Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995-2006)

OBJECTIVE: To determine indications for cystostomy tube use in dogs and cats, complications associated with their use, and outcome of dogs and cats in which cystostomy tubes had been inserted. DESIGN: Retrospective case series. ANIMALS: 37 dogs and 39 cats. PROCEDURES: Information was obtained from medical records. Long-term follow-up information was obtained by use of a client questionnaire. RESULTS: Indications for cystostomy tube placement were bladder dysfunction, urinary tract rupture, obstructive urinary tract neoplasia, urinary diversion following urogenital surgery, obstructive urolithiasis, and feline lower urinary tract disease. Median time tubes were in place was 11 days, but duration of tube use was significantly longer for animals with bladder dysfunction than for animals with urinary tract trauma, urinary diversion, or urinary tract obstruction. Thirty-seven (49%) animals had tube complications. Development of complications was not significantly associated with species, age, body weight, duration of tube use, or tube type, except that animals were significantly more likely to develop complications following long-rather than short-term use. In 42 animals, the underlying condition resolved and the tube was removed; 22 animals died or were euthanatized with the tube in place. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that cystostomy tubes may be used for animals with various conditions related to problems with urine outflow. Nearly half the animals in the study developed complications related to the cystostomy tube, suggesting that potential complications should be discussed with owners prior to tube placement. However, most complications were easily resolved.     

Minimally Invasive Inguinal Approach for Tube Cystostomy

Objective— To report a technique for tube cystostomy placement via a minimally invasive inguinal approach and outcome in 9 dogs and 6 cats with urinary tract obstruction or detrusor atony.
Study Design— Case series.
Animals— Dogs (n=9) and cats (6).
Methods— Medical records (January 2004–January 2008) of dogs and cats that had tube cystostomy via an inguinal approach were reviewed. Retrieved data included signalment, diagnosis, surgical technique, and complications. Access to the bladder was through a muscle splitting approach in the inguinal region with the cystostomy tube placed through a skin incision made several centimeters proximal to this incision and secured in the bladder by a purse string suture. Cystopexy during closure of the muscle layers ensured secure closure and minimized the likelihood of uroabdomen if tube dislodgment occurred.
Results— Cystostomy tubes were placed in 5 cats as an emergency procedure for treatment of acute urinary tract obstruction or urethral rupture, and as an elective procedure in 9 dogs and 1 cat. No complications occurred during cystostomy tube placement. Postprocedural complications were minor (peristomal irritation in 2 dogs with latex catheters, catheter laceration, premature removal) and only occurred when tubes were retained for >4 weeks. Urinary tract infection at catheter removal in 6 dogs resolved with antibiotic administration.
Conclusions— An inguinal approach for cystostomy tube placement facilitated rapid catheter placement into the bladder with minimal soft tissue dissection. Cystopexy during abdominal wall closure provided peritoneal protection should premature dislodgement of the cystostomy tube occur.
Clinical Relevance— An inguinal approach should be considered for rapid tube cystostomy particularly in metabolically compromised animals.     

Tube cystostomy in the dog and cat]

Prepubic tube cystostomy was performed in 10 dogs and one cat. Indications include urinary bypass following urethral trauma or surgery (six cases), following surgery for prostatic abscesses or cysts (four cases) and bladder atony secondary to urethral obstruction (one case). Tubes were left in situ for a minimum of seven days. All patients returned to normal micturition following tube removal. Urine leakage occurred for up to four days after tube removal by which time the stoma was granulating. Nosocomial infection was a consistent finding, but was controlled with antibiotic treatment following tube removal. Tube cystostomy was considered an effective means for diverting irritant urine from healing epithelium and thereby minimising the risk of urethral cicatrisation. It may also be indicated in the management of urinary retention as an alternative to repeated urethral catheterisation. This study indicates that tube cystostomy is readily performed, with few unexpected or serious complications.     

Complications with non-endoscopic percutaneous gastrostomy in 31 cats and 10 does: a retrospective study

Percutaneous gastrostomy tubes were placed non-endoscopically in 31 cats and 10 dogs using either a rigid insertion tube (n=13) or an Eld gastrostomy tube applicator (n=28). Tubes were placed successfully in 38 of the 41 animals and the consequent feeding was of therapeutic benefit to 31 of the animals. Six of 41 died or were euthanased for reasons unrelated to gastrostomy. In four cases (10 per cent), gastrostomy failed with respect to correct tube placement or tube feeding. Overall complications occurred in 18 of 41 animals. Severe procedural complications occurred in two cats; a cardiorespiratory arrest during pharyngeal manipulation and erroneous tube placement through the distal oesophagus. Moderate late complications included peristomal food leakage (n=2), peristomal abscess (n=2) and pyloric outflow obstruction by a migrated tube (n=1). Complications associated with the feeding procedure, nausea and vomiting (n=3), led to aspiration pneumonia in one case.     

