudal renal pole, and the subcapsular ureteral segment was markedly dilated. Distal to the renal capsula, the left ureter was very thin when compared to the right. The parenchyma of the left kidney, as suggested by ultrasonographical evaluation, was extremely reduced in thickness. An ureteronephrectomy was performed. Histopathological evaluation revealed glomerular sclerosis and diffuse parenchymal fibrosis. Severe hydronephrosis derived from an altered renal pelvic anatomy and abnormal ureteral course determining functional stenosis. Diagnosis of congenital anomaly before development of complications such as hydronephrosis could have allowed a surgical renal capsulectomy and obstruction relief. To the author's knowledge, this is the first report of severe hydronephrosis associated to altered renal pelvic anatomy and proximal ureteral ectopia in cat.     

Ureteral fibroepithelial polyp in an owl monkey (Aotus nancymae)

Ureteral fibroepithelial polyps are benign mesodermal tumors in humans that occur predominantly in the proximal ureter. During a routine necropsy of a wild-caught, research na?ve, adult, male, Aotus nancymae, the left ureter just distal to the renal pelvis contained a pedunculated, lobulated neoplasm with a narrow stalk at the base projecting into the lumen. The left renal pelvis was found to be mildly dilated. The histologic characteristics of the ureteral mass were consistent with a fibroepithelial polyp. To our knowledge, this is the first report describing a ureteral fibroepithelial polyp in a nonhuman primate.     

Perioperative Occlusion of a Subcutaneous Ureteral Bypass Secondary to a Severe Pyonephrosis in a Birman Cat

A subcutaneous ureteral bypass (SUB) was placed in a 10-year-old Birman cat for management of unilateral ureterolithiasis. Perioperative occlusion of the nephrostomy tube of the SUB device happened secondary to a severe pyonephrosis. Flushing of the system throught the subcutaneous shunting port was made with saline solution after clamping the urinary bladder catheter. Repetitive flushing of the device was performed daily for 3 days to be sure of the remanent patency of the catheter. Repetitive flushing of the SUB device is a successful renal-sparing treatment for pyonephrosis in a cat and may be considered as an effective treatment option for this condition.     

Idiopathic renal haematuria in an Egyptian Arabian stallion

A 17-year-old Egyptian Arabian stallion was presented for haematuria and blood clots in the urine of 4 days’ duration. During micturition, haematuria was noted mid-stream with passage of blood clots occurring at the end of urination. Physical examination findings were unremarkable aside from pale mucous membranes. Cystoscopic examination revealed intermittent passage of frank blood (with clots) from the left ureteral orifice compared to grossly normal-appearing urine issuing from the right ureteral orifice. Transcutaneous ultrasonographic evaluation of the right kidney yielded normal findings while the left kidney exhibited pyelectasia, a decreased cortico-medullary ratio, and markedly increased echogenicity of the renal pelvis. Diagnosis of idiopathic renal haematuria was confirmed at necropsy.     

Successful treatment of bilateral paecilomyces pyelonephritis in a German shepherd dog

A six‐year‐old female entire German shepherd dog was investigated for polyuria, polydipsia and lethargy. Investigations revealed a mild azotaemia and abdominal ultrasound revealed marked bilateral dilation of the renal pelves with echogenic material and proximal left hydroureter. Urine cytological examination and aspirates from the right renal pelvis revealed mats of fungal hyphae consistent with fungal bezoar formation. Fungal cultures revealed a profuse growth of Paecilomyces variotii. Initial treatment with oral itraconazole was unsuccessful, leading to bilateral nephrotomies to remove the fungal material. Postoperatively the Paecilomyces infection persisted despite continued itraconazole therapy. Treatment was commenced with amphotericin B, leading to resolution of the dog's clinical signs. To the authors’ knowledge this is the first report of canine Paecilomyces pyelonephritis, without disseminated systemic disease, which documents its successful treatment.     

