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.     

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.     

Percutaneous tube cystostomy and vesicular irrigation for treatment of obstructive urolithiasis in a goat

Treatment of a 3-month-old male goat with obstructive urolithiasis by means of percutaneous tube cystostomy and vesicular irrigation with a chemolysis solution is described. The cystostomy tube was inserted percutaneously with ultrasonographic guidance. Patency of the urethra was reestablished with no clinical evidence of urethral stricture or recurrence of obstruction during the following 12 months. Results in this goat suggest that percutaneous tube cystostomy may be an economical alternative to surgical cystostomy tube placement. Chemical dissolution of calcium phosphate uroliths with a commercially available compound appears to be feasible in goats.     

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.     

Temporary tube cystostomy as a treatment for urinary obstruction secondary to adrenal disease in four ferrets

Adrenal neoplasia is a common problem in middle-aged to older ferrets. Male ferrets may present for stranguria and dysuria due to prostatic/paraurethral tissue enlargement secondary to elevation in androgens produced by the neoplastic tissue. Progressive urethral compression followed by complete urinary obstruction can result. Urinary obstruction can persist for days following surgery requiring urinary diversion. Four ferrets presenting with signs consistent with urinary obstruction secondary to adrenal disease were immediately treated with urethral catheterization or cystocentesis followed by adrenalectomy and temporary tube cystostomy. The tube cystostomy placement and use were associated with minimal complications and allowed recovery from surgery.     

Short- and long-term outcome and factors predicting survival after surgical tube cystostomy for treatment of obstructive urolithiasis in small ruminants

OBJECTIVE: To evaluate outcome of small ruminants after tube cystostomy without urethral flushing. STUDY DESIGN: Retrospective clinical study. ANIMALS: Small ruminants (n=63; 50 goats, 13 sheep). METHODS: Medical records (January 1996-October 2003) for all small ruminants undergoing tube cystostomy were analyzed. Signalment, laboratory data, intraoperative findings, urolith type, and postoperative outcome were compared. Long-term follow-up was obtained at 6 and > or= 12 months postoperatively. RESULTS: Most animals were castrated males. Pygmy goats were overrepresented. Mean time to normal urination after tube cystostomy was 11 days, and mean hospitalization was 14 days. Seventy-six percent of animals were successfully treated with tube cystostomy (90% of those discharged from hospital). Short- and long-term survival was good for those animals with follow-up data. Reobstruction occurred in <20% of animals at 6 and 12 months. Goats, castrated males, and animals with normal serum potassium, no fluid in the abdomen, or no urethral process amputation were more likely to survive. Stone type, bladder appearance, and age at castration were not associated with outcome. CONCLUSION: Surgical tube cystostomy without urethral flushing is an effective technique for resolution of obstructive urolithiasis in small ruminants. CLINICAL RELEVANCE: Goats, small ruminants with an intact urethral process, absence of abdominal fluid, and serum potassium concentration <5.2 mEq/L at admission were all associated with survival after tube cystostomy. Castrated males may also be more likely to survive. These factors should be considered in management of small ruminants with urolithiasis.     

CONTRAST RADIOGRAPHY OF THE LOWER URINARY TRACT IN THE MANAGEMENT OF OBSRUCTIVE UROLITHIASIS IN SMALL RUMINANTS AND SWINE

Contrast radiographic visualization of the small ruminant and porcine lower urinary tract is an infrequently used modality for the evaluation and management of obstructive urolithiasis. The administration of contrast medium through a tube cystostomy catheter used to divert urine flow until the resolution of the obstruction may provide an easy method to evaluate the status of the urethral obstruction. Contrast fluoroscopy is utilized to monitor and visualize therapeutic flushing of the urethra. A review of 26 patients seen at the Veterinary Medical Teaching Hospital suggested that among the radiographic techniques used, positive contrast normograde cystourethrography through the tube cystostomy catheter allowed the best visualization of the lower urinary tract structures and enabled assessment of the resolution of the obstructive lesion.     

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.     

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.     

