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三只犬膀胱镜或膀胱尿道镜在治疗下尿路出血引起的良性肉眼血尿中的应用

Use of cystoscopy or cystourethroscopy in treating benign macroscopic hematuria caused by lower urinary tract hemorrhage in three dogs.

作者信息

Himelman Jessica F, Berent Allyson C, Weisse Chick W, Bagley Demetrius H

出版信息

J Am Vet Med Assoc. 2019 Jul 1;255(1):90-97. doi: 10.2460/javma.255.1.90.

Abstract

CASE DESCRIPTION

A 5-year-old 11.5-kg (25.3-lb) castrated male Boston Terrier (dog 1), an 8-year-old 27.8-kg (61.2-lb) castrated male Boxer (dog 2), and a 10.5-year-old 15.9-kg (35.0-lb) spayed female Pembroke Welsh Corgi (dog 3) were evaluated because of severe, gross hematuria and suspected idiopathic renal hematuria.

CLINICAL FINDINGS

All 3 dogs had hematuria, anemia, blood clots in their urinary bladders, and unremarkable findings on coagulation and mucosal bleeding time assessments. With cystourethroscopy, lower urinary tract hemorrhage originating from a small lesion in the urinary bladder (n = 2) or urethra (1) and normal-appearing yellow urine jetting from both ureterovesicular junctions were visualized in each dog.

TREATMENT AND OUTCOME

Cystoscopically guided surgical resection of a hemorrhagic lesion of the urinary bladder was performed on dog 1, and histologic evaluation of the resected tissue confirmed urinary bladder telangiectasia. Dogs 2 and 3 each underwent cystourethroscopically guided laser ablation of a hemorrhagic lesion (presumptively diagnosed as hemangioma, angioma, or telangiectasia) in the urinary bladder (dog 2) or urethra (dog 3). The longest follow-up duration was 7 years, and none of the 3 dogs had subsequent recurrence of gross hematuria.

CLINICAL RELEVANCE

Findings suggested that cystourethroscopy should be considered part of the diagnostic plan for hematuria in dogs before pursuing major surgical treatment or when results of conventional diagnostic procedures do not indicate the underlying cause. In addition, histologic results for dog 1 indicated urinary bladder telangiectasia, previously an unreported cause of severe, chronic lower urinary tract hematuria in dogs.

摘要

病例描述

一只5岁、体重11.5千克(25.3磅)的去势雄性波士顿梗犬(犬1)、一只8岁、体重27.8千克(61.2磅)的去势雄性拳师犬(犬2)以及一只10.5岁、体重15.9千克(35.0磅)的去势雌性彭布罗克威尔士柯基犬(犬3)因严重肉眼血尿及疑似特发性肾性血尿接受评估。

临床发现

所有3只犬均有血尿、贫血、膀胱内血凝块,且凝血及黏膜出血时间评估结果无异常。经膀胱尿道镜检查,每只犬均可见膀胱(n = 2)或尿道(1)小病变引起的下尿路出血,以及从双侧输尿管膀胱连接处喷出外观正常的黄色尿液。

治疗及结果

对犬1进行膀胱镜引导下膀胱出血性病变手术切除,切除组织的组织学评估证实为膀胱毛细血管扩张症。犬2和犬3分别接受膀胱尿道镜引导下膀胱(犬2)或尿道(犬3)出血性病变(初步诊断为血管瘤、血管痣或毛细血管扩张症)激光消融术。最长随访时间为7年,3只犬均未出现肉眼血尿复发。

临床意义

研究结果表明,在进行主要手术治疗前或传统诊断程序结果未提示潜在病因时,应考虑将膀胱尿道镜检查作为犬血尿诊断计划的一部分。此外,犬1的组织学结果显示为膀胱毛细血管扩张症,这是此前未报道的犬严重慢性下尿路血尿病因。

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