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Rigid endoscopy: urethrocystoscopy and vaginoscopy

image of Rigid endoscopy: urethrocystoscopy and vaginoscopy
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Abstract

Endoscopic examination of the lower urinary tract and reproductive tract is an important part of the diagnostic evaluation and treatment of a number of disorders in dogs and cats. This chapter describes instrumentation, clinical history and examination, preoperative diagnostic investigations, intraoperative diagnostic imaging, pathological conditions, approaches to male and female animals, operative techniques, reproductive procedures, cervical catheterization, postoperative care and complications. The chapter also contains two video clips.

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Figures

Image of 11.1
11.1 Artist’s rendition of the view through a telescope with a 30-degree viewing angle by rotating the endoscope along its longitudinal access, keeping the camera head fixed and rotating, using the light guide cable. (Drawing by Tim Vojt. Reproduced with the permission of The Ohio State University)
Image of 11.2
11.2 Two commonly used rigid cystoscopes with telescope and accompanying sheath. The upper scope is a 4.0 mm diameter x 30 cm telescope with a separate sheath and bridge (shown assembled), and the lower one is a 2.7 mm x 18 cm telescope with an integrated sheath and bridge. (Reproduced with the permission of The Ohio State University)
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11.3 An assembled 4.0 mm x 30 cm cystoscope with compatible grasping and biopsy forceps. (Reproduced with the permission of The Ohio State University)
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11.6 Laparoscopic-assisted cytoscopic view of uroliths. The round structure at the top left of the image is the inflated bulb of a Foley catheter. (Courtesy of P Lhermette)
Image of 11.7
11.7 Extramural ectopic ureter. Computed tomographic excretory urogram of a 10-month-old male neutered Domestic Shorthaired cat with a chronic history of urinary incontinence. The transverse image shows the bladder and the entry of the left ureter (arrowhead) laterally into the urethra (arrowed) distal to the neck of the bladder. (Reproduced with the permission of The Ohio State University)
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11.8 Endoscopic appearance of a paramesonephric remnant. Note the presence of multiple nodules due to lymphoid hyperplasia. (Courtesy of P Lhermette)
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11.9 (a) Urethral stricture in a 5.5-year-old male entire English Bulldog with a 3-day history of straining to urinate. Note the urethroliths trapped proximal to the stricture. (b) Partially imperforate perineal urethra in a 1-year-old male entire English Springer Spaniel with a history of difficulty urinating since weaning. (Reproduced with the permission of The Ohio State University)
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11.10 Left distal opening of an ectopic ureter in a 5-month-old female entire Golden Retriever. The dog had a history of urinary incontinence noticed soon after birth. A = The vaginal os partially occluded by a paramesonephric septal remnant. B = The urethra. C = The ectopic ureter. (Reproduced with the permission of The Ohio State University)
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11.11 Inflammatory ‘fried egg’ lesions in the bladder of a 5-year-old female entire Golden Retriever with urinary incontinence and recurrent urinary tract infections. (Reproduced with the permission of The Ohio State University)
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11.12 Polypoid cystitis in a 1-year-old male entire English Springer Spaniel (same dog as in Figure 11.9b ). This dog had urolithiasis and a partially imperforate urethra. (Reproduced with the permission of The Ohio State University)
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11.13 (a) Urethrolith in the penile urethra of a 2.5-year-old male entire Rottweiler with a history of urethral obstruction. The urolith is lodged at the base of the os penis. (b) Further uroliths in the bladder of the same dog. These were determined by analysis to be cysteine uroliths. (Reproduced with the permission of The Ohio State University)
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11.14 Transitional cell carcinoma extending into the vaginal vestibule from the urethra in a 10-year-old female neutered Dachshund with a 4-month history of straining to urinate. (Reproduced with the permission of The Ohio State University)
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11.15 Proliferative urethritis in a 7-year-old female neutered mixed-breed dog with a 2-week history of straining to urinate. A biopsy taken at the time of cystoscopy confirmed that the lesion was inflammatory and not neoplastic. (Reproduced with the permission of The Ohio State University)
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11.16 Mesonephric remnant in a 5-month-old female entire English Bulldog with a history of urinary incontinence. This dog was diagnosed with bilateral ectopic ureters. Note the lymphoid follicles in the vestibule. (Reproduced with the permission of The Ohio State University)
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11.17 Normal ureters in a 3-year-old female neutered mixed-breed dog. Note the pulsatile flow of urine from the right ureter. (Reproduced with the permission of The Ohio State University)
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11.18 Laser lithotripsy of calcium oxalate cystoliths in a 7-year-old female neutered Shih Tzu. (a) The tip of the laser fibre is positioned in a crevice in the urolith. (b) As the laser is fired, the fluid at the tip of the fibre is superheated and vaporizes, producing a shockwave that shatters the urolith. (Reproduced with the permission of The Ohio State University)
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11.19 Laser ablation of an ectopic ureter in a 7-month-old female neutered Soft Coated Wheaten Terrier. (a) The ureteral catheter is shown in place and the tip of the laser fibre is positioned at the leading edge of the medial ureteral wall. (b) As the laser is fired, it cuts along the medial ureteral wall, moving the terminal ureteral opening proximally. (Reproduced with the permission of The Ohio State University)
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11.21 Diagrams showing the vaginoscopic appearance in the bitch from late anoestrus through pro-oestrus and oestrus and into the early luteal phase. The diagrams should be read from left to right and line by line. The top left panel represents low and flattened mucosal folds typical of the inactive phase (I) of anoestrus. As pro-oestrus commences and the bitch progresses into early oestrus, oestrogen concentrations are increased, which causes a rounded swelling of the mucosa that protrudes into the lumen (oedematous phase; O). As the cycle progresses, oestrogen concentrations decline and the profiles, which are still rounded, develop small wrinkles that gradually increase in appearance; this is the progressive shrinkage phase (S1–2) which occurs before ovulation. At the time of ovulation, oestrogen is low and progesterone has started to increase, and this results in an initial distinct shrinkage and angulation of the mucosal folds (A1); these angulation changes progress throughout the fertilization period (A2–3). Relatively high progesterone concentrations at the end of the fertilization period result in a flaccid appearance to the mucosa, which progressively becomes more flattened (decline phases; D1–4), until the mucosa returns to a similar appearance seen in anoestrus (I).
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11.22 Relationship between vaginoscopic score, time of ovulation, fertile and fertilization periods, and plasma progesterone concentrations in bitches.
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11.23 Rupture of the urethra in a 2-year-old neutered female Welsh Corgi during laser ablation of ectopic ureters. Note the fibrous bands as the tissue separates. The dog was managed with a urinary catheter for 2 days and recovered uneventfully.

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Normal urethrocystoscopy of the neutered bitch.

Normal urethrocystoscopy of the neutered bitch. (Reproduced with the permission of The Ohio State University)

Normal urethrocystoscopy of the neutered male dog.

Normal urethrocystoscopy of the neutered male dog. (Reproduced with the permission of The Ohio State University)

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