Caprine obstructive urolithiasis: requirement for 2nd surgical intervention and mortality after percutaneous tube cystostomy, surgical tube cystostomy, or urinary bladder marsupialization

OBJECTIVES: To determine the requirement for 2nd surgical interventions and mortality after 3 different surgical techniques (percutaneous tube cystostomy [10 goats], surgical tube cystostomy [25 goats], urinary bladder marsupialization [10 goats]) for caprine obstructive urolithiasis, and to determine whether pre- or 24-hour postoperative physical examination findings or serum chemistry results could be used as predictors of mortality. STUDY DESIGN: Retrospective study. ANIMALS: Male goats (45) with obstructive urolithiasis. METHODS: Medical records for all male goats admitted and operated for obstructive urolithiasis between 1993 and 2003 were reviewed. Data retrieved included signalment, pre- and 24-hour postoperative values for temperature, pulse, respiratory rate, packed cell volume, serum K(+), serum creatinine, and blood urea nitrogen [BUN]. The type of initial surgical procedure, time to 2nd surgical intervention, time to death, and duration and cost of hospitalization were also obtained. RESULTS: Percutaneous tube cystostomy was associated with a significantly increased requirement for (5.6-fold increased hazard) and decreased time to a 2nd intervention (P=.002). There were no differences between the 3 procedures for time to mortality. Increased BUN and respiratory rate at admission were associated with increased mortality (hazards ratio of 4.8 and 5.0, respectively). Urinary bladder marsupialization was associated with significantly decreased hospitalization time (P=.02) and cost (P=.04) compared with surgical tube cystostomy and percutaneous tube cystostomy. CONCLUSION: Surgical tube cystostomy and bladder marsupialization are both acceptable surgical methods for treatment of caprine obstructive urolithiasis. Each procedure has inherent complications that should be discussed with the owner before choosing the surgical treatment. CLINICAL RELEVANCE: There are acceptable options for treatment of caprine obstructive urolithiasis; however, percutaneous tube cystostomy should be avoided.     

Management of obstructive urolithiasis and concurrent urethral rupture in a goat

A 4-month-old, male castrated Alpine White goat presented to the University of Guelph, Veterinary Teaching Hospital, with urolithiasis and a ruptured urethra. A tube cystostomy was performed using an indwelling Foley catheter. Postoperatively, the goat remained in good health, and was discharged with the cystostomy catheter in situ. Five weeks following surgery, the goat was noted to pass urine through its urethra. Seven weeks following surgery, the catheter became dislodged and the goat was observed to urinate normally. Six months following surgery, the goat was apparently healthy and urinating normally. Tube cystostomy may be a useful therapeutic option in the management of small ruminants with obstructive urolithiasis with concurrent rupture of the urethra, especially for cases in which treatment cost is a limiting factor.     

Gastric torsion in the dog—II. Nonsurgical treatment by aspiration of gastric contents during repeated rotation of the animal

Gastrocentesis followed by introduction of a stout gastric tube and aspiration of gastric content during repeated rotation of the animal around its long axis was attempted as a nonsurgical treatment in 30 cases of gastric torsion. One of the dogs died in the initial phase of the treatment. One dog died at exploratory laparotomy performed because of fundic necrosis. In one animal, obstruction of the cardia remained in spite of effective emptying of the stomach. This dog died at a subsequent exploratory laparotomy showing a remaining gastric torsion of about 270^o. The other 27 cases survived and could be discharged in good condition. The findings at a subsequent laparotomy which was performed after recovery to produce a prophylactic gastropexy, are discussed to the extent to which they seemed to be related to the acute attack.     

Tracheal Obstruction due to Glossal Entrapment by a String Foreign Body in a Peahen (Pavo cristatus)

A female juvenile peahen (Pavo cristatus) presented with acute respiratory distress after the owner observed the bird apparently “choking” the night before presentation. A swelling at the base of the throat was also noted by the owner approximately 2 days prior to the “choking” incident. An air sac breathing tube was placed immediately following presentation and the respiratory rate and effort returned to normal. While performing a physical examination on the patient, a string foreign body was identified and removed from the oral cavity. The string had been wrapped around the base of the tongue, initially resulting in a laceration at the base of the tongue and displacing the glottis caudally, but eventually retroflexed the tongue resulting in occlusion of the glottis. Once the string was transected, the tongue was replaced into normal anatomic position. Three days after presentation, the bird was able to breathe normally with the air sac tube occluded, thus the air sac tube was removed. The lesions under the tongue completely resolved 8 weeks following the initial presentation. Although there have been reports of string foreign bodies in avian species, there are no reports of these foreign bodies causing entrapment of the tongue with subsequent obstruction of the glottis.     

