Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch

Detalhes bibliográficos
Autor(a) principal: Ferreira, Ariele Aparecida
Data de Publicação: 2019
Outros Autores: Tortato, Neíse Nathalie Guariza, Teixeira, William Timboni, Albernaz, Vinicius Gonzalez Peres [UNESP], Carareto, Roberta, Froes, Tilde Rodrigues, Castro, Jorge Luiz Costa, Dornbusch, Peterson Triches
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.22456/1679-9216.95768
http://hdl.handle.net/11449/199931
Resumo: Background: The ectopic ureter (EU) is considered a congenital anomaly in which the ureteral aperture opens in a position other than the bladder neck. The diagnosis involves the use of different methods or combination of image exams, including excretory urography, pneumocystography, ultrasonography, cystoscopy and computed tomography. The technics for surgical repair should be considered evaluating the number and functionality of the EU, the location of the ureteral opening, functional condition of ipsilateral kidney and the presence of other abnormalities. The case reports aims to show the surgical repair of an intramural EU in an English Bulldog bitch by cystoscopy-guided monopolar cautery. Case: A 1-year-old English Bulldog bitch received medical care due to a history of urinary incontinence since a few months of life. The animal had laboratory abnormalities compatible with lower urinary tract infection, followed by a profound growth of Klebsiella sp in urine culture, and received antibiotic treatment for 21 days based on antibiogram results. Due to a suspect EU, a urinary tract tomography was performed and indicated a congenital kidney malformation (renal dysplasia), enlargement and distal insertion of the left ureter (in comparison with the contralateral one), rising suspiciously of its intramural progression. We choose to proceed to cystoscopy examination, in which both right and left ureteral ostium could be seen in the urethral region. A guide of a pigtail catheter was inserted through both ureteral ostia in order to orient the ureteral incision. The monopolar cautery was inserted in cystoscopy working channel to section the mucosa of EU channel on urethra region, separating the lumen of EU from the urethra and extending the incision cranially inside the urinary bladder lumen. After a complete section of the ectopic tissue, a pigtail urinary catheter was correctly placed in both ureters. After bilateral repair of EU, the bitch showed a significative decrease of urinary incontinence, although full resolution could not be obtained. Discussion: Studies showing the treatment of EU using the ablation of the tissue separating the ureteral and urethral or bladder lumen using cystoscopy-guided laser showed lower post-operative pain and hospitalization time, besides being a minimally invasive technique in comparison with traditional surgery. The limiting factor is the specialized equipment required for the procedure. In our surgical routine, there is a cystoscope, however, we do not own a diode laser or radiofrequency equipment. The adaptation of a monopolar cautery with the objective of correct an intramural EU proved to be feasible in practice since we achieved satisfactory recovery of the patient, similar than what is seen with lasers. Even after surgical repair of both EU, the patient sustained urinary incontinence, although lesser than before surgery. The remaining of the clinical sign, in this case, is compatible with the low rate of postoperative urinary continence in bitches, irrespective of the surgical technique, varying between 25% and 58% with or without medical treatment. To our knowledge, there was no published report on the use of monopolar cautery to treat EU. The monopolar cautery can be used as a less invasive and alternative technique to traditional surgery in the treatment of intramural EU through cystoscopy in bitches.
