Interventions and experience after complicated total cystectomy in a dog with transitional cell carcinoma

Abstract

Objective: To report surgical and postoperative management of complicated total cystectomy in a dog with transitional cell carcinoma (TCC). Study design: Case report. Animals: One male neutered Shetland sheepdog.Methods: The dog was presented after a 1-month history of stranguria, unresponsive to oral antibiotic therapy. A craniodorsal bladder mass was identified by computed tomography (CT), and partial cystectomy was performed with 1-cm gross lateral margins (day 1). Results of histopathology provided evidence for a diagnosis of TCC, and the dog was treated with adjuvant mitoxantrone. The dog presented with uroperitoneum on day 67 after recurrence and spontaneous perforation. Total cystectomy and ureterourethral anastomosis were performed. Ureteral obstruction developed after removal of catheters that had been placed intraoperatively. Surgical revision included resection of the anastomosis site, bilateral ureteral stenting, and transection and reorientation of the distal urethra to facilitate tension-free closure. Postoperative leakage was managed with bilateral percutaneous nephrostomy tube placement. Results: The dog was discharged on day 88. Adjuvant treatment with vinblastine was pursued. Local recurrence was noted at day 154. Subcutaneous ureteral bypass was performed on day 247 to manage repeat obstruction. Repeated urinary tract infections were subsequently encountered. The dog was euthanized on day 368 because of abdominal discomfort and inappetence, with evidence of progressive urethral, ureteric, and abdominal wall TCC. Conclusion: Complicated cystectomy can be managed to provide survival comparable to previous reports regarding total cystectomy. Clinical significance: Nephrostomy tube placement, ureteral stenting, and subcutaneous ureteral bypass may be considered to manage complicated cystectomy.Preemptive stenting or urinary diversion may help prevent complications.

Modified Toyoda technique for total cystectomy and cutaneous ureterostomy in a cat

“…In another study, the estimated median survival time after surgery of 10 dogs that underwent total cystectomy and subsequent urinary diversion to the prepuce or vagina was 385 days, and two of the 10 dogs had distant metastasis and three had recurrence 11 . Death or euthanasia due to metastasis or postoperative complications at approximately 1 year has been described in other case reports 8,9,12 . In cats, there are very few reports of surgery (partial cystectomy and urethral/ureteral stent placement), medical therapy, and radiation therapy for the treatment of TCC 2,5,6 .…”

“…Owing to historically poor outcomes, the role of surgery in the management of bladder TCC has become largely palliative, with the goal of maintaining or restoring the urinary tract 6 . However, there are a few reports of radical cystectomy and subsequent urinary diversion for TCC of the bladder trigone in dogs 8–12 . Median survival time of four dogs after total cystectomy and cutaneous ureterostomy was reported to be 278.6 days (range: 48–498), and distant metastasis in two dogs were at 47 days (bone) and 369 days (lung) after surgery 10 .…”

“…In dogs, several therapies for TCC have been described in the veterinary literature, including surgery (palliative cystostomy tube or ureteral stent replacement, radical cystectomy, and partial cystectomy), radiation therapy, medical therapy, and local intravesicular therapy. 6,[8][9][10][11][12] Owing to historically poor outcomes, the role of surgery in the management of bladder TCC has become largely palliative, with the goal of maintaining or restoring the urinary tract. 6 However, there are a few reports of radical cystectomy and subsequent urinary diversion for TCC of the bladder trigone in dogs.…”

“…6 However, there are a few reports of radical cystectomy and subsequent urinary diversion for TCC of the bladder trigone in dogs. [8][9][10][11][12] Median survival time of four dogs after total cystectomy and cutaneous ureterostomy was reported to be 278.6 days (range: 48-498), and distant metastasis in two dogs were at 47 days (bone) and 369 days (lung) after surgery. 10 In another study, the estimated median survival time after surgery of 10 dogs that underwent total cystectomy and subsequent urinary diversion to the prepuce or vagina was 385 days, and two of the 10 dogs had distant metastasis and three had recurrence.…”

A combined protocol with piroxicam, chemotherapy, and whole pelvic irradiation with simultaneous boost volumetric modulated arc radiotherapy for muscle-invasive canine urinary transitional cell carcinoma: First clinical experience

“…Dogs with invasive TCC have different treatment options, including cyclooxygenase (COX) inhibitors (e.g., piroxicam, deracoxib, and pirocoxib) [ 26 , 32 , 34 , 35 , 36 , 38 , 39 , 57 , 63 ], cytotoxic chemotherapy drugs (cisplatin, carboplatin, mitoxantrone, vinblastine, gemcitabine) [ 1 , 19 , 26 , 28 , 34 , 35 , 36 , 39 , 54 ], metronomic chemotherapy (chlorambucil) [ 13 , 20 , 23 , 24 , 47 , 48 , 49 , 64 , 68 , 69 ], laser ablation [ 14 , 26 , 43 ], urethral or ureteral stent placement [ 9 , 26 , 52 , 74 ], surgery [ 11 , 26 , 29 , 34 , 35 , 50 , 54 , 66 , 67 , 70 , 76 , 77 ], and other radiation therapy protocols [ 55 , 56 , 62 , 73 ]; however, a single treatment that leads to a robust response is lacking.…”