"Pineapple" the dog

History:

 

  • "Pineapple", a 7 year old, female spayed mixed breed dog, presented to her regular veterinarian because she was straining to urinate but unable to.

  • Prior to this, Pineapple had been treated twice for a urinary tract infection that was difficult to get under control.  In fact, she was still on medication to treat her urinary tract infection when she presented.

  • Repeated urine cultures had been performed to help guide her treatment and her bloodwork was all normal.

  • On presentation her veterinarian performed x-rays which showed a very full urinary bladder, but no obvious stones or other abnormalities.

  • An ultrasound was performed, which also confirmed no stones and no obvious tumors in the bladder.

  • Attempts were made to pass a catheter into Pineapples bladder, but were unsuccessful. 

  • Due to the urgen nature of the case, the urinary bladder was drained using a needle under ultrasound guidance (cystocentesis), and her regular veterinarian called to discuss the possibility of passing a scope to try to determine the cause of the blockage.

  • We all agreed that this was a good approach and the procedure was booked right away.

Findings:

 

  • A standard 2.7mm cystoscope with operating sheath was passed through the vulva, and the vestibule and vagina were evaluated prior to entering the urethra.  This area appeared normal.

  • The scope was then passed into the urethra and moved slowly toward the urinary bladder.

  • Grossly, the urethra appeared very inflamed, with multiple areas of thickening and redness (see above).

  • The scope entered the bladder and a full cystoscopy was performed.  The main body of the bladder was inflamed with multiples areas of pinpoint ulceration.  There were no bladder stones appreciated and both ureters were functioning properly.

  • The scope was slowly pulled back to evaluate the trigone area of the bladder (where the urethra begins from the bladder itself), and diffuse thickening was evident.  There was extensive tissue erosion and fibrin present (see image to right along with the short video).  Multiple biopsy samples were collected paying special attention to this area and were sent to a pathologist.

  • A urinary catheter was placed to keep Pineapple comfortable while we waited for the results.

  • Unfortunately, the pathology report confirmed our fears and a diagnosis of bladder carcinoma was made.

urethroscopy, cystoscopy, dogs, minimally invasive, carcinoma
cystoscopy, urethroscopy, dog, minimally invasive, carcinoma

Discussion:

 

Unfortunately, diseases of the urinary bladder are all too common in our pets.  Chronic issues like urinary crystals, bladder stones, and cystitis are far more common than bladder cancer.  In fact, the expectation in this case was that we might find a stone or obstruction in the urethra itself.  However, cancer/masses in this particular part of the bladder (the neck) are seen more often than other areas of the bladder.  Unfortunately, this can be a very challenging area to perform surgery and therefore many tumors found here cannot be fully removed.  This case does however illustrate the value of performing urethroscopy and cystoscopy in difficult urinary cases.  We were able to evaluate the lower urinary tract in great detail and collect biopsy samples in a minimally invasive way, allowing Pineapple's family to obtain a diagnosis and help guide their treatment options while keeping Pineapple comfortable.

"It Doesn't Have to Hurt"

Dr. Paul Hodges

416-884-1008

phodgesmip@gmail.com