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Cystoscopy

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Abstract

The principle form of endoscopy for the urinary tract in veterinary medicine is transurethral cystoscopy. It is an integral part of the diagnostic evaluation of dogs and cats with recurrent or persistent lower urinary tract disease. This chapter covers equipment, diagnostic techniques, therapeutic techniques, and risks and complications of cystoscopy.

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Figures

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8.2 The tips of rigid and flexible cystoscopes used for cystoscopy. From left to right: 4 mm rigid cystoscope within 19 Fr cystoscopy sheath (5 Fr cup biopsy instrument in working channel); 2.7 mm diameter rigid cystoscope with 14.5 Fr sheath; 1.9 mm diameter cystoscope with 9 Fr sheath; and 2.8 mm diameter flexible ureteroscope with stone basket in the working channel.
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8.3 Appearance of the bladder mucosa in a bitch with calcium oxalate uroliths (uroliths not visible). Note the visibility of the large and small blood vessels in the submucosa of the bladder wall in the normal portion of the urinary bladder (*). In contrast, the vessels are less visible in the cranioventral portion of the urinary bladder owing to oedema and mucosal thickening (arrowed) in response to the uroliths. Three air bubbles are also visible on the left side of the image.
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8.4 Cystoscopic view of normal ureteral openings (arrowed) in a bitch placed in dorsal recumbency with minimal bladder distention.
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8.5 Calcium oxalate uroliths in the urinary bladder with multiple smaller uroliths. A 550 μm diameter flexible quartz laser fibre is positioned near the surface of the urolith (see Chapter 27).
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8.6 Variable appearance of transitional cell carcinoma (TCC) in dogs. (a) Large haemorrhagic and partially necrotic mass in the urinary bladder. (b) Papillary structure of TCC. Note the blood vessel extending to the tip of the papillary structure, which is highly suggestive of TCC. (c) Multiple discrete masses in the urethra of a bitch with urethral TCC. Also note that the entire surface of the urethral mucosa is irregular. (d) Urethral TCC resulting in complete urethral obstruction in a bitch.
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8.7 Polypoid cystitis in a dog. (a) Polypoid cystitis in the apex of the urinary bladder of a dog. (b) Basket biopsy of polyps from a dog with polypoid cystitis.
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8.8 Proliferative urethritis in a bitch with recurrent urinary tract infection and urinary obstruction. Note the side-to-side bands of tissue, which are more commonly observed with proliferative urethritis than with neoplasia.
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8.9 Bilateral ectopic ureters in a bitch. (a) The right ureteral opening (arrowhead) is located in the proximal urethra just distal to the junction with the urinary bladder. The left ureteral opening is visible in the dorsal aspect of the mid-urethra (black arrow). (b) A urological guide wire is passed through an open-ended ureteral catheter proximally into the left ectopic ureter.
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8.10 Gross haemorrhagic urine from the left ureteral orifice in a bitch with unilateral idiopathic renal haematuria.
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8.11 Urolith trapped in stone basket and positioned near the end of the cystoscope prior to removal. Note additional uroliths adjacent to stone basket.
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8.12 Urethral stricture in a queen. (a) Note the marked reduction in urethral diameter and firm white appearance of the urethral stricture. (b) Guide wire (0.025 inch diameter) passed through the stricture. (c) Initial stage of balloon dilation of the urethral stricture using a clear balloon catheter passed parallel to the cystoscope over the 0.64 mm guide wire. (d) Complete balloon dilation of the urethral stricture.

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