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In-hospital medical management of feline urethral obstruction: A review of recent clinical research.The Canadian Veterinary Journal = La... Jun 2020Evidence-based medical practice requires that clinical research be conducted to help guide veterinary recommendations. Unfortunately, clinical research on the treatment... (Review)
Review
Evidence-based medical practice requires that clinical research be conducted to help guide veterinary recommendations. Unfortunately, clinical research on the treatment of feline urethral obstruction (UO) is limited. Over the past decade, a body of clinically relevant scientific literature related to the in-hospital management of feline UO has been published. This review of the literature from December 2007 to February 2019 encompasses management options, stabilization, anesthetic considerations, unblocking procedures, urinary bladder lavage, intravesical treatments, post-obstructive diuresis, urinary catheter management, catheter-associated bacterial complications, and oral medications. Studies are briefly summarized with respect to their main findings and limitations. Common recurring limitations observed include small sample sizes leading to insufficient power and potential type II errors, lack of standardized treatment protocols, and assessment of multiple inter-related confounding variables. The authors' intent is for this article to inform practitioners and inspire future clinical research initiatives which address these limitations, possibly with large-scale multicenter studies, standardized treatment protocols, and multivariate regression modeling.
Topics: Animals; Cat Diseases; Cats; Hospitals; Research; Urethral Obstruction; Urinary Bladder; Urinary Catheters
PubMed: 32675811
DOI: No ID Found -
Journal of the American Veterinary... May 2022To determine if prazosin administration decreased the rate of recurrent urethral obstruction (rUO) before hospital discharge and within 14 days.
OBJECTIVE
To determine if prazosin administration decreased the rate of recurrent urethral obstruction (rUO) before hospital discharge and within 14 days.
ANIMALS
388 cats with urethral obstruction.
PROCEDURES
Veterinarians who either always or never prescribed prazosin (generally, 0.5 to 1 mg, PO, q 12 h for 14 days) were recruited to complete observational surveys. Patient data and characteristics of relieving the obstruction, including perception of a gritty feel within urethra or difficulty unobstructing the cat, were recorded. The rate of development of rUO before hospital discharge and by day 14 was compared between cats that received or did not receive prazosin with the Fisher exact test. Other variables were similarly compared between cats with and without rUO.
RESULTS
302 (78%) cats received prazosin, while 86 (22%) did not. There was no association between prazosin administration and risk of rUO prior to discharge, with 34 of 302 (11.3%) cats receiving prazosin and 5 or 86 (5.8%) not receiving prazosin developing rUO. Within 14 days, a significantly higher proportion of prazosin-treated cats (73/302 [24%]) developed an rUO, compared with the proportion of non-prazosin-treated cats (and 11/86 [13%]). The perception of a "gritty feeling urethra" or difficulty of performing the catheterization was associated with increased risk of rUO.
CLINICAL RELEVANCE
Prazosin administration increased the likelihood of rUO by 14 days; ongoing investigation of other therapies to decrease rUO in cats is warranted. Without specific indications, the use of prazosin for the prevention of rUO should be discouraged.
Topics: Animals; Cat Diseases; Cats; Prazosin; Urethra; Urethral Obstruction
PubMed: 35290210
DOI: 10.2460/javma.21.10.0469 -
Journal of Feline Medicine and Surgery Oct 2022The aims of this study were to evaluate serum symmetric dimethylarginine (SDMA) and creatinine concentrations in cats with urethral obstruction pre- and...
OBJECTIVES
The aims of this study were to evaluate serum symmetric dimethylarginine (SDMA) and creatinine concentrations in cats with urethral obstruction pre- and post-decompression of the obstruction, and to determine if pre-decompression values were predictive of post-decompression renal function, as measured by SDMA and creatinine.
METHODS
This was a prospective observational study. Twenty-five client-owned cats with urethral obstruction were hospitalized for decompression of the obstruction. Serum SDMA and creatinine were prospectively assessed at presentation, 24 h post-decompression and 5-20 days post-decompression. Urinalysis and culture were assessed at presentation and at the final follow-up. Exclusion criteria included positive urine culture, reobstruction or failure to obtain required samples.
RESULTS
Mean SDMA concentration dropped by 41.8% from an initial pre-decompression concentration of 17.6 µg/dl to 10.3 µg/dl 24 h post-decompression ( <0.001). The mean creatinine value dropped by 38.4% from an initial pre-decompression concentration of 2.5 mg/dl to 1.5 mg/dl 24 h post-decompression ( <0.001). There was no association between SDMA concentration at initial presentation and SDMA concentration 5-20 days after urethral catheterization (Spearman's ρ = 0.205, = 0.314). Creatinine concentration upon initial presentation was associated with the 5-20 day values after urethral catheterization (Spearman's ρ = 0.583, <0.002). Twenty percent of cases were excluded due to bacterial growth on initial urine culture. SDMA and creatinine concentrations were significantly higher in these cases (median 59 µg/dl and 10.9 mg/dl, respectively) compared with those with negative cultures (median 14 µg/dl and 1.6 mg/dl [ <0.002 and <0.001], respectively).
