Fluoroscopy-guided balloon dilation of a proximal urethral stricture caused by a urethral membrane in a female cat

Abstract

Case summary A proximal urethral stricture was diagnosed by retrograde urethrogram in a 2-year-old female neutered cat, which was referred following a 2-month history of stranguria, pollakiuria and urinary incontinence. Cystoscopic examination confirmed the presence of a severe narrowing of the proximal urethra near to the bladder neck, consisting of a membrane arising from the urethral mucosa. Fluoroscopy-guided balloon dilation was performed. Twelve months after the procedure, the cat did not show any recurrence of clinical signs. Relevance and novel information To our knowledge, this is the first report of a proximal urethral stricture in a cat. Management by fluoroscopy-guided balloon dilation proved to be a successful and minimally invasive option with an excellent outcome.

Balloon dilation of a urethral stricture caused by a congenital obstructive proximal urethral membrane (COPUM) in a dog

“…Both of the previously reported cats with congenital urethral strictures were treated with fluoroscopy‐guided balloon dilation. Repeat balloon dilation procedures were unsuccessful in the first case and a stent was required to resolve the clinical signs7 but, similar to the outcome of this case, the second cat had complete resolution of signs after a single balloon dilation procedure 8. Balloon dilation has been advocated as first‐line intervention in human patients with urethral strictures and as was performed in this case, some authors perform this procedure without the use of fluoroscopy and with cystoscopic visualisation alone 17.…”

“…While to the best of our knowledge, this is the first reported case of a congenital urethral stricture in a dog, two single case reports describing congenital urethral strictures in cats have recently been published. These two cats were older at the time of diagnosis than the dog reported here with the first being 33 months old and the second being two years old 7 8…”

Successful management of pelvic urethral strictures with balloon dilation in 3 cats

“…As noted previously, there have been anecdotal, single‐case reports of success with this procedure (with or without stent placement). However, these were in cases of abnormal urethral membranes, urethral strictures, or traumatic urethral tears, and long‐term outcomes and repeat imaging were not reported in most cases 19–24 . There have also been multiple previous reports of success with more invasive procedures, such as urethral stenting with alternative urinary diversion techniques 25–28 .…”

“…Although anecdotally reported, there is little information in the veterinary literature about the use of balloon dilation in cases of stricture formation post‐urethral obstruction. There are single‐case reports of balloon dilation used with or without stent placement in cats with urethral strictures and urethral membrane formation, as well as a recent report of successful balloon dilation of a urethral stricture that developed at a urethroplasty site performed after a large urethral tear due to blunt force trauma 19–24 . Long‐term outcomes were not reported in these cases.…”

“…There are single-case reports of balloon dilation used with or without stent placement in cats with urethral strictures and urethral membrane formation, as well as a recent report of successful balloon dilation of a urethral stricture that developed at a urethroplasty site performed after a large urethral tear due to blunt force trauma. [19][20][21][22][23][24] Long-term outcomes were not reported in these cases. To the authors' knowledge, this is the first case series to describe the long-term success of balloon dilation and concurrent indwelling urinary catheter support in 3 cats that developed urethral strictures after treatment for urethral obstruction.…”