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spelling Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitchPigtail catheterUreteral ectopiaUrinary incontinenceBackground: The ectopic ureter (EU) is considered a congenital anomaly in which the ureteral aperture opens in a position other than the bladder neck. The diagnosis involves the use of different methods or combination of image exams, including excretory urography, pneumocystography, ultrasonography, cystoscopy and computed tomography. The technics for surgical repair should be considered evaluating the number and functionality of the EU, the location of the ureteral opening, functional condition of ipsilateral kidney and the presence of other abnormalities. The case reports aims to show the surgical repair of an intramural EU in an English Bulldog bitch by cystoscopy-guided monopolar cautery. Case: A 1-year-old English Bulldog bitch received medical care due to a history of urinary incontinence since a few months of life. The animal had laboratory abnormalities compatible with lower urinary tract infection, followed by a profound growth of Klebsiella sp in urine culture, and received antibiotic treatment for 21 days based on antibiogram results. Due to a suspect EU, a urinary tract tomography was performed and indicated a congenital kidney malformation (renal dysplasia), enlargement and distal insertion of the left ureter (in comparison with the contralateral one), rising suspiciously of its intramural progression. We choose to proceed to cystoscopy examination, in which both right and left ureteral ostium could be seen in the urethral region. A guide of a pigtail catheter was inserted through both ureteral ostia in order to orient the ureteral incision. The monopolar cautery was inserted in cystoscopy working channel to section the mucosa of EU channel on urethra region, separating the lumen of EU from the urethra and extending the incision cranially inside the urinary bladder lumen. After a complete section of the ectopic tissue, a pigtail urinary catheter was correctly placed in both ureters. After bilateral repair of EU, the bitch showed a significative decrease of urinary incontinence, although full resolution could not be obtained. Discussion: Studies showing the treatment of EU using the ablation of the tissue separating the ureteral and urethral or bladder lumen using cystoscopy-guided laser showed lower post-operative pain and hospitalization time, besides being a minimally invasive technique in comparison with traditional surgery. The limiting factor is the specialized equipment required for the procedure. In our surgical routine, there is a cystoscope, however, we do not own a diode laser or radiofrequency equipment. The adaptation of a monopolar cautery with the objective of correct an intramural EU proved to be feasible in practice since we achieved satisfactory recovery of the patient, similar than what is seen with lasers. Even after surgical repair of both EU, the patient sustained urinary incontinence, although lesser than before surgery. The remaining of the clinical sign, in this case, is compatible with the low rate of postoperative urinary continence in bitches, irrespective of the surgical technique, varying between 25% and 58% with or without medical treatment. To our knowledge, there was no published report on the use of monopolar cautery to treat EU. The monopolar cautery can be used as a less invasive and alternative technique to traditional surgery in the treatment of intramural EU through cystoscopy in bitches.Department of Veterinary Medicine Federal University of Paraná (UFPR), Rua dos Funcionários n. 1540.Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science São Paulo State University (UNESP)Department of Veterinary Medicine Pontifical Catholic University of Paraná (PUCPR)Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science São Paulo State University (UNESP)Universidade Federal do Paraná (UFPR)Universidade Estadual Paulista (Unesp)Pontifical Catholic University of Paraná (PUCPR)Ferreira, Ariele AparecidaTortato, Neíse Nathalie GuarizaTeixeira, William TimboniAlbernaz, Vinicius Gonzalez Peres [UNESP]Carareto, RobertaFroes, Tilde RodriguesCastro, Jorge Luiz CostaDornbusch, Peterson Triches2020-12-12T01:53:09Z2020-12-12T01:53:09Z2019-01-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://dx.doi.org/10.22456/1679-9216.95768Acta Scientiae Veterinariae, v. 47.1679-92161678-0345http://hdl.handle.net/11449/19993110.22456/1679-9216.957682-s2.0-85077603840Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengActa Scientiae Veterinariaeinfo:eu-repo/semantics/openAccess2021-10-23T10:11:20Zoai:repositorio.unesp.br:11449/199931Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T20:23:12.921334Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
title Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
spellingShingle Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
Ferreira, Ariele Aparecida
Pigtail catheter
Ureteral ectopia
Urinary incontinence
title_short Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
title_full Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
title_fullStr Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
title_full_unstemmed Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
title_sort Use of monopolar cauterization by cystoscopy for ectopic intramural ureter correction in a bitch
author Ferreira, Ariele Aparecida
author_facet Ferreira, Ariele Aparecida
Tortato, Neíse Nathalie Guariza
Teixeira, William Timboni
Albernaz, Vinicius Gonzalez Peres [UNESP]
Carareto, Roberta
Froes, Tilde Rodrigues
Castro, Jorge Luiz Costa
Dornbusch, Peterson Triches
author_role author
author2 Tortato, Neíse Nathalie Guariza
Teixeira, William Timboni
Albernaz, Vinicius Gonzalez Peres [UNESP]
Carareto, Roberta
Froes, Tilde Rodrigues
Castro, Jorge Luiz Costa
Dornbusch, Peterson Triches
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidade Federal do Paraná (UFPR)
Universidade Estadual Paulista (Unesp)
Pontifical Catholic University of Paraná (PUCPR)
dc.contributor.author.fl_str_mv Ferreira, Ariele Aparecida
Tortato, Neíse Nathalie Guariza
Teixeira, William Timboni
Albernaz, Vinicius Gonzalez Peres [UNESP]
Carareto, Roberta
Froes, Tilde Rodrigues
Castro, Jorge Luiz Costa
Dornbusch, Peterson Triches
dc.subject.por.fl_str_mv Pigtail catheter
Ureteral ectopia
Urinary incontinence
topic Pigtail catheter
Ureteral ectopia
Urinary incontinence
description Background: The ectopic ureter (EU) is considered a congenital anomaly in which the ureteral aperture opens in a position other than the bladder neck. The diagnosis involves the use of different methods or combination of image exams, including excretory urography, pneumocystography, ultrasonography, cystoscopy and computed tomography. The technics for surgical repair should be considered evaluating the number and functionality of the EU, the location of the ureteral opening, functional condition of ipsilateral kidney and the presence of other abnormalities. The case reports aims to show the surgical repair of an intramural EU in an English Bulldog bitch by cystoscopy-guided monopolar cautery. Case: A 1-year-old English Bulldog bitch received medical care due to a history of urinary incontinence since a few months of life. The animal had laboratory abnormalities compatible with lower urinary tract infection, followed by a profound growth of Klebsiella sp in urine culture, and received antibiotic treatment for 21 days based on antibiogram results. Due to a suspect EU, a urinary tract tomography was performed and indicated a congenital kidney malformation (renal dysplasia), enlargement and distal insertion of the left ureter (in comparison with the contralateral one), rising suspiciously of its intramural progression. We choose to proceed to cystoscopy examination, in which both right and left ureteral ostium could be seen in the urethral region. A guide of a pigtail catheter was inserted through both ureteral ostia in order to orient the ureteral incision. The monopolar cautery was inserted in cystoscopy working channel to section the mucosa of EU channel on urethra region, separating the lumen of EU from the urethra and extending the incision cranially inside the urinary bladder lumen. After a complete section of the ectopic tissue, a pigtail urinary catheter was correctly placed in both ureters. After bilateral repair of EU, the bitch showed a significative decrease of urinary incontinence, although full resolution could not be obtained. Discussion: Studies showing the treatment of EU using the ablation of the tissue separating the ureteral and urethral or bladder lumen using cystoscopy-guided laser showed lower post-operative pain and hospitalization time, besides being a minimally invasive technique in comparison with traditional surgery. The limiting factor is the specialized equipment required for the procedure. In our surgical routine, there is a cystoscope, however, we do not own a diode laser or radiofrequency equipment. The adaptation of a monopolar cautery with the objective of correct an intramural EU proved to be feasible in practice since we achieved satisfactory recovery of the patient, similar than what is seen with lasers. Even after surgical repair of both EU, the patient sustained urinary incontinence, although lesser than before surgery. The remaining of the clinical sign, in this case, is compatible with the low rate of postoperative urinary continence in bitches, irrespective of the surgical technique, varying between 25% and 58% with or without medical treatment. To our knowledge, there was no published report on the use of monopolar cautery to treat EU. The monopolar cautery can be used as a less invasive and alternative technique to traditional surgery in the treatment of intramural EU through cystoscopy in bitches.
publishDate 2019
dc.date.none.fl_str_mv 2019-01-01
2020-12-12T01:53:09Z
2020-12-12T01:53:09Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.22456/1679-9216.95768
Acta Scientiae Veterinariae, v. 47.
1679-9216
1678-0345
http://hdl.handle.net/11449/199931
10.22456/1679-9216.95768
2-s2.0-85077603840
url http://dx.doi.org/10.22456/1679-9216.95768
http://hdl.handle.net/11449/199931
identifier_str_mv Acta Scientiae Veterinariae, v. 47.
1679-9216
1678-0345
10.22456/1679-9216.95768
2-s2.0-85077603840
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Acta Scientiae Veterinariae
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.source.none.fl_str_mv Scopus
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
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