Multiple congenital urogenital abnormalities in a Tennessee Walking Horse colt

A 9-month-old, Tennessee Walking Horse colt was examined for urinary incontinence. Cystoscopy revealed a single identifiable ureter that appeared abnormal, and sabulous urolithiasis. Only the left kidney, which appeared lobulated and hydronephrotic, could be located using ultrasound. Results of serum chemistries were consistent with renal failure. Necropsy revealed unilateral agenesis of the right kidney and ureter with severe left ureterolithiasis, bilateral cryptorchidism and segmental aplasia of the ductus deferens. Histopathological examination revealed cystitis and diffuse interstitial fibrosis of the left kidney. Congenital malformations should be included as differential diagnoses for urinary incontinence and urogenital disease. Ultrasonography and cystoscopy can be useful to diagnose suspected agenesis of the urinary system in adult horses.     

Feline ureteral strictures: 10 cases (2007-2009)

Background: Feline ureteral obstructions have emerged as a common problem. Ureteral strictures rarely are reported as a cause and the predisposing factors and clinical course of this condition have not been described. Objectives: Evaluate cases of feline ureteral strictures and characterize historical features, clinical signs, diagnostic imaging, surgical and endoscopic findings, histopathology, treatment modalities, and short‐ and long‐term outcomes. Animals: Ten cats diagnosed with ureteral strictures based on compatible findings from at least 2 of the following: ultrasonography, ureteropyelography, surgical exploration, or histopathology. Methods: Retrospective study. Results: Median age, serum creatinine concentration, and size of the renal pelvis were 12 years, 3.7 mg/dL, and 11.75 mm, respectively. Six of 10 cats had hyperechoic periureteral tissue on ultrasound examination at the stricture site. Four cats had evidence of a circumcaval ureter at surgery. Eight cats had an intervention including ureteral stent placement (n = 6) and traditional surgery (n = 2). Seven of 8 cats had decreases in serum creatinine concentration and renal pelvic parameters preceding discharge and 6 had persistently improved results at their last examination. All patients survived to discharge. Median survival time was >294 days (range, 14 to >858 days) with 6/10 cats still alive. Conclusions and Clinical Importance: Ureteral strictures may occur in cats secondary to ureteral surgery, inflammation, a circumcaval ureter, impacted ureterolithiasis, or for unknown causes. With appropriate and timely intervention, the prognosis for long‐term survival is good. In addition to ureteral reimplantation or ureteronephrectomy, ureteral stenting or SC ureteral bypass may be considered as future therapeutic options.     

Ultrasonographic-anatomic correlation and an imaging protocol of the normal canine kidney

Ultrasonographic or anatomic observations or both were made of the kidneys of 26 dogs. The anatomic studies established precise correlations between the gross anatomic features of the organ and its ultrasonographic images obtained in transverse, sagittal, dorsal, and 2 oblique planes. Uniformly mottled echogenicity of the renal cortex could be clearly differentiated from the less echogenic renal medulla. In the mid-dorsal plane, the papillae of the renal pyramids were directed towards the renal sinus. The bases of the pyramids were almost circular in outline in the midsagittal images and the renal crest was seen as an echogenic line. Although the renal sinus was highly echogenic, neither the renal pelvis nor its recesses were detected. The walls of each of the interlobar arteries provided echogenic parallel lines, passing in the renal recesses between the renal pyramids. Arcuate arteries were demonstrated at the corticomedullary junction and interlobular arteries were detected within the renal cortex. For the right kidney, transverse images were obtained with the ultrasonographic transducer at the last 2 intercostal spaces; images in the dorsal, sagittal, and oblique planes were obtained with the transducer placed over the caudal extremity of the kidney. In the left kidney, transverse images were made with the transducers at, and caudal to, the last intercostal space; images in the dorsal, sagittal, and oblique planes were obtained with the transducer placed over the lateral border of the kidney. The use of such a protocol ensures that the entire organ is inspected and a diagnosis of either a normal or pathologic kidney is made.     

