Use of cystoscopic-guided laser ablation for treatment of unilateral ureterovesicular stenosis and secondary orthotopic ureterocele in a female dog

Abstract

CASE DESCRIPTION A 4-year-old spayed female Beagle was evaluated because of a 2-month history of intermittent pollakiuria, stranguria, dysuria, and abdominal pain. A diagnosis of bacterial cystitis was initially made, but clinical signs persisted despite appropriate antimicrobial treatment, so the dog was referred for further evaluation and treatment. CLINICAL FINDINGS Abdominal ultrasonography revealed a large, thin-walled, cystic structure in the urinary bladder at the level of the expected right ureterovesicular junction that communicated with the uniformly dilated right ureter. Severe right-sided pyelectasia was also detected. A presumptive diagnosis was made of a right-sided orthotopic ureterocele with secondary hydroureter and pyelectasia. TREATMENT AND OUTCOME Cystoscopy revealed a large cystic structure in the region of the right ureterovesicular junction without obvious communication between the ureter and urinary bladder. Portable C-arm fluoroscopy was used to confirm the presence of an intramural orthotopic tract and to measure the diameter of the ureter and renal pelvis via retrograde contrast ureteropyelography. Complete laser ablation of the ureterocele was performed by incising it circumferentially near its base. Clinical signs resolved immediately following the procedure. Six weeks later, the dog remained free of clinical signs and abdominal ultrasonography revealed resolution of hydroureter with persistence of mild right-sided pyelectasia. CLINICAL RELEVANCE Cystoscopic-guided laser ablation of an orthotopic ureterocele secondary to ureterovesicular stenosis was a safe and effective minimally invasive treatment for the dog of this report, resulting in immediate and continued improvement of clinical signs and ultrasonographic changes. Laser ablation should be considered as an alternative to surgery for the treatment of orthotopic ureteroceles in dogs.

Endoscopic laser‐ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008‐2017)

“…In veterinary medicine, a small number of published reports exist of ureteroceles in dogs . Renal‐sparing interventions were performed in only 15 of 21 cases . Historically, surgical management of ureteroceles in dogs has been the mainstay of treatment .…”

“…Cystoscopic and fluoroscopic‐guided laser ablation (CLA) is reported as a therapeutic modality for ureteroceles in dogs . However, to date, a single case report exists describing the use of CLA for treatment of unilateral orthotopic ureterocele in a female dog with follow‐up .…”

“…Cystoscopic and fluoroscopic‐guided laser ablation (CLA) is reported as a therapeutic modality for ureteroceles in dogs . However, to date, a single case report exists describing the use of CLA for treatment of unilateral orthotopic ureterocele in a female dog with follow‐up . This case report documented resolution of pollakiuria and ultrasonographic resolution of hydroureter with persistent mild pyelectasia; however, only 6 weeks of follow‐up was available .…”

“…However, to date, a single case report exists describing the use of CLA for treatment of unilateral orthotopic ureterocele in a female dog with follow‐up . This case report documented resolution of pollakiuria and ultrasonographic resolution of hydroureter with persistent mild pyelectasia; however, only 6 weeks of follow‐up was available . An additional case series describes CLA for the treatment of congenital distal UO stenosis in 16 dogs that included 4 dogs with ureteroceles .…”

“…Thorough descriptions are lacking of CLA for male dogs with ureteroceles and for female dogs with ectopic ureteroceles. Standardized long‐term outcomes like continence scores, assessment of renal function, and imaging are also lacking . In this study, we describe the technique and clinical outcome of attempted CLA for the treatment of ureteroceles in dogs.…”