An intact male 3 year old with history of straining to urinate and hematuria. The patient presented three times in the course of about 6 weeks with clinical signs. Prostate exam non-painful radiographs negative for calculi. Ultrasound of non distended bladder showed echogenic material, a few hyperechoic shadows.The severity of the straining and lack of response to antibiotics led to surgery. The cystotomy was performed. No calculi found blood clots in the bladder at surgery. The bladder wall was cultured and was negative. Post op dog was fine no further blood or straining.
An intact male 3 year old with history of straining to urinate and hematuria. The patient presented three times in the course of about 6 weeks with clinical signs. Prostate exam non-painful radiographs negative for calculi. Ultrasound of non distended bladder showed echogenic material, a few hyperechoic shadows.The severity of the straining and lack of response to antibiotics led to surgery. The cystotomy was performed. No calculi found blood clots in the bladder at surgery. The bladder wall was cultured and was negative. Post op dog was fine no further blood or straining. The reason for the post today is at 14 days we rechecked the incison and looked with the probe just to see if any stone material forming.We found a bladder full of echogenic material. I did not expect this two weeks post op and within 48hrs of this scan he was urinating blood again???Any thoughts?
two weeks post op
pre-op
Comments
The derbis is classified as
The derbis is classified as “ghosts” which can be many things both renal debris blood clots uti. Any coagulopathy? Renal disease? Passing stones? Aerobic and anaerobic culture? As that third image looks like gas accumulation at 2 o’clock but video is best with these. Not sure the bladder is necessarily the issue but that apical thickening in the pre op image can cause embedded bacteria in th ewall. Too young for TCC but anything is possible. Histopath on bladder wall?
Hi- Chem/cbc pre-op
Hi- Chem/cbc pre-op unremarkable.Aerobic culture only. Not sure if took wall culture apex I will ask. No histopath on wall . The surgeon felt bladder looked nearly normal which surprised us. We thought he was passing some stone material. I did not scan the kidney at the post op I believe I did a month ago with NSF. I’m also thinking about coagulopathy.Do you have a reference on the “ghosts” or any cases I can look at.Nothing has made sense with this young dog. It is a larger shep mix type so breed really doesn’t fit either.Thanks it is very helpful to know about this post op image I will chase down other differentials.
The derbis is classified as
The derbis is classified as “ghosts” which can be many things both renal debris blood clots uti. Any coagulopathy? Renal disease? Passing stones? Aerobic and anaerobic culture? As that third image looks like gas accumulation at 2 o’clock but video is best with these. Not sure the bladder is necessarily the issue but that apical thickening in the pre op image can cause embedded bacteria in th ewall. Too young for TCC but anything is possible. Histopath on bladder wall?
Hi- Chem/cbc pre-op
Hi- Chem/cbc pre-op unremarkable.Aerobic culture only. Not sure if took wall culture apex I will ask. No histopath on wall . The surgeon felt bladder looked nearly normal which surprised us. We thought he was passing some stone material. I did not scan the kidney at the post op I believe I did a month ago with NSF. I’m also thinking about coagulopathy.Do you have a reference on the “ghosts” or any cases I can look at.Nothing has made sense with this young dog. It is a larger shep mix type so breed really doesn’t fit either.Thanks it is very helpful to know about this post op image I will chase down other differentials.
Some questions: Was
Some questions: Was histopathology done of the bladder wal, does a urinary catheter pass easily, what is evident on urinalysis, and is the patient anemic?
Unfortunately no histopath,
Unfortunately no histopath, we were really expecting just some post infection stone material. He was not anemic pre-op. intra-op cath passed easily and urethra was flushed . He has had no straining with this current episode of hematuria. The hematuria was reported to last one day then normal. I think we need to look at other possibilities at this point. Thanks
Some questions: Was
Some questions: Was histopathology done of the bladder wal, does a urinary catheter pass easily, what is evident on urinalysis, and is the patient anemic?
Unfortunately no histopath,
Unfortunately no histopath, we were really expecting just some post infection stone material. He was not anemic pre-op. intra-op cath passed easily and urethra was flushed . He has had no straining with this current episode of hematuria. The hematuria was reported to last one day then normal. I think we need to look at other possibilities at this point. Thanks
Think of idiopathic renal
Think of idiopathic renal hematuria, renal/bladder vascular anomaly, glomerular disease, parasites (Capillaria, Dioctophyma), eosinophilic cystitis.
Thanks so much I will pursue
Thanks so much I will pursue these differentials ,once resolved I’ll let you know !
Think of idiopathic renal
Think of idiopathic renal hematuria, renal/bladder vascular anomaly, glomerular disease, parasites (Capillaria, Dioctophyma), eosinophilic cystitis.
Thanks so much I will pursue
Thanks so much I will pursue these differentials ,once resolved I’ll let you know !
You can do a traumatic
You can do a traumatic catheterization of the bladder to get histopath as well.
http://sonopath.com/resources/interventional-procedures
Oh good idea!
Oh good idea!
You can do a traumatic
You can do a traumatic catheterization of the bladder to get histopath as well.
http://sonopath.com/resources/interventional-procedures
Oh good idea!
Oh good idea!
You can do a traumatic
You can do a traumatic catheterization of the bladder to get histopath as well.
http://sonopath.com/resources/interventional-procedures
You can do a traumatic
You can do a traumatic catheterization of the bladder to get histopath as well.
http://sonopath.com/resources/interventional-procedures
I like to rule out
I like to rule out thrombocytopenia (IMT), Ehrlichia, and Anaplasmosis, and confirm that the kidneys and prostate appear normal sonographically. This is a zebra, but I once had a German Shepherd with disseminated aspergillosis in the spine and bladder. I don’t recall if she had hematuria.
I like to rule out
I like to rule out thrombocytopenia (IMT), Ehrlichia, and Anaplasmosis, and confirm that the kidneys and prostate appear normal sonographically. This is a zebra, but I once had a German Shepherd with disseminated aspergillosis in the spine and bladder. I don’t recall if she had hematuria.
Wow thanks.Snap 4dx was
Wow thanks.Snap 4dx was normal as was cbc. I have scheduled to scan the kidneys . So far no more hematuria but I doubt this is the end of his story. I’ll post any findings.
Wow thanks.Snap 4dx was
Wow thanks.Snap 4dx was normal as was cbc. I have scheduled to scan the kidneys . So far no more hematuria but I doubt this is the end of his story. I’ll post any findings.