Case Study

Urethral mass, obstructed ureter and pyelonephritis is a 12 year old FS Labrador Retriever

A 12-years-old FS Labrador Retriever was presented for evaluation of hematuria that had not responded to antibiotic therapy. Additional clinical signs were decreased appetite, pollakiuria, and dribbling urine. Vaginitis was present on vaginal examination. Initial urinalysis was consistent with bacterial cystitis but now showed hematuria and large numbers of transitional epithelial cells. Survey radiographs were normal.

Sonographic Differential Diagnosis

Urethral mass.
Severe pyelonephritis. Nephritis with pericapsular inflammatory pattern.
Obstructed left ureter.

Image Interpretation

The urinary bladder in this patient presented a urethral mass with focal areas of mineralization. The urethral mass extended at least 4.0 cm caudally from the cystourethral junction. Periserosal inflammatory pattern was noted. The bladder was over distended. The left kidney presented hydronephrosis and dilated ureter with echogenic debris or infiltrative debris. The left ureter was obstructed by the infiltrative urethral mass 0.5 cm in width distally and dilated at 0.6 cm at the level of the left renal pelvis. Pericapsular inflammatory pattern was noted along with a thickened, irregular cortex. Pyelectasia in the left kidney was noted and measured 0.62 cm. The left kidney was hypervascular. The right kidney revealed pyelectasia that measured 0.55 cm. The right kidney measured 8.65 cm in length. Retroperitoneal fluid accumulation was noted.

DX

Urethral mass, ureteral obstruction, nephritis with pericapsular inflammation

Outcome

Transitional cell carcinoma with secondary infection is likely. There is a potential for
TCC within the left ureter versus echogenic debris and puss. Ultrasound-guided laser
ablation of the urethra would be ideal along with treatment for pyelonephritis. Potential
ureteral and urethral stent placement would be the next step in this patient. Very
guarded prognosis.

Clinical Differential Diagnosis

Bladder – bacterial cystitis, neoplasia, uroliths, polyploid cystitis
Urethra – urethritis, granulomatous urethritis, liths, neoplasia
Kidney – secondary pyelonephritis, hydronephrosis