Percutaneously Placed, Low-Profile Cystostomy Tubes

At SCVS, we offer a minimally invasive, non-surgical option for placement of low-profile, permanent cystostomy tubes for long-term management of obstructive urethral disease in dogs. Obstructive urethral diseases are common in dogs and include neoplasia (particularly TCC), detrusor-urethral dyssynergia and granulomatous urethritis. While other interventional options such as urethral stenting are available, placement of a low-profile cystostomy tube may allow for improved patient outcomes. Placement of a low-profile cystostomy tube avoids complications such as stent obstruction due to neoplastic ingrowth or post-stenting urinary incontinence. We offer percutaneous placement of low-profile cystotomy tubes and our ability to place these tubes non-surgically is often appealing to pet owners.

Key facts

• Minimally invasive, non-surgical option for long-term management of patients with obstructive urethral disease which avoids the complication of urinary incontinence or repeat obstruction
• We use low-profile tubes which are very cosmetic and cannot normally be seen when the patient is in a normal standing or lying position
• Owners very quickly become accustomed to management of the tubes and they are very well tolerated by patients
• No bandaging required and patients can return to their normal lives (running, swimming, playing) relatively soon after tube placement.

Balloon dilation and urethral stenting for obstructive urethral disease

For some patients with obstructive urethral disease (such as TCC or benign urethral strictures), interventional management with balloon dilation or stenting may be the most appropriate first step for management. Balloon dilation is considered the most appropriate intervention in the first instance for patients with benign urethral strictures and balloon dilation has recently been shown to result in significant improvement with regards to clinical signs in patients with obstruction due to prostatic or urethral neoplasia. These procedures can be performed with endoscopic or fluoroscopic guidance (or a combination of both) and usually result in rapid improvement of clinical signs.

Key facts

• Minimally invasive option for management of benign urethral strictures and malignant obstructions
• Rapid recovery time and short hospitalisation - procedures can be performed on an outpatient basis
• Rapid improvement/resolution of obstructive signs expected in the majority of patients

Subcutaneous Ureteral Bypass (SUB) for uni or bilateral ureteral obstruction

Ureteral obstruction is usually caused by ureterolithiasis in cats and is a common, life-threatening cause of post-renal azotemia. Ureterolithiasis is also seen in dogs, albeit less commonly and other indications for ureteral bypass include obstructive ureteral neoplasia, ureteral strictures and ureteral trauma. Rapid intervention is vital to manage life-threatening sequelae such as hyperkalemia and to prevent irreversible renal damage. The soft tissue surgery team at SCVS has experience with subcutaneous ureteral bypass and many cases have been successfully treated with excellent long-term outcomes.

Key facts

• Rapid intervention and establishing a route for urinary drainage is essential for both short and long-term success in patients with ureteral obstruction
• Medical management is typically associated with a low success rate (<10%) in patients with ureteral obstruction and is contra-indicated in patients with azotemia, complete obstruction/evidence of hydronephrosis and in patients with significant acid-base or electrolyte imbalances
• SUB placement offers a definitive treatment option for cases of obstructive ureteral disease

Submucosal Urethral Bulking

Treatment for Urethral Sphincter Mechanism Incompetence (USMI)

Submucosal Urethral bulking is a minimally invasive procedure for the long-term management of urethral sphincter mechanism incompetence (USMI) in female dogs. We are one of only a very small number of referral centres in the UK offering cystoscopic injection of a human-grade, submucosal bulking agent for the management of urinary incontinence in female dogs. The procedure has a high success rate with durable responses. The procedure can be performed on an outpatient basis and is suitable as a first-line, sole treatment for USMI (without medication) or as an adjuvant treatment in patients which are refractory to medications such as Propalin and/or Incurin.

Veterinary professionals, please do not hesitate to contact us if you would like to discuss case suitability further or to refer a case.

Key facts

• Minimally invasive procedure for the long-term management of urethral sphincter mechanism incompetence (USMI) in female dogs at SCVS
• High success rate with durable responses
• Treatment available on an outpatient basis.

Notes
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