Complications and outcomes associated with use of gastrostomy tubes for nutritional management of dogs with renal failure: 56 cases (1994-1999)

OBJECTIVE: To evaluate complications and outcomes associated with use of gastrostomy tubes in dogs with renal failure. DESIGN: Retrospective study. ANIMALS:56 dogs. PROCEDURE: Medical records were reviewed for dogs with renal failure that were treated by use of gastrostomy tubes. RESULTS: Mean +/- SD BUN concentration was 134 +/- 79 mg/dl and mean serum creatinine concentration was 9.0 +/- 3.8 mg/dl. Low-profile gastrostomy tubes were used for initial placement in 10 dogs, and traditional gastrostomy tubes were used in 46 dogs. Mild stoma-site complications included discharge, swelling, erythema, and signs of pain in 26 (46%) of dogs. Twenty-six gastrostomy tubes were replaced in 15 dogs; 11 were replaced because of patient removal, 6 were replaced because of tube wear, and 3 were replaced for other reasons. Six tubes were replaced by low-profile gastrostomy tubes. Gastrostomy tubes were used for 65 +/- 91 days (range, 1 to 438 days). Eight dogs gained weight, 11 did not change weight, and 17 lost weight; information was not available for 20 dogs. Three dogs were euthanatized because they removed their gastrostomy tubes, 2 were euthanatized because of evidence of tube migration, and 1 died of peritonitis. CONCLUSIONS AND CLINICAL RELEVANCE: Gastrostomy tubes appear to be safe and effective for improving nutritional status of dogs with renal failure.     

Vaginourethroplasty as a salvage procedure for management of traumatic urethral rupture in a cat

This report describes a cat that suffered pelvic urethral rupture associated with multiple pelvic fractures. A vaginourethroplasty was performed as a salvage procedure, via intrapelvic anastomosis of the proximal urethra to the caudal vagina, following failure of a primary urethral anastomosis. Urinary diversion was achieved via tube cystostomy and a vagino-urethral catheter was maintained for 3 days postoperatively. Anterograde cystourethrography was performed at 7 days and 14 days postoperatively. Absence of contrast leakage from the vagino-urethral anastomosis was documented at 14 days postoperatively and the tube cystostomy was removed. An Escherichia coli urinary tract infection was treated following removal of the tube cystostomy and subsequent urine culture revealed no evidence of urinary tract infection. The cat retained normal urinary continence and elimination behaviour during the 7-month follow-up period. Vaginourethroplasty could be considered as a salvage option for management of traumatic pelvic urethral rupture in the neutered female cat.     

Complications and outcomes of one-step low-profile gastrostomy devices for long-term enteral feeding in dogs and cats

Sixteen dogs and cats with a variety of primary diseases were retrospectively evaluated following endoscopic placement of a one-step low-profile gastrostomy device. Overall, the devices were well tolerated, with most complications being minor in nature. Complications included bloody or purulent peristomal discharge, peristomal swelling, peristomal inflammation, discomfort associated with the device, leaking through the device, chewing at the device, premature removal of the device, peritonitis, and aspiration pneumonia. Dogs survived for up to 2241 days, and cats survived for up to 593 days after initial device placement. The median survival time after device insertion for dogs was 89 days, and for cats it was 87 days.     

The use of a low-profile cystostomy tube to relieve urethral obstruction in a dog

A 10-year-old, spayed female Dalmatian was diagnosed with granulomatous urethritis causing urethral obstruction. Due to the extensive involvement of the urethra, a urethrostomy was not possible. A commercially available, silicone, low-profile gastrostomy tube was placed as a prepubic cystostomy tube to achieve urinary diversion. This tube is easy to use, has a one-way valve, and lies flush with the skin margin, thereby decreasing the likelihood of inadvertent removal. This tube should be considered to achieve long-term urinary diversion when urethral involvement is extensive.     