CONCLUSIONS AND RELEVANCE
Both SDMA and creatinine decreased significantly after urethral catheterization, suggesting that renal function post-decompression cannot be predicted by the pre-decompression concentrations of these values.
Topics: Animals; Arginine; Biomarkers; Cat Diseases; Cats; Creatinine; Renal Insufficiency, Chronic; Urethral Obstruction
PubMed: 34894831
DOI: 10.1177/1098612X211060677 -
Journal of Feline Medicine and Surgery Dec 2022The purpose of this study was to evaluate the correlation between clinical aspects and urethral lesions with reproductive status and age at neutering in obstructed male...
OBJECTIVES
The purpose of this study was to evaluate the correlation between clinical aspects and urethral lesions with reproductive status and age at neutering in obstructed male cats.
METHODS
All cats with compatible signs of urethral obstruction (UO) treated at the Veterinary Hospital of the Federal Rural University of Pernambuco from 2019 to 2021 were divided into three groups according to their reproductive status: intact; prepubertal neutered; and post-pubertal neutered. Cats with compatible signs of UO were selected for further analysis. Age, clinical signs, age at neutering and age of the first obstructive event were documented. Cats with recurrent obstructive urinary signs or urethral trauma that made catheterization impossible were referred for perineal urethrostomy. The morphology of the excised penises was assessed by histopathological analysis.
RESULTS
Of 84 cats with signs of UO included in this study, 28.6% were classified as intact, 28.6% as prepubertal neutered and 42.8% as post-pubertal neutered. Intact cats had a significantly earlier onset of UO compared with prepubertal and post-pubertal neutered cats, as seen by the age at obstruction (3.6 vs 5.7 and 5.5 years, respectively). Similar clinical signs and histopathological lesions were observed in all groups. The main clinical signs observed were stranguria, hematuria and pollakiuria. All cats had some degree of injury in the penile urethra. The most common lesions were hemorrhage, fibrosis and congestion.
CONCLUSIONS AND RELEVANCE
It appears that intact cats had an earlier onset of UO than neutered cats, regardless of age at neutering. Urethral histopathological lesions and clinical signs were similar in both groups. Pediatric neutering represents a useful tool in the control of abandoned and stray animals and the consequent dissemination of zoonoses, thus having a positive impact on public health.
Topics: Animals; Cats; Male; Cat Diseases; Urethral Obstruction; Orchiectomy
PubMed: 36453601
DOI: 10.1177/1098612X221128781 -
World Journal of Urology Nov 2022We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis... (Review)
Review
PURPOSE
We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis by the American Urologic Association (2016), Société Internationale d'Urologie (2010), and European Urologic Association (2022).
METHODS
The AUA, SIU, and EAU guidelines were evaluated for recommendations on the diagnosis, evaluation, and treatment of posterior urethral stenosis. We also included the EAU and AUA urologic trauma guidelines for the trauma-related stenosis. The level or strength of recommendations is included in case of disparity between the guidelines.
RESULTS
The three guidelines align considerably in recommendations provided for the diagnosis, management, and follow-up of patients with posterior urethral stenosis. SIU and EAU emphasize the role of repeat endoscopic treatment in guidelines compared to AUA.
CONCLUSION
The preferred method to repair bulbo-membranous stricture/stenosis following radiation therapy remains an area of active interest, focusing on continence preservation. Additionally, there may be a role for advanced endoscopic treatments with or without adjunct therapies to manage even obliterated stenoses.
Topics: Humans; Male; Urethral Stricture; Urethra; Constriction, Pathologic; Urologic Diseases; Urology; Urologic Surgical Procedures, Male
PubMed: 36018366
DOI: 10.1007/s00345-022-04131-y -
Asian Journal of Andrology 2020For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign... (Review)
Review
For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.
Topics: Humans; Male; Middle Aged; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate; Urethra; Urethral Stricture
PubMed: 31898584
DOI: 10.4103/aja.aja_126_19 -
TheScientificWorldJournal Oct 2009The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality... (Review)
Review
The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy) are the goals for the care of children with posterior urethral valves[1].
Topics: Fetal Diseases; Humans; Male; Prenatal Diagnosis; Prognosis; Urethra; Urethral Obstruction
PubMed: 19838598
DOI: 10.1100/tsw.2009.127 -
Deutsches Arzteblatt International Mar 2013Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious consequences for the entire... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious consequences for the entire urinary tract. Its prevalence among men in industrial countries is estimated at 0.9%. It produces obstructive and irritative urinary symptoms and can ultimately impair renal function. Urethral strictures can be caused by diagnostic or therapeutic urological procedures. These procedures are being performed ever more commonly, because the population is aging; thus, urethral strictures will probably become more common as well.
METHODS
We selectively reviewed pertinent original articles and meta-analyses (1995-2012) on the causes, diagnostic evaluation, and treatment of urethral strictures, which were retrieved by a search in the PubMed database.
