Urethral Disease Management
When your pet is struggling to urinate, straining, has blood in urine, or chronic infections:
- Urethral disease can cause all the above symptoms
- It is VERY important to investigate these symptoms as not being able to urinate and straining to urinate are uncomfortable and can be life threatening.
- CAUSES: tumors (transitional cell carcinoma, hemangiosarcoma), proliferative urethritis (inflammation of the urethra), strictures (benign narrowing of the urethra), stones obstructing urethra, trauma.
- Cystocentesis urine cultures (sterile sample from bladder with ultrasound guidance).
- Abdominal Radiographs
- Urinary ultrasound
- Rectal examination to check urethra and prostate
- Cystoscopy: we can scope all dogs, female cats, male cats through a small port in the bladder to investigate the entire lower urinary tract
- Prostatic sampling via ultrasound or scoping
Surgery is VERY invasive to investigate the urinary tract and requires pelvic fracturing to access the majority of the urethra. This is why our minimally invasive options are so important to reduce any pain/morbidity when dealing with issues in this area.
Minimally invasive therapies for urethral issues/blockage:
- Cystoscopy for diagnosis and biopsy and culture of tissue
- Urethral stenting
- Laser ablation of excessive tissue/masses (UGELAB-ultrasound guided, endoscopic laser ablation) can be used to reduce tissue burden and allow these patients to urinate until the diagnosis is made or they begin radiation or chemotherapy
- Cystostomy tube placement in male cats that cannot be unblocked in a routine fashion through the penis
- Cystostomy tube placement in dogs that cannot pee and are
Further therapy after the procedure:
- Radiation and chemotherapy for any cancer of the urinary tract
- Antibiotics and steroids for proliferative urethritis or stricture
- Routine rechecks to check for stones/re-obstruction, progressive disease
TRANSITIONAL CELL CARCINOMA/UROTHELIAL CARCINOMA:
- May need cystoscopy for diagnosis vs. blind biopsy or traumatic catheter
- Urethral stent if cannot urinate vs. laser ablation
- Chemotherapy and radiation to treat tumor
- Intra-arterial chemotherapy and/or prostatic embolization for prostatic carcinomas:
- These are specialized techniques that can be used for cases that are not responding to traditional therapies where through a small access to the artery on the leg we can instill chemotherapy and remove the blood supply to the cancer.
- Ureteral stent percutaneously placed:
- This disease can also invade/block ureters that drain urine from the kidneys.
- We can fix the ureter obstruction with a stent placed in a minimally invasive way where there is no incision
- The stent will stay in place to allow urine flow