Owner experiences and complications with home use of a replacement low profile gastrostomy device for long-term enteral feeding in dogs

The purpose of this study was to evaluate complications and owner impressions of a low profile gastrostomy device (LPGD) for enteral feeding in dogs. Medical records of dogs that had placement of a percutaneous endoscopic gastrostomy tube followed by a LPGD between 1995 and 2003 were reviewed. Fifteen dogs had 29 devices placed for a variety of disease states in which enteral nutritional support was indicated. The individual tubes were placed for a median duration of 212 d. Most complications occurred more than 15 d after placement and were of no health risk to the animals. The most common reason for LPGD replacement was leakage through the 1-way antireflux valve. Fourteen of 15 owners that were contacted were supportive of the device. Based on its durability, ease of placement, minor complications, and positive owner impressions, we conclude that the LPGD is a valuable device for long-term enteral nutritional support of dogs.     

The effects of indwelling transurethral catheterization and tube cystostomy on urethral anastomoses in dogs.

The influence of urinary diversion procedures on urethral healing was studied in 15 male dogs following transection and anastomosis of the intrapelvic portions of their urethras. Dogs were randomly assigned to one of three treatment groups and had urine diverted from the surgical site by indwelling transurethral catheter, cystostomy catheter, or a combination of transurethral catheter and cystostomy catheter. There were no statistically significant differences in urethral healing when considering the different diversion methods, based on clinical, radiographic, and urodynamic parameters evaluated.     

Management of peristomal tissue necrosis following prepubic urethrostomy in a cat

This report describes the successful management of peristomal tissue necrosis following prepubic urethrostomy in a cat. The novel technique of temporary urethral ligation was used in combination with temporary tube cystostomy and vacuum assisted closure to allow for wound management prior to performing wound closure by utilization of a flank fold skin flap then definitive prepubic urethrostomy. Eleven month follow-up indicated excellent outcome with the cat having returned to normal behaviour apart from having adapted its posture to urinate.     

Behavior of hearing or vision impaired and normal hearing and vision dogs (Canis lupis familiaris): Not the same,but not that different

The article compared behavioral characteristics of dogs (Canis lupis familiaris) labeled as hearing and/or vision impaired by their owners with cohort dogs labeled as having normal hearing and vision (NHV) by their owners. The Canine Behavioral Assessment and Research Questionnaire, developed by Hsu and Serpell (2003), was used to survey owners. Four hundred sixty-one dog owners completed the online survey, with 183 of these being owners of hearing and/or vision impaired (HVI) dogs. Data analysis revealed that HVI dogs were reported by owners to show less aggression, less excitement, and were less likely to engage in behaviors, such as chasing of rabbits and rolling in feces than their normally hearing/seeing (NHV) cohorts. HVI dogs, however, were reported to be more likely to chew inappropriate objects, consume feces, bark excessively, and engage in greater licking behavior. When owners were surveyed about the type of training method used, owners of HVI dogs were found to be more likely to use hand signs, physical prompts, or combination of these training methods. Owners of NHV dogs reported being more likely than owners of HVI dogs to use gestures or report no formal training with their dogs. The data provide evidence that HVI dogs are as trainable as NHV dogs, can make excellent pets, and show behavior that is well within the parameters of NHV dog behavior. Still, because of their sensory limitations, specialized training methods and adaptations should be implemented with these dogs. This may limit HVI dogs to owners who are motivated, understand the sensory deficits, and are willing to engage in the modified training.     

Transurethral resection in the management of urethral and prostatic neoplasia in 6 dogs

OBJECTIVE: To assess cystoscopic transurethral resection (TUR) for the palliative management of dogs with neoplastic infiltration of the urethra. STUDY DESIGN: Prospective clinical trial. ANIMALS: Six client-owned dogs. METHODS: Cystoscopic examination and electrosurgical TUR were performed in dogs with urination difficulties caused by prostatic or urethral neoplasia. TUR was performed in a retrograde manner in female dogs and antegrade in male dogs via exploratory celiotomy and ventral cystotomy. Cystoscopic examination was used to determine the extent of neoplastic involvement of the urethra. TUR involved piecemeal removal of neoplastic tissue from the urethral lumen using an electrocautery cutting loop. Hemorrhage was controlled with a cystoscopic cauterized roller-ball. In 2 male dogs, intraoperative radiation therapy (IORT) was used to treat both prostatic neoplasia and the sublumbar lymph node bed. Surgical technique, complications, adjuvant treatment, and outcome were recorded. RESULTS: TUR was performed in 3 male dogs with prostatic carcinoma and 2 female dogs with urethral transitional cell carcinoma (TCC). In 1 female dog, TUR was attempted but not successful because of cystoscope diameter. Iatrogenic urethral perforation occurred during TUR in 3 dogs. In 2 dogs, prolonged exposure to lavage fluid resulted in clinical and biochemical abnormalities consistent with TUR syndrome. Dysuria resolved in 5 dogs within 10 days of TUR. Treatment-related complications included urinary tract infection and tumor seeding. Local tumor progression and metastasis occurred in all dogs. CONCLUSIONS: TUR (in combination with chemotherapy+/-IORT) resulted in rapid palliation of urination difficulties in male dogs with prostatic carcinoma. In female dogs with urethral TCC, however, electrosurgical TUR cannot be recommended because of a high intra- and postoperative complication rate with no improvement in postoperative management compared with historical reports of tube cystostomy. CLINICAL RELEVANCE: TUR is a novel alternative for the palliation of male dogs with prostatic carcinoma. In female dogs with urethral TCC, electrosurgical TUR does not provide any advantages compared with tube cystostomy.     

