- 12 yr old mn Yorkshire Terrier dx with bladder TCC in February of 2018. Was tx with chemotherapy at the U. Ureteral stent placed at the beginning of this month due to obstruction at the urinary papilla. Only able to successfully place one stent on the left side. Both kidneys have had progressive cortical cysts for years, worst on the right side.
- 12 yr old mn Yorkshire Terrier dx with bladder TCC in February of 2018. Was tx with chemotherapy at the U. Ureteral stent placed at the beginning of this month due to obstruction at the urinary papilla. Only able to successfully place one stent on the left side. Both kidneys have had progressive cortical cysts for years, worst on the right side.
- Recent history of coughing, lethargy, vomiting, diarrhea, anorexia and weight loss. Owners have been unable to give medications for several days (no piroxicam and no pimobendan for stage 2 MVdz). Dog is not respsonding to oral anti-ulcer medication and injectable Cerenia.
- CBC and chem prof are wnl. Urine culture is pending. Primary vet wanted to rule out an ulcer.
- Abdominal US shows previously documented cystic kidneys, previously documented mineralized prostate, and a normal GI tract. The bladder masses are small but are located at the trigone and cystourethral junction. The left ureteral stent can be visualized.
- Why is this dog depressed and not eating? Rule outs include paraneoplastic syndrome, GI ulceration not visible on ultrasound, infection, stent malposition or obstruction, and pain.
- I have not scanned a ureteral stent before and am not sure about how to assess placement. The renal pelvis looks dilated but I assume this is due to the stent? The patient is not azotemic. Are ureteral stents painful?
- Can anyone on this forum comment on the stent appearance and complications associated with stents?
Comments
As there is no obvious
As there is no obvious uretral obstruction and no azotemia would make stent issues highly unlikley. Pain generally not a feature of stents unless there is obstruction with dilation of the renal pelvis. With being on piroxicam and the presenting clinical signs would consider GI ulceration as highly likley. How long and what anti-ulcer therapy has he been on?
Metatastic disease – bone, joints, lungs is also possible.
ureteral stents are usually
ureteral stents are usually pig tailed in the renal pelvis and then pig tailed again in the trigone after traversing the u pap. If they are causing irritation then usually inflammatory pattern along the ub wall will develop but Ive only seen it once. Inflammation around the tumor may be an issue as well where you will see “fuzzy fat” around the tumor on the sonogram. I don’t see any of this in the still images posted. Otherwise I agree with remo look elsewhere.
Thanks guys. The history I
Thanks guys. The history I had from the owner was several days off of piroxicam. The primary vet had GI ulceration high on the list but this guy has a normal BUN and nothing obvious on ultrasound. His current meds include sucralfate 1 gm- 1/2 tab (in slurry) and omeprazole suspension 2 mg/mL- 2 mL PO SID. I suppose chest rads would be another route to look for metastatic disease but not sure how that translates into GI signs. I suspect that the U probably took chest radiographs prior to placing the ureteral stent but I don’t know that for sure.
Possibly a studpid question
Possibly a studpid question but: is the sulcrafate and ompreazole given at different tome intervals?
Sucralfate should be give
Sucralfate should be give before or after any other medications. I usually give it 1-1 2/ hours before or after any medication or meals.
Anyone concerned about the prostate here?
Thanks Randy. This dog has
Thanks Randy. This dog has TCC and has had a small, mineralized prostate for 1-2 years, so it could be related to the TCC….or not. The clinic in charge of this dog knows their meds well and so I am sure that they gave the owners appropriate instructions.
I can only see the bladder
I can only see the bladder end of the catheter. Have you flushed the device to check for patency, and culture the contents within the tubes?