RESULTS
Most of the relevant publications are reports of retrospective studies from single centers. Only a few prospective randomized trials and structured reviews are available. The overall level of the scientific evidence is low. 45% of urethral strictures are iatrogenic, 30% idiopathic, and 20% due to bacterial urethritis. Strictures are diagnosed with a flow test and a retrograde urethrogram. Short bulbar strictures can be treated endoscopically. For recurrent and complex strictures, only open urethral surgery can reliably and permanently remove the infravesical obstruction.
CONCLUSION
Urethral strictures must be recognized and treated so that their most serious long-term complication, impaired renal function, can be prevented. The clinical utility of urethrotomy is limited by a high recurrence rate.
Topics: Causality; Comorbidity; Endoscopy; Humans; Internationality; Kidney Diseases; Male; Prevalence; Risk Assessment; Urethral Stricture; Urethritis; Urinary Diversion
PubMed: 23596502
DOI: 10.3238/arztebl.2013.0220 -
Journal of Feline Medicine and Surgery Dec 2023Feline idiopathic cystitis (FIC) and urethral obstruction (UO) are commonly linked to increased stress. The influence of human movement restrictions on their incidence...
OBJECTIVES
Feline idiopathic cystitis (FIC) and urethral obstruction (UO) are commonly linked to increased stress. The influence of human movement restrictions on their incidence remains undetermined. FIC with or without UO is associated with environmental stress factors. The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic restricted human movement and working behaviours. It is unknown if these restrictions increased the risk of FIC or UO in cats.
METHODS
Total cat emergency accessions and transfers between 8 February 2019 and 8 February 2021 at two private hospitals were retrospectively reviewed. Cats were included in the FIC group if they presented with lower urinary tract signs and supporting urinalysis, and were included in the UO group if they presented with UO. Cats with current urinary tract infection, or previous FIC or UO, were excluded. Groups were considered 'pre-COVID-19' between February 2019 and 2020 and 'COVID-19' between February 2020 and 2021. Cases of FIC and UO were compared between COVID-19 and pre-COVID-19 using Fisher's exact test and relative risk (RR) calculations.
RESULTS
The pre-COVID-19 incidence of FIC was 4.3% (63/1477, 95% confidence interval [CI] 0.0332-0.053), non-obstructive FIC was 1.4% (20/1477, 95% CI 0.008-0.020) and UO was 2.9% (43/1477, 95% CI 0.020-0.038). One cat was excluded as obstruction occurred during hospitalisation. The COVID-19 incidence of FIC was 5.4% (113/2081, 95% CI 0.044-0.64), non-obstructive FIC was 2.1% (70/2081, 95% CI 0.014-0.027) and UO was 3.4% (70/2081, 95% CI 0.026-0.042). The risk of non-obstructive FIC ( = 0.122; RR 0.652, 95% CI 0.387-1.096), UO ( = 0.382; RR 0.839, 95% CI 0.577-1.22) or either ( = 0.098; RR 0.773, 95% CI 0.572-1.044) was not significantly higher in the COVID-19 period than the pre-COVID-19 period.
CONCLUSIONS AND RELEVANCE
No clear association between COVID-19 movement restrictions and the incidence of UO or non-obstructive FIC was found within this retrospective population.
Topics: Humans; Cats; Animals; Retrospective Studies; Queensland; Incidence; COVID-19; Urologic Diseases; Australia; Cystitis; Urethral Obstruction; Cat Diseases
PubMed: 38095946
DOI: 10.1177/1098612X231214931 -
The Canadian Journal of Urology Oct 2015Elderly men with multiple comorbidities may be unfit to undergo surgical management of benign prostatic obstruction (BPO). Permanent and temporary prostatic stents have... (Review)
Review
INTRODUCTION
Elderly men with multiple comorbidities may be unfit to undergo surgical management of benign prostatic obstruction (BPO). Permanent and temporary prostatic stents have been developed as an alternative to chronic indwelling catheters in men unfit for surgery.
MATERIALS AND METHODS
Herein we review the past and present literature on the role and effectiveness of prostatic stents in the treatment of BPO.
RESULTS
Permanent prostatic stents have largely been abandoned in North America due to unfavorable outcomes and improved technologies to allow for treatment of BPO. Currently, the temporary Spanner stent is the only available stent on the market, but its effectiveness has mostly been documented for temporary relief of tissue edema following minimal invasive ablative treatments for BPO.
CONCLUSIONS
The advent of well-tolerated surgical treatments for BPO (KTP laser vaporization, bipolar TURP, urethral lift devices) has diminished the need for permanent prostatic stents. The temporary Spanner stent is an alternative to urethral catheter, but requires adequate detrusor function and can cause irritative symptoms.
Topics: Aged; Aged, 80 and over; Follow-Up Studies; Frail Elderly; Humans; Male; Prostatic Hyperplasia; Prosthesis Design; Prosthesis Failure; Prosthesis Implantation; Risk Assessment; Stents; Treatment Outcome; Urethral Obstruction; Urinary Catheterization
PubMed: 26497347
DOI: No ID Found