Spirocercosis-associated pyothorax in dogs

The records of five dogs diagnosed with spirocercosis-associated pyothorax were retrospectively reviewed. On admission, the most common clinical findings were weakness, anorexia, depression, dyspnoea and fever. All dogs had typical oesophageal Spirocerca lupi granulomas. Contrast thoracic radiography revealed contrast material leakage from the oesophagus into the pleural cavity in two dogs only. All dogs were medically treated with broad-spectrum antibiotics, repeated chest tube drainage and thoracic lavage, and four of the dogs were treated with doramectin. One dog was euthanased due to a concurrent non-related disease at the owners request while the remaining four survived. S. lupi infection should be included in the differential diagnoses of canine pyothorax in endemic areas. Conservative medical management of pyothorax with antihelmintic medication was shown to be effective in the treatment of S. lupi-associated pyothorax.     

Evaluation of methods for localization of urinary tract infection in the female dog.

Urinary tract infection (UTI) was induced in the left kidney of seven female dogs and in the urinary bladder of eight female dogs. Several methods advocated for localization of UTI in other species were tested in the infected dogs. Although fever, renal pain, and leukocytosis were detected in some dogs with renal infection, findings were transient. Radiographic changes in the kidneys and ureters were detected in some dogs with renal infection, but were absent in others. Bladder washout studies were not reliable for differentiating renal infection from bladder infection. Antibody coating studies were positive in dogs with bladder infection and in dogs with renal infection. The positive results from dogs with bladder infection may have been because of nonspecific binding of immunoglobulins to Staphylococcus aureus after leakage of serum immunoglobulins into urine. Studies of six dogs of both sexes with naturally occurring UTI indicated that their serum contained antibody against common urinary pathogens and that this antibody gained access to the urine in some dogs. It was concluded that the antibody coating test was unreliable for localization of UTI in the dog.     

A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes

Esophagostomy feeding tubes were placed in 46 cats. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 21 cats. Owner management and complications and facility of use were evaluated retrospectively by review of medical records and owner survey. Both tube types were equally effective for maintenance of body weight, ease of owner management, and complication rates. All of 12 owners surveyed were comfortable with PEG tube management. Ninety-six percent of 24 owners surveyed were comfortable with esophagostomy tube management. The esophagostomy tube can be placed less invasively, without specialized equipment, making it an excellent alternative to the PEG tube.     

Tube Cystostomy for Treatment of Obstructive Urolithiasis in Small Ruminants

Tube cystostomy was used to treat 13 goats and two sheep with obstructive urolithiasis. The cystostomy tube was intermittently occluded 3 to 4 days after placement to determine if urine could be voided through the urethra. If the animal showed no discomfort during urination after the cystostomy tube had been occluded for several days, the tube was removed. This procedure was successful in relieving urethral obstruction in 12 animals. The mean time until the animal could urinate freely and until the cystostomy tube was removed was 11.5 and 14.4 days respectively. Follow-up was available for 10 animals; seven were alive with no recurrence of urinary obstruction. One goat died from causes unrelated to urinary obstruction 1 year postoperatively. One goat died from unknown causes, and one goat died after urinary obstruction recurred.     

Ureterocolonlc Anastomosis in Ten Dogs with Transitional Cell Carcinoma

Ureterocolonic anastomosis (UCA) was performed in 10 dogs with transitional cell carcinoma of the urinary bladder trigone or the urethra, or both. All grossly visible tumor was excised. All of the dogs recovered from anesthesia and surgery and had anal continence with no urine leakage. One dog died of undetermined causes 7 days after surgery. Nine dogs survived 1 to 5 months. The owners of eight of the dogs considered their dog's quality of life to be acceptable. Four dogs were euthanatized because of neurologic disease, three of which also had nausea and vomiting. The neurologic and gastrointestinal signs may have been caused by hyperammonemia, metabolic acidosis, and uremia. Blood ammonia levels were elevated in two dogs with neurologic signs. Hyperchloremic metabolic acidosis that was reversible with bicarbonate therapy was diagnosed in five dogs. All of the dogs were azotemic because of intestinal recycling of urea. Serum creatinine concentrations increased in four dogs after surgery. Drug-induced renal disease may have developed in two dogs. Pyelonephritis developed in five kidneys, two of which had outflow obstruction and two had bilateral hydroureteronephrosis before the UCA. In this small number of dogs, surgical excision of transitional cell carcinoma was not curative with six dogs having confirmed metastatic lesions at the time of death.     