Hematuria caused by abdominal abscessation in a foal

A 4.5-month-old Standard-bred filly was referred for evaluation of pigmenturia. Initially, the pigmenturia had resolved with the administration of antibiotics, only to recur after their withdrawal. A dark red urine sample contained numerous RBC, WBC, and gram-negative rods (Escherichia coli). Ultrasonography revealed the right kidney to be large, with multiple cystic structures and a dilated renal pelvis and calices. Cystoscopy revealed a large blood clot within the bladder and urine coming from the left ureteral opening. Urine was not observed coming from the right ureter. It was suspected that the primary infection within the urinary tract was coming from the right kidney, with secondary ureteral obstruction and cystitis. Trimethoprim-sulfamethoxazole treatment was initiated. However, acute depression and abdominal pain developed several days later, and the foal died before assistance could be provided. Necropsy revealed a large abscess that had eroded into the right ureter and aorta and had ruptured, resulting in acute blood loss and death. The location and extensive nature of the lesion would have precluded surgical intervention.     

Glenoid dysplasia and bicipital tenosynovitis in a Maine coon cat

This report describes a rare case of bicipital tenosynovitis in a Maine coon cat. The cat, a three-and-half-year-old neutered female, presented with chronic weightbearing lameness of the left forelimb. Flexion of the left glenohumeral joint and extension of the left cubital joint were resented, and palpation of the biceps brachii tendon in the bicipital groove elicited pain. A mild incongruity of the joint with mild degenerative changes was seen radiographically. Glenohumeral joint dysplasia was suspected. Ultrasound examination revealed marked thickening of the bicipital tendon and moderate effusion of the left bicipital tendon sheath. Positive contrast radiography of the joint confirmed dilation of the tendon sheath. A tentative diagnosis of bicipital tenosynovitis was made and confirmed on arthrotomy. Surgical removal of osteophytes resulted in the cat being free from pain but a mild lameness recurred six months after surgery.     

Urinoma (para-ureteral pseudocyst) as a consequence of trauma in a cat

A two-year-old cat was involved in a road traffic accident. Survey abdominal radiographs and urinary function were considered unremarkable. Six weeks later the cat presented with a palpable dorsal abdominal mass. Radiography revealed a soft tissue opacity mass caudal to the right kidney. Ultrasonography revealed a cyst-like structure with moderately echogenic contents, and right-sided hydronephrosis. There was no excretion of contrast medium from the right kidney after intravenous urography. Surgery revealed a disrupted right ureter adherent to the retroperitoneal mass. The mass contained serosanguineous fluid consistent with extravasated urine. Ureteronephrectomy was performed. The majority of the mass was excised and the cavity ablated. Histopathology of the excised tissue revealed a thick fibrous wall with no epithelial lining, consistent with a urinoma, which is thought to have developed as a consequence of ureteral trauma. The cat was clinically well three months postoperatively.     

Suspect severe gastroenteritis associated with ingestion of caterpillar setae fragments in a cat

A 6-month-old male neutered Domestic Shorthair cat was assessed for a 24-h history of anorexia, lethargy, depressed mentation, mild abdominal pain and persistent bradycardia. Abdominal ultrasound revealed marked thickening of the gastric wall, gastric distension, free abdominal fluid, distension and corrugation of the small intestine. Full-thickness histopathological biopsy of the gastric wall demonstrated intralesional chitinous structures whose morphology (size and presence of obvious barbs) supports these structures being urticating hairs (setae). A processionary caterpillar is considered most likely as these are the most common urticating caterpillars in Australia. This is the first case of suspected severe gastroenteritis associated with the ingestion of caterpillar setae fragments in a cat.     

Percutaneous nephrostomy in short-term management of ureterolithiasis and renal dysfunction in a filly

Percutaneous nephrostomy was used to provide urine output in a 3-year-old Thoroughbred filly with azotemia and obstructive ureterolithiasis. Previous left ureteral surgery had failed to provide clinical improvement, and the filly became more azotemic. Nephrostomy was performed in the standing patient, with ultrasonographic guidance and local anesthesia. Continuing IV fluid therapy and diuresis through the nephrostomy tube resulted in a decrease in clinical signs of azotemia. However, the filly developed a cecal impaction, which ruptured during surgery because of colic, and was euthanatized.     

