BackgroundHyperosmolar therapy, using either mannitol or hypertonic saline (HTS), is considered the treatment of choice for intracranial hypertension. However, hyperosmolar agents may impair coagulation and platelet function, limiting their use in patients at risk for hemorrhage. Despite this, studies evaluating the effects of mannitol compared to other hyperosmolar agents in dogs are largely lacking. The aim of this study was to compare the in vitro effects on global hemostasis and platelet function of 20 % mannitol and 3 % HTS on canine blood.MethodsCitrated whole blood from 15 healthy dogs was diluted with 0.9 % saline, 20 % mannitol and 3 % HTS in ratios of 1:16 and 1:8. Rotational thromboelastometry (ROTEM) was used to assess clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) following extrinsic activation (Ex-tem) and after platelet inhibition (Fib-tem). A platelet function analyzer (PFA-100) was used to assess closure time (CtPFA).ResultsNo significant differences were observed between untreated whole blood and samples diluted with saline. Samples diluted with both mannitol and HTS were hypocoagulable compared to untreated whole blood samples. At a dilution of 1:16, no significant differences were found between any measured parameter in samples diluted with saline compared to mannitol or HTS. At a 1:8 dilution, CtPFA was prolonged in samples diluted with mannitol and HTS compared to saline, and CtPFA was prolonged more with mannitol than HTS. Ex-tem CT was increased at a 1:8 dilution with mannitol compared to HTS. Ex-tem CFT was prolonged at a 1:8 dilution with both agents compared to saline, and was prolonged more with mannitol than HTS. Ex-tem MCF was reduced at a 1:8 dilution with both agents compared to saline.Discussion and ConclusionsData in this study indicate that both mannitol and HTS affect canine platelet function and whole blood coagulation in vitro in a dose-dependent fashion. The most pronounced effects were observed after high dilutions with mannitol, which impaired platelet aggregation, clot formation time, clot strength, and fibrin formation significantly more than HTS. Further in vivo studies are necessary before recommendations can be made.

Objectives The aim of this study was to describe a method of subcutaneous ureteral bypass (SUB) device placement with intraoperative ultrasound guidance, with or without microsurgical ureterotomy, for the treatment of benign ureteral obstruction(s) in cats. A secondary aim was to describe the complications and outcomes in our population, and compare the two groups with and without ureterotomy. Methods The medical records of cats with benign ureteral obstruction(s) treated with SUB device placement with intraoperative ultrasound guidance between April 2013 and June 2018 were reviewed. Results Twenty-four cats with 30 obstructed ureters had a SUB device placement with intraoperative ultrasound guidance in 26 surgeries. A microsurgical ureterotomy was performed in 14/26 surgeries. Median age was 10.07 years (range 4–16.6). Eleven of 24 cats (46%) had a previous history of chronic kidney disease (CKD). All cats, including two patients with minimal pelvic dilation (⩽4 mm), had a successful intrapelvic placement of the SUB device. Median survival time was 1555 days (4.25 years); this was not significantly different between the two groups ( P = 0.4494). Stone analysis and bacterial culture, where available for review, revealed calcium oxalate in 12/12 and a negative culture in 6/7. The ureterotomy significantly prolonged the procedure duration (180 vs 125 mins) without significantly decreasing the short- and long-term complications ( P = 0.1588 and P = 0.2921, respectively), or the survival time ( P = 0.8437). Conclusions and relevance SUB device placement with intraoperative ultrasound guidance is an effective alternative for the treatment of ureteral obstruction. Ultrasound guidance may be a more accessible option when a trained veterinarian does not have access to fluoroscopy. Microsurgical ureterotomy did not show any advantage and prolonged the anesthesia. Our median survival time emphasizes a good outcome of SUB device placement, even in cats with a previous history of CKD.

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Progression of transitional cell carcinoma (TCC) in dogs often leads to urinary obstruction. This observational pilot study aimed to evaluate the safety and efficacy of irreversible electroporation (IRE) balloon therapy for the palliative treatment of TCC with partial urethral obstruction. Three client-owned dogs diagnosed with TCC causing partial urethral obstruction were enrolled. After ultrasonographic and cystoscopic examination, IRE pulse protocols were delivered through a balloon catheter device inflated within the urethral lumen. After the procedure, the patients were kept overnight for monitoring and a recheck was planned 28 days later. No complication was observed during the procedure and postprocedural monitoring. After 28 days, one dog had a complete normalization of the urine stream, one dog had stable stranguria, and one dog was presented with a urethral obstruction secondary to progression of the TCC. On recheck ultrasound, one dog had a 38% diminution of the urethral mass diameter whereas the other two dogs had a mass stable in size. IRE balloon therapy seems to be a feasible and apparently safe minimally invasive novel therapy for the palliative treatment of TCC causing urethral obstruction. Further studies are needed to better characterize the safety, efficacy, and outcome of this therapy.

