Small animal veterinary case study – Mika the dachshund
Case provided by Yvonne McGrotty BVMS CertSAM DipECVIM-CA MRCVS
European Specialist in Veterinary Internal Medicine
RCVS Specialist in Veterinary Internal Medicine
History:
Mika was presented with a 3 month history of dribbling urine unconsciously while asleep and excessive licking of the preputial region. More recently he had been straining to urinate and only passing small volumes of urine or interrupted streams of urine. Frequency of urination was increased. Appetite was now reduced but there was no history of vomiting or diarrhoea. Thirst was normal. Mika had been whining and yelping recently also. Urinalysis revealed concentrated urine with an inactive sediment. He was medicated with Propalin syrup which reduced the frequency of the dribbling and antibiotics which the owner also felt resulted in some improvement.
Physical Examination:
On clinical examination Mika was very bright and alert and in good body condition at 6.4kg. Mucous membranes were pink and moist and pulse quality was good. Thoracic auscultation was unremarkable. Mika showed signs of pain on palpation of the caudal abdomen over the bladder. The bladder felt fairly small. There was no evidence of any lesions on the prepuce or penis and no penile discharge.
Clinical Pathology:
Urine collected by cystocentesis contained 4+ blood. Crystals were not identified on a sediment exam. Biochemistry and electrolytes were unremarkable. Urine has been submitted for further culture and results are pending.
Diagnostic Imaging:
Following sedation, an abdominal ultrasound was performed. There was no free fluid and no enlarged LNs. The liver and spleen were unremarkable. The gastrointestinal tract was unremarkable. Both kidneys were unremarkable with good peripheral blood flow and no evidence of pelvic dilation. The bladder was moderately distended and contained a large volume of hyperechoic corpuscular debris. The bladder wall was thickened and irregular both cranioventrally and towards the trigone (Figure 1).
Figure 1. In this sagittal plane image of the bladder, hyperechoic debris can be seen suspended within the urine (red circle) and the cranioventral bladder wall is thickened and irregular (red arrows).
Radiographs of the caudal abdomen were then performed. There is a non-union fracture of the left acetabulum with lateral displacement of the iliac fracture segment. Moderate remodelling changes of the left femoral head are noted. There are also chronic non-union fractures of the left and right pubic and ischial bones.
Under sedation we attempted to catheterise the urethra. An obstruction to passage of a small gauge catheter was noted approx. 4cm inside the urethra; once this region had been passed the catheter was advanced to a distance of 18cm at which point we were unable to advance the catheter further.
Enemas were performed and a general anaesthetic administered. A retrograde urethrogram was then performed. There is persistent focal narrowing of the prostatic urethra with focal mild dilation on either side of the narrowed region (Figure 2). No other significant urethral abnormalities are seen. There is a mild amount of reflux of contrast into the prostate. There is no evidence of reflux of contrast in the ureters. There is unremarkable contrast filling of the urinary bladder. The focal narrowing of the prostatic urethra is concerning for fibrosis or cicatrisation from previous trauma given the healed/chronic pelvic fractures.
Figure 2. Lateral (left) and dorsoventral (right) radiographs acquired following a retrograde urethrogram. The narrowed region of the prostatic urethra is visible on both radiographs (red arrow) and the non-union fracture of the left acetabulum can be seen (red circle).
Diagnosis:
Urethral stricture and pelvic fractures
Plan:
Attempts will be made to use a balloon dilator to stretch the stricture, or a urethral stent will be considered.