Radical cystectomy and subsequent ureterohysterostomy in a bitch

Abstract

Objective To describe and report the outcome of a ureterouterine anastomosis after unilateral dehiscence of a ureterovaginal anastomosis after total cystectomy in a bitch. Study design Case report. Animal A 10‐year‐old intact female border collie with a urinary bladder leiomyosarcoma. Methods The dog was diagnosed with an invasive urinary bladder tumor, treated by radical cystectomy and bilateral ureterovaginal anastomosis. Postoperative necrosis of the distal ureter led to dehiscence of the anastomosis on the right side. To preserve the right kidney, the right ureter was anastomosed to the right uterine horn, and a stent was placed across the uterine cervix. Results The dog recovered from surgery and regained satisfactory urine output. Both ureteral anastomoses were patent at 10 months postoperatively. At 12 months postoperatively, intraluminal obstruction of the uterine stent, loss of patency of the right ureter, and severe right renal hydronephrosis were noted. The owner declined nephrectomy, and the dog died 2 months later. Conclusion This is the first published report of a ureterouterine anastomosis and stenting of the uterine cervix in a dog. The functional outcome was satisfactory for 1 year postoperatively. The uterine stent and distal ureter were eventually obstructed by soft tissue. Clinical significance Ureterouterine anastomosis can be considered as a salvage procedure when other surgical techniques have failed.

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 .…”

“…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.…”

“…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.…”

“…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 Partial cystectomy has been reported in cats, but radical cystectomy and subsequent urinary diversion has not.…”

“…In dogs, ureteral reimplantation to the urethra, uterus, vagina, or prepuce and cutaneous ureterostomy have been reported as techniques for subsequent urinary diversion after total cystectomy. [8][9][10][11][12] In a retrospective study of 10 dogs treated with total cystectomy and ureteral transplantation to the prepuce or vagina for TCC of the bladder trigone, the major complications were dehiscence of ureterostomy (n = 2), pyelonephritis (n = 3), oliguria (n = 2), azotemia (n = 1), and ureteral obstruction (n = 1). 11 In a case series of four female dogs with cutaneous ureterostomy, the complications reported included mild dermatitis due to diapers (n = 1) and bilateral mild hydronephrosis and hydroureter (n = 1).…”