Post-traumatic paraureteral urinoma in a cat

A retroperitoneal urinoma (uriniferous pseudocyst) was diagnosed in a domestic shorthair cat exhibiting a sublumbar swelling two weeks after a road traffic accident. Plain radiography revealed a soft tissue opacity in the left retroperitoneal space. Intravenous urography and fine-needle aspiration were diagnostic. Contrast was seen pooling in the dilated ipsilateral renal pelvis and proximal ureter. Fluid aspirated from the retroperitoneal space had a creatinine level five times that of serum. Surgical drainage followed by nephrectomy and omentalisation of the pseudocyst was curative.     

CALCIUM OXALATE URETEROLITH IN A CAT

A 4-year-old cat was presented for polyuria and polydipsia. Unilateral hydronephorosis and hydroureter was diagnosed on ultrasound examination of the abdomen, and right ureteral calculi were seen in survey abdominal radiographs. Intravenous urography confirmed hydronephrosis and indicated poor renal funttion in the right kidney. Surgical removal of the ureteral calculus improved right renal function. Analysis of the calculus indicated composition of calcium oxalate, an uncommon calculus in cats.     

Perirenal pyelocaliceal diverticulum in an infant cat

A 3-month-old female tortoise-shell cat showing azotemia died with a marked swollen abdomen. Necropsy revealed a huge perirenal cyst (8.5 x 6.0 x 4.5 cm) on the ventral aspect of the right kidney. The cyst was filled with the pellucid yellow fluid with a smell of urine. The lumen was connected with irregularly dilated renal pelvis by a narrow channel passing through the renal parenchyma. The cyst was lined by epithelial cells and its wall was consisted of collagen fibers and smooth muscle cells as that of the renal pelvis and ureter. Renal parenchyma adjacent to the channel showed interstitial infiltration of the lymphoid cells. The cyst was a diverticulum of the renal pelvis due to an impaired development.     

Bilateral fusion of a supernumerary kidney in a cat

A rare case of bilateral fusion of a supernumerary kidney was found during the necropsy of a female, 8-year-old, mixed breed cat that died as a result of azotemia and chronic enteritis. Apart from enteritis, necropsy revealed four kidneys, two in the sublumbar left region and two in the sublumbar right region, with cortical and medullary regions well individualized and independent; however, the pelvis was partially fused, giving rise to a single ureter. The kidneys were small, whitish and firm, with irregular surfaces. Microscopically, all kidneys displayed normal renal glomeruli and tubules among the immature renal glomeruli and tubules with characteristics of hypoplasia. Foci of glomerulosclerosis, nephrocalcinosis and interstitial fibrosis were also observed.     

Ultrasonographic evaluation of abdominal distension in 52 camels (Camelus dromedarius)

The purpose of this study was to assess the diagnostic value of ultrasonography in the evaluation of abdominal distension in 52 camels (Camelus dromedarius). The conditions included trypanosomiasis (n=35), intestinal obstruction (n=12) and ruptured urinary bladder (n=5). Fifteen clinically normal camels were included as controls. Transabdominal and transrectal ultrasonography was carried out on all camels. In animals with trypanosomiasis, ultrasonographic findings included accumulation of massive amounts of hypoechoic abdominal fluids where liver, intestine, kidney, spleen and urinary bladder were imaged floating. Except in two cases of bile duct calcification and one of hepatic abscessation, no detectable abnormal sonographic lesions were detected while imaging the hepatic and renal parenchyma, and the heart and its valves and major blood vessels. In camels with intestinal obstruction, ultrasonographic findings included distended intestinal loops with markedly reduced or absent motility. In one camel, the intestinal lumen contained localised hyperechoic material that was consistent with a foreign body. Hypoechoic fluid with or without fibrin was seen between intestinal loops. In camels with ruptured urinary bladder, ultrasonographic findings included collapsed and perforated bladder, echogenic blood clots within the urinary bladder and peritoneal cavity, increased thickness of the bladder wall, floating intestines in hypoechogenic fluid and echogenic calculi within the urethra. Ultrasonography was considered a useful tool for the evaluation of dromedary camels with abdominal distension.