Rigid endoscopy: urethrocystoscopy and vaginoscopy

image of Rigid endoscopy: urethrocystoscopy and vaginoscopy
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Examination of the lower urinary tract and reproductive tract is a core part of the diagnosis of various medical and surgical disorders of small animals. Historically, radiographic examinations were almost the sole way to investigate structural abnormalities, but more recently both ultrasonography and endoscopy have become essential additional modalities for diagnosis. Anatomical considerations limit the application of urethroscopy in male animals, especially the cat, but in females the entire urethra and the bladder are readily accessible to endoscopic evaluation. In the male, examination of the urethra may be possible in some dogs, using highly specialized equipment; the bladder of male dogs and cats is accessible via a transabdominal approach (laparoscopic or laparoscopically assisted cystoscopy). Interventional procedures in the lower urinary tract are still limited in application, but urolith removal and ablation, tissue biopsy, injection of bulking agents into the urethral wall, and palliation of urethral neoplasia have been reported. This chapter covers Anatomical considerations; Indications; Preoperative diagnostic work-up; Intraoperative diagnostic work-up (under general anaesthesia); Urethrocystoscopy; Transabdominal cystoscopy; Laparoscopic-assisted cystomy tube placement; Vaginoscopy in the bitch; Pathological conditions; Assessment of breeding time in the bitch; Cervical catheterization; Postoperative care; and Complications.

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10.1 Schematic representation of the caudalurogenital tract of the bitch.
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10.2 Dorsal vaginal fold. (Courtesy of P Lhermette)
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10.3 Endoscopic appearance of normal urethra. (Courtesy of P Lhermette)
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10.4 Endoscopic appearance of a normal bladder wall. (Courtesy of P Lhermette)
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10.5 Normal feline vestibule with vaginal os above urethral opening. (Courtesy of P Lhermette)
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10.6 Normal ureteral openings in the dog. In (b) urine can be seen discharging into the bladder. (Courtesy of P Lhermette)
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10.7 Endoscopic appearance of taking a tissue biopsy from a mass in the proximal urethra. (Courtesy of P Lhermette)
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10.8 Canine urethra following laser ablation of transitional cell carcinoma. Note the 8 Fr urinary catheter in the lumen. (Courtesy of P Lhermette)
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10.9 Urethrocystoscope with built-in catheter deflecting device in operation, suitable for cervical catheterization in the bitch.
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10.10 Normal anatomy of the vulva of the bitch. The endoscope should not be inserted into the clitoral fossa (black arrow) but should be directed above the transverse frenular fold into the vestibular opening (white arrow).
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10.11 Schematic representation of the direction of endoscope insertion into the caudal reproductive tract of the bitch. Correct angle of insertion of the endoscope into the vestibule.
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10.12 Endoscopic appearance of the caudal vagina of a bitch in anoestrus. The mucosa is relatively dry and red, with small folds.
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10.13 Schematic representation of the differentiation of the dorsal median fold into three distinct tubercles. This is normally evident when examinations are conducted during oestrus.
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10.14 Endoscopic appearance of the mid-vagina of a bitch in late pro-oestrus/early oestrus. The mucosa is oedematous and relatively thickened and has an obvious white colour. The mucosa is arranged in larger rounded folds than in the non-oestrous bitch.
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10.15 Endoscopic appearance of the mid-vagina of a bitch on days 3 and 5 after ovulation. The mucosa remains thick but there is extensive wrinkling and angulation of the mucosal fold profiles compared with early oestrus.
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10.16 Early and severe transitional cell carcinoma in the canine urethra. (Courtesy of P Lhermette)
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10.17 Endoscopic appearance of an ectopic ureter. (Courtesy of P Lhermette)
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10.18 Endoscopic appearance of feline idiopathic interstitial cystitis. (Courtesy of T McCarthy) Endoscopic appearance of moderate to severe cystitis. (Courtesy of P Lhermette)
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10.19 Polypoid cystitis in the dog. (Courtesy of P Lhermette)
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10.20 Endoscopic appearance of transitional cell carcinoma in the trigone and proximal urethra and transitional cell carcinoma in the bladder wall. (Courtesy of P Lhermette)
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10.21 Endoscopic appearance of uroliths. The round structure at the top left of the image is the inflated bulb of a Foley catheter. (Courtesy of P Lhermette)
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10.22 Endoscopic appearance of a paramesonephric remnant. Note multiple nodules due to lymphoid hyperplasia. (Courtesy of P Lhermette)
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10.24 Vaginoscopic appearance from late anoestrus through pro-oestrus and oestrus and into the early luteal phase. See text for explanation.
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10.25 Relation between vaginoscopic score, time of ovulation, fertile and fertilization periods, and plasma progesterone concentrations in bitches.
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