RETROGRADE CYSTOGRAPHY

MICHELLE PHAM, LVT

TARLETON STATE UNIVERSITY
 WINSTON

7 YEAR OLD MN DACHSHUND MIX

HISTORY OF INAPPROPRIATE URINATING WITH INTERMITTENT DYSURIA AND
HEMATURIA OVER THE LAST SEVERAL MONTHS
RDVM HAS TREATED FOR UTI WITH SEVERAL ROUNDS OF ANTIBIOTICS
UPON THIRD EVALUATION OF URINALYSIS THERE IS A LARGE AMOUNT OF
TRANSITIONAL CELLS NOTED
RADIOGRAPHS AND ULTRASOUND ARE PERFORMED
RDVM DIAGNOSIS A MASS IN THE BLADDER
WINSTON IS REFERRED FOR A RETROGRADE CYSTOGRAPHY
 PHYSICAL EXAM

WEIGHT: 7.5 KG CARDIOVASCULAR: 132 BPM, NO MURMURS

GENERAL APPEARANCE: NORMAL GASTROINTESTINAL: PAINFUL UPON
PALPATION
TEMPERATURE: 101.5
SKIN/COAT: NORMAL RESPIRATORY: 28 RPM

EYES/FUNDIC EXAM: NORMAL NERVOUS SYSTEM: NORMAL

LYMPH NODES: NO PALPABLE
EARS/OTOSCOPIC EXAM: NORMAL
LYMPHADENOPATHY
ORAL CAVITY: NORMAL
 DIAGNOSTICS

URINALYSIS: REVEALS RBC/HPF 3+, WBC/HPF 3+, SPG 1.020, PH 7.5,

CBC AND COMPREHENSIVE PANEL REVEALS NO ABNORMALITIES
ABDOMINAL RADIOGRAPHS REVEAL MASS IN THE BLADDER
RADIOGRAPHS OF THORAX ARE TAKEN TO RULE OUT METASTASES
RETROGRADE CYSTOGRAPHY IS ORDERED TO EVALUATE MASS WITHIN BLADDER
 RETROGRADE CYSTOGRAPHY

CYSTOGRAPHY IS THE STUDY OF THE BLADDER VIA THE RETROGRADE INFUSION OF CONTRAST
MEDIA THROUGH A URINARY CATHETER (BROWN & BROWN, 2014)
PRECAUTIONS
IATROGENIC TRAUMA OR BACTERIAL INFECTIONS
ALTHOUGH RARE A GAS EMBOLISM CAN OCCUR AFTER ADMINISTRATION OF NEGATIVE
CONTRAST MEDIA
 DOUBLE CONTRAST RETROGRADE CYSTOGRAPHY

CONTRAST MEDIA AND DOSAGE EQUIPMENT/SUPPLIES

WATER SOLUBLE ORGANIC IODIDE DILUTED STERILE URINARY CATHETER
TO 150-200 MG OF IODINE/ML
STERILE LUBRICATING JELLY
DOGS LESS THAN 10 KG: 1-3 ML LIGHT SOURCE
20 TO 50 ML SYRINGE
NEVER USE BARIUM FOR ANY URINARY
2% LIDOCAINE JELLY
STUDIES INCLUDING CYSTOGRAPHY
THREE WAY STOP COCK
 DOUBLE CONTRAST RETROGRADE CYSTOGRAPHY

PATIENT PREPARATION
VENTRODORSAL AND RIGHT LATERAL SURVEY RADIOGRAPHS
SEDATION IS OFTEN USED AS DISTENTION OF BLADDER CAN BE UNCOMFORTABLE
WINSTON WAS NPO FOR 24 HOURS AND ADMINISTERED AN ENEMA 4 HOURS PRIOR TO
PROCEDURE TO INSURE AN OBSTRUCTED VIEW OF THE BLADDER
COLLECT ALL URINE SAMPLES PRIOR TO INFUSION OF CONTRAST MEDIA TO AVOID
INCREASING SPECIFIC GRAVITY, CREATING FALSE POSITIVE INCREASE OF PROTEIN AND
INHIBITION OF BACTERIAL GROWTH
 DOUBLE CONTRAST RETROGRADE CYSTOGRAPHY

ONCE WINSTON WAS SEDATED THE RDVM APPLIED 2% LIDOCAINE JELLY TO TIP OF URETHRAL
CATHETER AND ASEPTICALLY AND ATRAUMATICALLY INSERT UNTIL CATHETER TIP WITHIN THE
URINARY BLADDER
URINE WAS REMOVED FROM THE BLADDER AND NEGATIVE CONTRAST MEDIA IS INFUSED INTO THE
BLADDER VIA A THREE WAY STOP COCK, RIGHT & LEFT LATERAL, & VENTRODORSAL RADIOGRAPHS
ARE TAKEN
DOUBLE CONTRAST MEDIA WAS INFUSED INTO THE BLADDER AND WINSTON IS ROTATED FROM
SIDE TO SIDE TO COAT THE BLADDER, REPEAT RADIOGRAPHS WERE TAKEN
ONCE COMPLETED THE CONTRAST MEDIA IS REMOVED AND THE BLADDER WAS FLUSHED WITH
BROAD SPECTRUM ANTIBIOTICS AS A PRECAUTION
Negative Contrast Double Contrast
 DIAGNOSIS

CYTOLOGIC EVALUATION PERFORMED FROM THE TIP OF URINARY CATHETER

WINSTON WAS DIAGNOSED WITH TRANSITIONAL CELL CARCINOMA
 TREATMENT OPTIONS

SURGICAL EXCISION
RADIATION THERAPY.
CAN LEAD TO HARMFUL COMPLICATIONS

MEDICAL MANAGEMENT
CHEMOTHERAPY
 CONCLUSION

THE OWNER WEIGHED ALL THEIR OPTIONS AND ELECTED TO HAVE SURGERY AND MEDICAL
MANAGEMENT TO HAVE MORE TIME WITH HIM
8 MONTHS AFTER SURGERY WINSTON BECOMES INCREASINGLY SICK AND THE OWNERS
ELECT TO HAVE HIM HUMANELY EUTHANIZED
 REFERENCES

BROWN, L. AND BROWN, M. (2014). RADIOGRAPHY FOR VETERINARY TECHNICIANS (5TH ED).
ST. LOUIS, MO, SAUNDERS.