A 3-year-old spayed female English Springer Spaniel was presented twice 4 months apart for investigation of hematuria and pollakiuria without urinary tract infection.Both ultrasound examinations identified a stable craniodorsal bladder wall thickening.The first cystoscopic biopsy samples indicated lymphoplasmacytic cystitis and the second polypoid cystitis. The dog was represented 8 months later for recurrent clinical signs despite medical management. Although the ultrasound examination showed stable disease, repeat cystoscopic biopsy identified transitional cell carcinoma (TCC), confirmed on tissue removed by partial cystectomy. No BRAF mutation was ever detected in urine or tissue samples. To our knowledge, this case represents the first report of presumptive malignant transformation of polypoid cystitis into an apical TCC in a dog. Dogs with polypoid cystitis should be followed closely and surgical management considered if rapid resolution is not achieved with medical management.

A 12 week‐old Nigerian dwarf (Capra aegagrus hircus) buck kid was hospitalized for management of obstructive urolithiasis. Postoperatively, he was inadvertently administered 16‐times greater than his calculated dose of a nonsteroidal anti‐inflammatory drug (NSAID; 17.5 mg/kg flunixin meglumine, IV). The goat was treated with intravenous administration of lipid emulsion (ILE) prior to membrane‐based therapeutic plasma exchange (mTPE) under general anesthesia. The increased coagulability inherent to small ruminants in comparison with dogs and cats warranted specific adjustments in the prescription of anticoagulation, blood flow, and filtration fraction to avoid circuit clotting during mTPE. Serum flunixin meglumine concentration measured before, during, and after mTPE revealed marked reduction in drug concentration. After the combined treatments, no clinical evidence of NSAID gastrointestinal or renal toxicosis was detected. This case report describes successful management of flunixin meglumine overdose in a small ruminant using combined ILE and mTPE.

Background: Therapeutic plasma exchange (TPE) is gaining popularity for the management of nonsteroidal anti-inflammatory drug (NSAID) overdose in dogs.Hypothesis/Objectives: Describe a population of dogs treated with TPE for NSAID overdose.Animals: Sixty-two dogs with NSAID overdose treated with TPE.Methods: Multicenter retrospective study of dogs treated with TPE for ibuprofen, carprofen, or naproxen overdose. Results:The median dose of ibuprofen, carprofen or naproxen ingested was 533 mg/kg (range, 36-4857 mg/kg), 217 mg/kg (range, 88-625 mg/kg) and 138 mg/ kg (range, 26-3000 mg/kg), respectively. Based on previously established toxic ranges for each NSAID, 2 (3.2%), 14 (22.6%), and 46 (74.2%) dogs ingested a gastrointestinal, renal, and neurological toxic dose, respectively. The median time between ingestion and presentation was 4 hours (range, 1-20 hours). The median number of plasma volumes processed was 1.6 (range, 0.4-2.2). The median TPE session duration was 2 hours (range, 1-4.5 hours). Circuit clotting developed during 8 (12.9%) sessions. Patient adverse events reported during 21 (33.8%) sessions consisted of urticaria (12.9%), asymptomatic hypocalcemia (9.6%), and hypotension (9.6%). The median duration of hospitalization was 2.25 days (range, 1-11 days).Sixty-one (98.4%) dogs survived to discharge, and none were rehospitalized. Thirtyone (91.1%) of the 34 dogs with at least 1 follow-up visit were not azotemic at the time of reevaluation.

A one‐year‐old male castrated Australian Shepherd presented for rectal trauma after falling into bushes. A 10‐cm long segment of tissue protruded from the anus, and there were no other visible injuries. Abdominal radiographs showed intrapelvic and perirectal subcutaneous emphysema extending into fascial planes of the right hindlimb. Exploratory surgery was performed, and the tissue protruding out of the anus was identified as proximal urethra extending through a 6 cm longitudinal tear in the ventral rectal wall. Urethral debridement and anastomosis were performed, and the rectal wall repaired. A urinary catheter was in place for 5 days postoperatively. The patient had intermittent episodes of stranguria and pollakiuria and multi‐drug resistant urinary tract infection (Enterococcus faecium) cultured. A pelvic urethral stricture was diagnosed on contrast cystourethrogram, and a nitinol stent placed under fluoroscopic guidance. Sporadic haematuria was observed, which was resolving in a few months. Urethral stent placement provided successful long‐term outcome.