Retrograde Cystography in the Canine Patient Jaci Christensen, LVT Tarleton State University Jaci Christensen, LVT Tarleton State University

“Lucy”- referred for possible bladder mass  Lucy is an 8 year old Scottish Terrier  History of hematuria and dysuria for approximately 3 months  Referring veterinarian had been treating with Baytril for a suspected UTI  When no improvement, an ultrasound was performed and a mass was seen at the apex of the bladder  Veterinarian made a referral for further work-up and treatment options  Lucy is an 8 year old Scottish Terrier  History of hematuria and dysuria for approximately 3 months  Referring veterinarian had been treating with Baytril for a suspected UTI  When no improvement, an ultrasound was performed and a mass was seen at the apex of the bladder  Veterinarian made a referral for further work-up and treatment options

Physical Exam  Weight kg  Temp *F  Heart Rate- 130 bpm  Resp Rate- 40 bpm  Mucous Membranes- Pink/Moist  CRT- <3 seconds  Heart/Lungs normal on auscultation  Weight kg  Temp *F  Heart Rate- 130 bpm  Resp Rate- 40 bpm  Mucous Membranes- Pink/Moist  CRT- <3 seconds  Heart/Lungs normal on auscultation  On abdominal palpation, patient is tense and painful.  No abnormalities on rectal palpation  Patient postured to urinate several times during physical exam

Preliminary Diagnostics  CBC- all values within normal limits  Chemistry Panel- BUN 54 (Range: 5-29), Creatinine 2.05 (Range: 0.3-2), all else within normal limits  Urinalysis- Blood: large amount, Protein: 3+, Bacteria: small amount  A retrograde cystography was recommended for further evaluation of the bladder mass seen on ultrasound images  CBC- all values within normal limits  Chemistry Panel- BUN 54 (Range: 5-29), Creatinine 2.05 (Range: 0.3-2), all else within normal limits  Urinalysis- Blood: large amount, Protein: 3+, Bacteria: small amount  A retrograde cystography was recommended for further evaluation of the bladder mass seen on ultrasound images

Retrograde Cystography A retrograde cystography occurs when contrast media is infused into the bladder via a urinary catheter. The bladder can then be evaluated using radiographs. Normal Canine Bladder A retrograde cystogram may be indicated in the following situations: Abnormal Urine Abnormal Urinary Habits Trauma Suspected Neoplasia

Procedure  Lucy was fasted for 24 hours prior to the cystogram to avoid the superimposition of fecal matter  Lucy was sedated with 0.3 mg/kg butorphanol and a propofol CRI for urinary catheter placement  A urinary catheter was placed using a sterile technique and the bladder was drained  Positive contrast media (75 mls) was infused slowly into the bladder  Radiographs were performed  Lucy was fasted for 24 hours prior to the cystogram to avoid the superimposition of fecal matter  Lucy was sedated with 0.3 mg/kg butorphanol and a propofol CRI for urinary catheter placement  A urinary catheter was placed using a sterile technique and the bladder was drained  Positive contrast media (75 mls) was infused slowly into the bladder  Radiographs were performed

Results Lack of contrast uptake confirmed the diagnosis of a bladder mass and assisted in evaluating the size and location of the tumor.

Contrast Studies  Contrast studies of the urinary system may evaluate the kidneys, bladder, ureters, prostate, or urethra. The method of evaluating the urinary system will vary based on the clinical signs of the animal and the treating veterinarian. Contrast used may be positive, negative, or double-contrast. Positive ContrastNegative ContrastDouble Contrast

Conclusion  Lucy’s bladder mass was sampled using a traumatic catheter and she was diagnosed with transitional cell carcinoma  Lucy received 8 treatments of vinblastine chemotherapy, followed by laser ablation  Lucy had a partial response to treatment and remained sub-clinical for 7 months, at which point humane euthanasia was elected.  Lucy’s bladder mass was sampled using a traumatic catheter and she was diagnosed with transitional cell carcinoma  Lucy received 8 treatments of vinblastine chemotherapy, followed by laser ablation  Lucy had a partial response to treatment and remained sub-clinical for 7 months, at which point humane euthanasia was elected.

References Brown, M., & Brown, L. (2014). Radiography for Veterinary Technicians, Fifth Edition. St. Louis: Elsevier.