1.  Veterinary Specialists of South Florida presents

2. “Kado”  Signalment  1.5Y MC Akita (47kg)  Presenting Complaint  Malaise, vomiting, anorexia x 2d  History  Cryptorchid castration at St. Elsewhere 2d ago  Has not urinated since surgery

3. “Kado”  Physical Examination Abnormalities  Depressed  7% dehydrated  Distended abdomen, palpable fluid wave  Quarter-sized lump with SQ edema in R inguinal region  Swollen erythematous scrotum

4. “Kado”  Diagnostics  Bloodwork  Sodium 127  Potassium 7.5  BUN 120  Creatinine 12  PCV 48%  Peritoneal effusion: serosanguineous  Creatinine 26.3  Sodium 127  Potassium 12.5

5. “Kado”

9. “Kado”  Surgery  Ruptured bladder (necrosis of bladder neck)  Ligated urethra  Prostatectomy  Retained right cryptorchid testicle  Dilation of the left ureter  Hydronephrosis of the left kidney  3L abdominal effusion  Approx 5cm proximal urethra missing  Severe soft tissue necrosis

10. “Kado”

11. “Kado”

15. “Kado”  Treatment Options  1) Left nephrectomy, cryptorchid castration, permanent cystostomy tube placement  2) Euthanasia

16. Uroabdomen  AKA uroperitoneum  The accumulation of urine within the peritoneum and or retroperitoneal spaces caused by leakage from the kidneys, ureters, bladder, or proximal urethra

17. Uroabdomen  Causes  Obstruction (uroliths, neoplasia)  Iatrogenic (catheterization, palpation, surgical)  Trauma (HBC, pelvic Fx, penetrating wound)  Clinical presentation  Lethargy, Anorexia, Vomiting, Discomfort

18. Uroabdomen  PE findings  Dehydration  Abdominal pain  Bladder palpable or not palpable  Bruising (perineum, ventral abdomen, inguinal)  Bradycardia (from hyperkalemia)

19. Uroabdomen  Etiology/Pathophysiology  Translocation of soluted (urea, creatinine, potassium, hydrogen) across the peritoneal lining into the ECF and systemic circulation  Post renal azotemia  Metabolic acidosis  Hyperkalemia  Chemical peritonitis

20. Uroabdomen  Definitive diagnosis  Contrast radiography  Cystourethrography or excretory urography  Abdominal paracentesis  Increased creatinine and potassium compared to serum

21. Uroabdomen  Treatment  1) Correct dehydration/shock (0.9% NaCl at first)  2) Treat hyperkalemia if severe (>7-8 or cardiac signs)  Insulin 0.5U/kg IV, dextrose 50% 4ml/U IV, calcium gluconate 10% 1ml/kg IV, bicarb 1-2mEq/kg IV  3) Remove urine (peritoneal drainage, urethral catheter)  4) Pain management (opioids)  5) Correct/eliminate leakage (surgery)

22. Uroabdomen  Prognosis  Good, provided the following are achieved:  early diagnosis  aggressive management  definitive repair

23. References  Romagnoli SE. Canine Cryptorchidism. Vet Clin North Am Small Anim Pract. 1991 May;21(3):533-544. Review.  Schulz KS, Waldron DR, Smith MM, Henderson RA, Howe LM. Inadvertant Prostatectomy as a Complication of Cryptorchidectomy in Four Dogs. J Am Anim Hosp Assoc. 1996 May-Jun;32(3):211-4.  Rieser TM. Urinary Tract Emergencies. Vet Clin North Am Small Anim Pract. 2005 Mar;35(2):359-373.  Boysen SR, Rozanski EA, Tidwell AS, Holm JL, Shaw SP, Rush JE. Evaluation of focused assessment with sonography for trauma protocol to detect free abdominal fluid in dogs involved in motor vehicle accidents. J Am Vet Med Assoc. 2004 Oct 15;225(8):1198-204.

24.  We would like to thank you for your continued support and referrals.