- 10 year old FS Sheltie with 4-6 week history of dripping blood from the vulva.
- Free catch U/A showed hematuria and bacteruria. CBC and Chemistry profile were wnl.
- 10 year old FS Sheltie with 4-6 week history of dripping blood from the vulva.
- Free catch U/A showed hematuria and bacteruria. CBC and Chemistry profile were wnl.
- Ultrasound shows a sessile mass in the apical half of the bladder, originating from the left dorsal wall. It is at least 3.75cm in width at its wall attachment. There is another bladder mass, caudal to this one, originating from the ventral wall of the bladder. The trigone appears unaffected, although there is increased echogenicity at the level of the proximal urethra. No intra-abdominal mets or enlarged lymph nodes are seen.
- Although the trigone appears unaffected, the presence of the additional bladder mass just ventral to the trigone suggests to me that there is not enough normal bladder left to leave behind. I am also concerned about the increased echogenicity at the proximal urethra as well as the history of “dripping blood” from the vulva.
- What is your criteria for determining if a bladder mass is resectable?
Comments
The CUJ LOOKS A BIT SUSPECT
The CUJ LOOKS A BIT SUSPECT HERE BUT THE CRITERIA WE USED IN THE UGELAB STUDY AFTER QUERY OF 2 BOARDED SURGEONS IS THAT IF THE LESION WAS AT LEAST 1 CM CRANIAL TO THE RIGHT URETERAL PAPILLA AND NO SEEDING CAUDAL TO THAT IN THE TRIGONE AND PELVIC UURETHRA THEN IT WAS DEAMED “RESECTABLE.” CAUTION YOU MUST GET DEEP PELVIC URETHRAL IMAGES BECAUSE DEEP URETHRAL SEEDS WILL OCCUR. Sorry for the caps lol.
See these cases and the urethral ones to get an idea.
http://sonopath.com/members/case-studies/search?text=urethral+tcc&species=All
If there are mets south of the right u-pap the can ugelab in females. Males tougher and not the best results but females are now > 1 year + MST in non resectable with ugelab in females done at Ridgewood VH in NJ. Can’t speak for TAMU as I don’t know their numbers.. see our small population study in JAVMA on ugelab.
http://sonopath.com/resources/research-publications
If you aren’t comfortable wiht deep pelvic urethra views then the SDEP 17-point abdomen protocol will help with that as well as any other high end view in the abdomen.
http://sonopath.com/products
The CUJ LOOKS A BIT SUSPECT
The CUJ LOOKS A BIT SUSPECT HERE BUT THE CRITERIA WE USED IN THE UGELAB STUDY AFTER QUERY OF 2 BOARDED SURGEONS IS THAT IF THE LESION WAS AT LEAST 1 CM CRANIAL TO THE RIGHT URETERAL PAPILLA AND NO SEEDING CAUDAL TO THAT IN THE TRIGONE AND PELVIC UURETHRA THEN IT WAS DEAMED “RESECTABLE.” CAUTION YOU MUST GET DEEP PELVIC URETHRAL IMAGES BECAUSE DEEP URETHRAL SEEDS WILL OCCUR. Sorry for the caps lol.
See these cases and the urethral ones to get an idea.
http://sonopath.com/members/case-studies/search?text=urethral+tcc&species=All
If there are mets south of the right u-pap the can ugelab in females. Males tougher and not the best results but females are now > 1 year + MST in non resectable with ugelab in females done at Ridgewood VH in NJ. Can’t speak for TAMU as I don’t know their numbers.. see our small population study in JAVMA on ugelab.
http://sonopath.com/resources/research-publications
If you aren’t comfortable wiht deep pelvic urethra views then the SDEP 17-point abdomen protocol will help with that as well as any other high end view in the abdomen.
http://sonopath.com/products
Thanks Eric. Is there any
Thanks Eric. Is there any criteria for how much of the bladder you can remove?
Thanks Eric. Is there any
Thanks Eric. Is there any criteria for how much of the bladder you can remove?
up to 2/3 of the bladder if
up to 2/3 of the bladder if you leave the 3 pipes but let me see if I can get Phil Zeltzman to pipe in here.
up to 2/3 of the bladder if
up to 2/3 of the bladder if you leave the 3 pipes but let me see if I can get Phil Zeltzman to pipe in here.
Hello,
I’d agree with 50%-66%
Hello,
I’d agree with 50%-66% resection… as long as trigone and ureteral openings are preserved. Of course prep your client for lots of bleeding and a frequent urge to urinate…
Ultimately you need a heart to heart with your client: how bold are they? How invasive do they want to be? Would they rather have a functional dog for a short period of time after conservative excision and piroxicam, or a bloody mess for (maybe) a bit longer?
UGELAB is definitely an option in this female…
Phil Zeltzman, DVM, DACVS, CVJ
Mobile board-certified surgeon in eastern PA and Western NJ
Hello,
I’d agree with 50%-66%
Hello,
I’d agree with 50%-66% resection… as long as trigone and ureteral openings are preserved. Of course prep your client for lots of bleeding and a frequent urge to urinate…
Ultimately you need a heart to heart with your client: how bold are they? How invasive do they want to be? Would they rather have a functional dog for a short period of time after conservative excision and piroxicam, or a bloody mess for (maybe) a bit longer?
UGELAB is definitely an option in this female…
Phil Zeltzman, DVM, DACVS, CVJ
Mobile board-certified surgeon in eastern PA and Western NJ
This is what you want to make
This is what you want to make sure isnt going on before you go to resection of a bladder mass. Be sure to image at least 3-4 cm caudal to the CUJ.
This is what you want to make
This is what you want to make sure isnt going on before you go to resection of a bladder mass. Be sure to image at least 3-4 cm caudal to the CUJ.
Ok, thanks! Do you know of
Ok, thanks! Do you know of anyone in the midwest performing ultrasound guided laser cystoscopy?
Ok, thanks! Do you know of
Ok, thanks! Do you know of anyone in the midwest performing ultrasound guided laser cystoscopy?
There is a referral facility
There is a referral facility in chicago I believe that does it but I do not know them and they did not train with us so I cannot vouch for abilities and I don;t know their numbers. I don’t know which facility its just a grapevine piece of information.
There is a referral facility
There is a referral facility in chicago I believe that does it but I do not know them and they did not train with us so I cannot vouch for abilities and I don;t know their numbers. I don’t know which facility its just a grapevine piece of information.