Evaluation of a modified castellated laryngofissure for alleviation of upper airway obstruction in dogs with laryngeal paralysis

A modified castellated laryngofissure procedure (castellated laryngofissure, vocal fold resection, and bilateral arytenoid lateralization) was performed on 12 dogs with bilateral laryngeal paralysis. Clinical signs of airway obstruction were assessed and a pulmonary function test (tidal breathing flow volume loop) was used to evaluate the severity of obstruction. The dogs were evaluated before surgery and at various periods from 4 days to 15 months after surgery. One dog died immediately after surgery and 3 dogs died due to nonrelated or unknown causes 1, 9, and 11 months after surgery. Clinical signs of upper airway obstruction disappeared or decreased in severity in the 11 dogs that recovered from surgery. Tidal breathing flow volume loop values were normal in 7 of 10 dogs evaluated within 5 to 189 days after surgery. The modified castellated laryngofissure procedure provided successful long-term relief of upper airway obstruction associated with bilateral laryngeal paralysis.     

Experimental evaluation of urinary bladder marsupialization in male goats

OBJECTIVE: To evaluate the outcome of urinary bladder marsupialization in male goats. STUDY DESIGN: Prospective, experimental study. ANIMALS: Six healthy mixed-breed male goats. METHODS: After experimentally induced urethral obstruction, 6 male goats had urinary bladder marsupialization. Renal ultrasonography, complete blood count, and serum biochemical analysis were evaluated preoperatively (day 0), at 7 postoperative days, and then at 30-day intervals until 180 days. Stomal diameter was recorded immediately postoperatively and at each postoperative interval. Necropsy examination was performed on day 180 or when stomal stricture or death occurred. RESULTS: Stomal stricture occurred in 1 goat at 120 days. Another goat was found dead at 150 days; severe, suppurative cystitis was identified on necropsy. All goats had mild urine scald dermatitis. Serum biochemical values remained within normal limits, but significant decreases in white blood cell count, serum creatinine concentration, and stomal diameter occurred. At necropsy, all bladders were tubular in shape. Histological evidence of chronic suppurative cystitis and chronic, mild lymphoplasmacytic pyelitis occurred in all goats. Bacterial culture of renal tissue yielded growth in 3 goats, and bladder mucosal swabs yielded bacterial growth in all goats. CONCLUSIONS: Although clinical signs of ascending urinary tract infection were not observed in goats with patent stomata, urinary bladder marsupialization may result in ascending urinary tract inflammation or infection. CLINICAL RELEVANCE: Based on our results, urinary bladder marsupialization should be recommended with caution as the primary method for management of urinary tract obstruction in clinical cases.     

Identification and treatment of Moniliformis clarki (Acanthocephala) in cotton-topped tamarins (Saguinus oedipus).

Ten cotton-topped tamarins (Saguinus oedipus) were infected with Moniliformis clarki a parasitic acanthocephalan. One animal died of intestinal perforation and peritonitis before treatment was initiated. Five of the remaining tamarins were treated successfully with oral albendazole at either 50 mg/kg b.i.d. for 16 days or 100 mg/kg b.i.d. for 3 days, then repeated biweekly for four treatments. A less-intensive treatment regime of 50 mg/kg albendazole orally s.i.d. for 3 days and monthly repeated treatments was unsuccessful. Parasites were removed via surgical enterotomy from two animals, both of which continued to shed acanthocephalan eggs postoperatively.     

