Case Study

Bladder mass in a 10 year old FS Boston Terrier with intermittent hematuria

A 10-year-old spayed female Boston Terrier was presented for intermittent hematuria. Physical examination was unremarkable. The patient was treated with a course of antibiotics, pending urinalysis and urine culture. On urinalysis, the urine was cloudy and amber in appearance, the specific gravity was normal, and there was 1+ bilirubinuria, 2+ hematuria, leukocyturia, and mild triple phosphate crystalluria. Urine culture was negative. On recheck urinalysis two weeks later, the urine was clear and light yellow in appearance, the specific gravity was normal and there was 1+ proteinuria and 3+ hematuria. Survey radiographs initially showed a possible urethral calculus above the descending colon. However, a radiographic consult revealed only degenerative spinal changes, no definitive evidence of urinary tract calculi, and a focal 4mm diameter ovoid soft-tissue opacity between the descending colon and the ventral aspect of L6.

Sonographic Differential Diagnosis

There is a dorsal bladder mass encroaching upon right ureteral papilla, however, there is no ureter obstruction at this time. No evident metastatic disease.

Image Interpretation

The urinary bladder had a dorsal, partially shadowing, dense mass with minor power flow Doppler signal approximately 0.25cm cranial to the right ureteral papilla. The resectability of this mass is debatable, although the urethra did not appear to be involved. Ultrasound guided laser ablation would be an option to debulk the mass and protect the right ureteral papilla.

DX

Dorsal bladder mass encroaching upon right ureter.

Outcome

The owners elected for the palliative therapy with piroxicam. BUN and creatinine were within normal range and CBC revealed thrombocytopenia. Within a month of therapy the owners reported that the patient was improving. Follow up BUN, creatinine, and CBC were all within normal limits. The patient remains on piroxicam and was doing well at time of this report.

Clinical Differential Diagnosis

Urethral disease – neoplasia, granuloma, urolith. Bladder pathology – urolith, bladder neoplasia, sterile cystitis.

Sampling

Specific treatment options discussed with the owners were laser ablation, cystoscopy with biopsies, and/or chemotherapy. Alternatively, palliative treatment with piroxicam could be considered given the high likelihood of transitional cell carcinoma.