Intra- and Interindividual Variation in Urine Osmolality and Urine Specific Gravity in Healthy Pet Dogs of Various Ages

Urine specific gravity (Usg) and urine osmolality (Uosm) are used routinely to assess renal concentrating ability, but limited data on these variables are available for healthy dogs. Consequently, we studied the intra- and interindividual variations in Usg and Uosm in healthy dogs as well as the influence of age and gender on these variables. Dogs were selected for health and anestrus in female dogs through the use of a detailed questionnaire. Eighty-nine owners collected morning and evening urine samples from their dogs on 2 consecutive days. In 8 dogs in which the Uosm of different samples varied more than 50%, owners collected urine for 24 hours at 2-hour intervals during the day and at 4-hour intervals at night. The possible effect of changes in adrenocortical function with age was assessed by measurements of urinary corticoid/creatinine (C/C) ratios. Among all samples, Uosm ranged from 161 to 2,830 mOsm/kg and Usg from 1.006 to > 1.050. In the morning, Uosm (1,541 ± 527 mOsm/kg, range 273–2,620 mOsm/kg) and Usg (1.035 ± 0.010, range 1.009- > 1.050) were higher than in the evening (Uosm 1,400 ± 586 mOsm/kg, range 161–2,830 mOsm/kg; Usg 1.031 ± 0.012, range 1.006- > 1.050). The interindividual coefficient of variation in Uosm was 34.2% for morning urine samples and 41.9% for evening samples. In 8 dogs with large differences in urine concentration, there were 2– to 3-fold increases or decreases in Uosm during the day, and the intraindividual coefficient of variation was 33.0%. There was no relation between gender and urine concentration. Urine concentration in both the morning and evening samples decreased with age. Urinary corticoid/creatinine ratios did not change with age. It can be concluded that Uosm and Usg vary widely among healthy dogs. Urine concentration is generally lower in the evening than in the morning and is not related to gender. Urine concentration decreases with age, and this cannot be ascribed to an associated increase in endogenous corticoids. In some dogs, Uosm varies widely during the day, with an intraindividual coefficient of variation approaching the interindividual coefficient of variation. This may be regarded as a biologic variation but also could represent an early undi-agnosed clinical abnormality.     

High Urine Concentrations of Basic Fibroblast Growth Factor in Dogs With Bladder Cancer

Because dogs with bladder cancer often have advanced disease at the time of diagnosis, the identification and use of a tumor marker that could facilitate earlier diagnosis is a valid approach to improve prognosis. The objective of this study was to determine if urine concentrations of the proan-giogenic peptide, basic fibroblast growth factor (bFGF), are high in dogs with bladder cancer compared with normal dogs and dogs with urinary tract infection. We used a commercially available enzyme-linked immunosorbent assay test kit to quantitate bFGF in the urine of 17 normal dogs, 10 dogs with urinary tract infection, and 7 dogs with locally active transitional cell carcinoma of the urinary bladder. In normal dogs, the median urine bFGF concentration was 2.23 ng/g creatinine (quartile range, 1.53 to 5.12 ng/g creatinine). The median urine bFGF concentration in dogs with urinary tract infection did not differ significantly from normal dogs. Dogs with bladder cancer had significantly higher urine bFGF concentrations than normal dogs ( P < .002) and dogs with infection ( P < .02). The median urine bFGF concentration in dogs with transitional cell carcinoma was 9.86 ng/g creatinine (quartile range, 7.40 to 21.63 ng/g creatinine). Six of 7 dogs with bladder cancer had urine bFGF concentrations that were up to 7.4 times the 90th percentile value for normal dogs. Only 1 of 10 dogs with infection had a urine bFGF concentration that exceeded the 90th percentile of normal. These data suggest that canine bladder cancers export bFGF, and that urine bFGF may be useful as a diagnostic tumor marker or noninvasive indicator of treatment response. J Vet Intern Med 1996;10:231–234. Copyright © 1996 by the American College of Veterinary Internal Medicine .