Intracapsular Prostatic Omentalization: A New Technique for Management of Prostatic Abscesses in Dogs

Twenty dogs with abscessation of the prostate gland were treated by celiotomy, drainage, and digital exploration of the gland through bilateral capsulectomy wounds. Omentum was introduced through the capsulectomy wounds and packed into the abscess cavities around the prostatic urethra. Most dogs were discharged from the hospital within 48 hours of the surgery. Long-term resolution of the problem (no recurrence within 12 months) was achieved in 19 dogs. One dog had recurrent abscessation that was managed by the placement of dependant Penrose drains. Temporary tube cystostomy was performed postoperatively in one dog for the management of transient dysuria. One dog with septic peritonitis resulting from preoperative abscess rupture was managed by concurrent open peritoneal drainage. Intracapsular prostatic omentalization was a simple and effective means of managing prostatic abscessation with minimal requirement for postoperative hospitalization of the patient. The frequency of serious complications, including postoperative urinary incontinence, was low.     

Disease caused by Mycoplasma mycoides subspecies mycoides LC in Hungarian goat herds

The occurrence of a goat disease caused by Mycoplasma mycoides subsp. mycoides LC in Hungary is reported. The disease occurred in two goat herds in the spring of 1999. In one herd 25% of the 4-12 weeks old kids (10 animals) while in the other herd 33% of the 6-12 weeks old kids (20 animals) became affected. The goat kids developed polyarthritis. The most severe lesions developed in the carpal joints. All animals died after 3-8 days of disease. Four dead kids were necropsied. All of them had serofibrinous and purulent polyarthritis, and in two animals bronchopneumonia, fibrinous pleuritis and meningitis were also found. In the articular exudates the presence of mycoplasmas was detected by PCR using a general mycoplasma primer. Mycoplasmas were cultured from the joints of all animals, from the abdominal parenchymal organs of two kids and from the lungs of one animal. The cultured mycoplasmas grew in strikingly large colonies, proved to be glucose positive, arginine negative and phosphatase positive, and liquefied the coagulated serum. They survived incubation at 45 degrees C for more than 24 h. Based upon their biochemical properties, the results of the immunofluorescence (IF) and growth inhibition tests and the sequence analysis of the PCR product, the cultured strains were identified as M. mycoides subsp. mycoides LC. Animals purchased in the previous autumn had been introduced to both farms. The disease may have been introduced with asymptomatic carrier animals, as earlier no similar disease had been observed at either farm.     

Clinical use of low-profile cystostomy tubes in four dogs and a cat

Traditional cystostomy tubes (used for temporary or permanent diversion of urine in dogs and cats) are long (> or = 22 cm) and cumbersome to stabilize, requiring sutures or bandages to hold the tube against the body. Use of a low-profile gastrostomy port system as a low-profile cystostomy tube (LPCT) in 4 dogs and a cat was investigated; owner satisfaction with the device was assessed. Technical difficulty associated with placement and management of LPCTs was similar to that for traditional cystostomy tubes; with LPCTs, activity and mobility of pets was not compromised, and bandaging was not required. Complications included lower urinary tract infection, mild peristomal leakage of urine and leakage from components of the system, and subcutaneous peristomal infection. Four of 5 owners considered the tube to be easy to use; all owners said they would be comfortable repeating their decision to use the LPCT in their pet.     

Intravenous catheterisation of conventional pigs without application of antimicrobial agents

In six experiments 43 castrated male conventional pigs weighing 25-41 kg were catheterised by inserting a cannula via the jugular vein into the cranal caval vein. The catheters were taped to the spinal neck region where the tap stops were located. Antimicrobial agents were not applied. One pig died 32 hour after surgery from Porcine Stress Syndrome. The catheters remained patent for at least nine days in 38 of the remaining 42 animals (90%). In two animals the catheter by mistake was not inserted into the jugular vein. Two animals got catheters with a one-way blockage four days after surgery. In these animals autopsy revealed thrombosis and phlebitis of the occluded vein and a valve-like thrombus at the tip of the catheters. In seven of the 43 pigs the effects of anaesthesia, surgery and catherisation were followed using rectal temperature and haematological and some blood biochemical parameters for nine days after the surgery. It is concluded that this catheterisation technique, without application of antimicrobial agents, can be used well for experimental infections and pharmacokinetic studies.