Treatment of a Urethral Duplication in a Dog Using Cyanoacrylate and Coil Embolization

A 3-year-old male castrated golden retriever was presented to the University of California-Davis Veterinary Medical Teaching Hospital (UCD VMTH) for evaluation of urinary incontinence. The dog had a history of urinary incontinence since 6 weeks of age; however, the incontinence had worsened during the 3 months before initial presentation to the UCD VMTH. The owners reported that the dog was able to urinate normally, with no urine stream alteration, straining or hematuria. The dog was treated with phenylpropanolamine (dose unknown) 1 year before presentation to the UCD VMTH, but this had been discontinued 3 months before his evaluation. His owners reported no other abnormal medical history, trauma or surgeries, other than a routine castration that was performed when the dog was approximately 24 months of age. On initial evaluation at the UCD VMTH, the dog was bright, alert, and responsive with normal vital parameters (temperature 101.8°F [reference range: 100.5–102.5°F]). His heart rate was 140 beats/min, and he was panting. Body weight was 40.4 kg, and he was noted to have a body condition score of 6 (on a scale of 9). On initial physical examination, his abdomen was soft and nonpainful, and his external genitalia appeared within normal limits. Rectal examination demonstrated that the palpable urethra was smooth and symmetrical and no stones or masses were palpate. The prostate was not palpable and no abnormalities were noted in other body systems. CBC and biochemistry were within normal limits. Urine had a specific gravity of 1.037, a pH of 7, 8–12 white blood cells/hpf (reference range: 0–2 white blood cells/hpf) and clusters of cocci. The urine culture yielded Staphylococcus pseudointermedius (beta-lactamase negative) and Staphylococcus intermedius. Both bacteria were sensitive to all antibiotics evaluated except that the Staphylococcus intermedius was resistant to penicillin. An abdominal ultrasound was performed and was within normal limits. Abdominal ultrasound revealed a normal urinary tract, however, only the right ureterovesicular junction was identified. While abdominal ultrasound did not reveal any abnormalities, the lifelong presence of urinary incontinence was still suggestive of a possible congenital urinary tract abnormality, and cystourethroscopy and contrast cystourethrogram were recommended. The dog was premedicated with atropine (0.03 mg/kg SC) and morphine (0.7 mg/kg SC). Anesthetic induction was performed with ketamine (3.2 mg/kg IV) and midazolam (0.25 mg/kg IV) through a cephalic vein catheter. Anesthesia was maintained with isoflurane in oxygen. The dog was placed in right lateral recumbency on a table in the fluoroscopic suite. The prepuce was clipped, prepared with sterile technique and draped. A 7.5-Fr, 67.5-cm working length, 270° deflection flexible urethroscope was introduced into the urethra. The urethroscope was passed into the urinary bladder and a complete evaluation of the urinary bladder, ureteral openings, and urethra was performed; no abnormalities were seen, and the ureteral openings were noted to be in the correct location. An 8-Fr red rubber catheter was then introduced into the urethra. The urinary bladder was filled with a 50%/50% combination of iodinated contrast and saline to ensure that the bladder was full, but not overly turgid. When the bladder was full, a retrograde contrast cystourethrogram was performed by slowly removing the urinary catheter while a continuous injection of the contrast : saline mixture was performed. The cystourethrogram revealed a tubular structure extending from the prostatic urethra and ending into a blind pouch at the level of the distal prepuce (Fig 1); a congenital urethral duplication was diagnosed as an accessory urethra was found to originate dorsally and to the left of the normal urethra. The prepuce was palpated at this point, and a soft swelling was noted that had not been previously appreciated during physical examination. From the School of Veterinary Medicine, University of California-Davis, Davis, CA (Palm, Culp); and the Sutter Health, Sacramento, CA (Glaiberman). Work completed at the University of California-Davis, Veterinary Medical Teaching Hospital. The study was not supported by a grant. This study has not been presented in abstract form. Corresponding author: Carrie Palm, DVM, DACVIM, University of California-Davis, School of Veterinary Medicine, One Garrod Drive, Davis, CA 95616; e-mail: [email protected] Submitted November 14, 2014; Revised January 6, 2015; Accepted February 4, 2015. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. DOI: 10.1111/jvim.12571 Abbreviation: