14 yr mn Norwegian Elkhound with hyperparathyroidism, bladder neoplasia (TCC), and likely liver metastases.
The dog has been on piroxicam for 1 year for the TCC and tramadol for hip dysplasia.
The dog has been experiencing progressive PU/PD (urinating q. 20 minutes), urinary incontinence, and hematuria
14 yr mn Norwegian Elkhound with hyperparathyroidism, bladder neoplasia (TCC), and likely liver metastases.
The dog has been on piroxicam for 1 year for the TCC and tramadol for hip dysplasia.
The dog has been experiencing progressive PU/PD (urinating q. 20 minutes), urinary incontinence, and hematuria
Urinalysis and urine culture were negative for infection
Abdominal US shows slow progressive growth of the bladder mass with calcification. The pelvic urethra appears clean although the trigone walls may be thickened (bladder was not well distended for this study). There is also progressive growth of a complex liver mass that is presumed by the oncologist to be metastasis from the bladder.
CBC, chem profile, and repeat urinalysis are pending
Rule outs for the progressive PU/PD include hyperparathyroidism, urolithiasis, progressive infiltration of the bladder wall by the TCC, urinary tract infection, renal failure. Rule outs for the urinary incontinence include bladder trigone/urethral infiltration, cystitis, urethritis, urethral mass (none seen), detrusor hyperspasticity, other.
The owners declined parathyroid surgery due to the concurrent bladder neoplasia.
Any recommendations for palliative treatment to help control the PU/PD and incontinence? Antibiotics? Phenylpropanolamine?
Comments
Sounds like pollakiuria
Sounds like pollakiuria being more of the issue unless USG < 1.020 when visible PUPD occurs. and therefore urethral involvement likely or the thickening at the CUJ is working as a check valve especially if mid-end stream urgency dysuria.
This is TCC til proven otherwise appears to be deriving from the dorsal wall but the ventral wall and cystourethral junction are thick as well. Deep pelvic urethra on the high resolution linear probe is important here but regardless complete resection is unlikely. See attached image of tcc at 8 mhz and a pelvic urethra at 12 mHz linear. The long arrow is the proximal urethral lumen. The mid arrows show the borders of the mass to the serosa filling the urethra. The mid arrow shows the typical dystrophic mineralization. This type of urethral involvement is often present with the clinical signs you mention here but best discovered wiht hi res and minimizing real estate between the urethra and the probe.
The dorsal part of the mass in your image could be resected as there is a bit of space between the mass and the ureter paps but pretty tight. Best option if this wrere a female in this case is UGELAB at ridgewood vh ridgewood NJ but texas a&m does it as well as does someone in chicago but we are 200+ cases into the procedure in ridgewood. Good opportunity to do a 3 day vacation in NYC as its right across the bridge. NYC and UGELAB cool combo:)
But since this is a male then a urethral stent placement best bet. Chick Weiss and Allicen Berent at AMC in NYC or regional folks may do it as well for the males and UGELAB doesnt do well here because of the need for a PU.
You can do a traumatic catherization in these cases for TCC confirmation. Procedure described here:
http://sonopath.com/resources/interventional-procedures
Or go to the basic search key word “transitional cell carcinoma” and lots of cases come up there as our research has been extensive for this disease
http://sonopath.com/members/case-studies/search?text=transitional+cell+carcinoma&species=All
And you can check out our JAVMA article on the UGELAB (for females) as well as abstracts
great post covers a lot of pee pee issues:)
Sounds like pollakiuria
Sounds like pollakiuria being more of the issue unless USG < 1.020 when visible PUPD occurs. and therefore urethral involvement likely or the thickening at the CUJ is working as a check valve especially if mid-end stream urgency dysuria.
This is TCC til proven otherwise appears to be deriving from the dorsal wall but the ventral wall and cystourethral junction are thick as well. Deep pelvic urethra on the high resolution linear probe is important here but regardless complete resection is unlikely. See attached image of tcc at 8 mhz and a pelvic urethra at 12 mHz linear. The long arrow is the proximal urethral lumen. The mid arrows show the borders of the mass to the serosa filling the urethra. The mid arrow shows the typical dystrophic mineralization. This type of urethral involvement is often present with the clinical signs you mention here but best discovered wiht hi res and minimizing real estate between the urethra and the probe.
The dorsal part of the mass in your image could be resected as there is a bit of space between the mass and the ureter paps but pretty tight. Best option if this wrere a female in this case is UGELAB at ridgewood vh ridgewood NJ but texas a&m does it as well as does someone in chicago but we are 200+ cases into the procedure in ridgewood. Good opportunity to do a 3 day vacation in NYC as its right across the bridge. NYC and UGELAB cool combo:)
But since this is a male then a urethral stent placement best bet. Chick Weiss and Allicen Berent at AMC in NYC or regional folks may do it as well for the males and UGELAB doesnt do well here because of the need for a PU.
You can do a traumatic catherization in these cases for TCC confirmation. Procedure described here:
http://sonopath.com/resources/interventional-procedures
Or go to the basic search key word “transitional cell carcinoma” and lots of cases come up there as our research has been extensive for this disease
http://sonopath.com/members/case-studies/search?text=transitional+cell+carcinoma&species=All
And you can check out our JAVMA article on the UGELAB (for females) as well as abstracts
great post covers a lot of pee pee issues:)
Thanks Eric. It is helpful
Thanks Eric. It is helpful to see your pictures. I mentioned the UGELAB to the client about 4 months ago, but they declined it. The U discouraged surgery at the initial time of diagnosis 1 year ago and the client has opted for palliative treatment because of the concurrent hyperparathyroidism and liver metastases. Do you ever see hypercalcemia with TCC?
Thanks Eric. It is helpful
Thanks Eric. It is helpful to see your pictures. I mentioned the UGELAB to the client about 4 months ago, but they declined it. The U discouraged surgery at the initial time of diagnosis 1 year ago and the client has opted for palliative treatment because of the concurrent hyperparathyroidism and liver metastases. Do you ever see hypercalcemia with TCC?
I dont believe the hyperca is
I dont believe the hyperca is related. Likely a different issue even though a carcinoma. has anyone else seen hypercalcemia with TCC??
I dont believe the hyperca is
I dont believe the hyperca is related. Likely a different issue even though a carcinoma. has anyone else seen hypercalcemia with TCC??
Not see/reported with TCC.
Not see/reported with TCC. The most common tumor is lymphoma with other tumors being anal sac adenocarcinoma, thyroid carcinoma, multiple myeloma, bone neoplasia, thymoma, squamous cell carcinoma, mammary gland carcinoma, melanoma, primary lung tumors, chronic lymphocytic leukemia, renal angiomyxoma, and parathyroid gland tumors. Also need to consider non-tumor etiologies such as granulomatous disease
Not see/reported with TCC.
Not see/reported with TCC. The most common tumor is lymphoma with other tumors being anal sac adenocarcinoma, thyroid carcinoma, multiple myeloma, bone neoplasia, thymoma, squamous cell carcinoma, mammary gland carcinoma, melanoma, primary lung tumors, chronic lymphocytic leukemia, renal angiomyxoma, and parathyroid gland tumors. Also need to consider non-tumor etiologies such as granulomatous disease
Thanks Remo. A
Thanks Remo. A repeat urinalysis showed a urinary specific gravity of 1.018 and evidence of a UTI.
Thanks Remo. A
Thanks Remo. A repeat urinalysis showed a urinary specific gravity of 1.018 and evidence of a UTI.