Internal Medicine – Frederick

Scarring (stricture) and cancer of the urethra can result in an inability to urinate.  The obstruction needs to be rapidly alleviated.  Ballooning of the stricture and/or delivery of urethral stent is a minimally invasive, safe, effective and proven method to “open up” the urethra and re-establish normal urine flow. For benign strictures, the use of temporary stents can also be recommended.  In dogs with malignancy of the urethra, a more permanent stent is used. This procedure can be performed in dogs and cats.

Bladder stones are encountered in our daily practices.  Surgery is often used for the removal of the bladder stones.  However, it does entail an abdominal incision with associated morbidities. Rather, we recommend less invasive methods to extract bladder stone such as cystoscopy-guided stone removal. If the stones are too large for cystoscopy removal,  another alternative that is less invasive than surgery is now available for your select cases and clients.  Percutaneous cystolithotomy  (PCCL) is a minimally invasive procedure where a very small abdominal incision is made to expose the bladder.  Through a small cannula, a cystoscope is then used to look inside the bladder. This allows a full visualization of the entire bladder and urethra (for female and most male).  All visualized stones in bladder and urethra are removed via the cannula assembly.  Partner IMED can help you decide whether PCCL is a good alternative to surgery.

Localized lesions  (polyps, tumors) of the bladder can be associated with significant bleeding and/or recurrence of lower urinary tract signs and infections.  Surgery has been typically recommended for removal of such lesions. However, cystoscopy-guided laser ablation of the abnormal tissue is routinely performed at Partner.  This technique seems to be safe and effective in removing focal lesions.

A weak urethral sphincter is a common problem in dogs and a major reason for owner frustration and ongoing care of the patient.  Medical therapy helps reduce incontinence but may ultimately fail.  Using a cystoscope, collagen injection to bulk the urethra is a safe and effective method to “strengthen” the urethra and improve urinary incontinence.  In more severe cases of incontinence, a hydraulic occluder can be surgically placed.  Partner IMED can help answer your questions as to whether this technique is appropriate for your dog (Cost of collagen procedure: $3600-$7400; deposit for cost of collagen due at scheduling).

Ectopic ureter is a common cause of urinary incontinence in young female dogs but can also affect male dogs.   A ureter is a small tube that brings the urine from the kidney to the bladder. In some cases, the tube opens up in the urethra rather than the bladder.  This causes urinary incontinence. Laser ablation of ectopic ureter(s) using cystoscopy is the method of choice to treat this congenital issue.  A diode laser is used to “relocate” the ureteral opening into the bladder.  Partner IMED is equipped with a state of the art diode laser system for use through the cystoscope working channel.  This advanced technique can avoid much more invasive surgeries and associated morbidities.

Ureteral obstructions can result from stones, blood clots, pus, scarring or tumors.  If left untreated, the unaffected kidney(s) will stop working. Cystoscopy-guided placement of ureteral stents is the method of choice in dogs with ureteral obstruction. The stents can be placed non-invasively, rapidly and safely and provide an immediate relief of the ureteral obstruction. In cats, surgical placement of a subcutaneous ureteral bypass (SUB) device is most often recommended.

This uncommon disease leads to discolored red urine, ureteral obstruction from blood clots and anemia.  The typical recommendation for dealing with primary (idiopathic) hematuria of renal origin has been removal of the affected kidney.  However, since the same issue can develop  in the opposite kidney in 20% of the cases, this is not always the best choice.

Recently, sclerotherapy has been used to stop the bleeding sites from the kidneys.  The sclerotherapy agent is delivered directly into the pelvis of the affected kidney(s) using cystoscopy and bleeding is stopped via chemical cauterization.  Please contact us if your dog is suspected to have this frustrating condition so we can discuss  available options.

Tracheal collapse is a common, progressive degenerative disease of the windpipe. This condition is often a result of cartilage weakening leading to subsequent airflow obstruction during breathing.  Tracheal stenting is a minimally invasive procedure used to reestablish patency within a narrowed tracheal lumen.  Tracheal narrowing is most commonly seen secondary to tracheal collapse in veterinary patients but it has also been seen with tracheal cancer and benign tracheal scarring.

Bronchoscopy (scoping of the airways) is minimally invasive and can be performed in dogs and cats with various causes of obstruction of the trachea and lower airways (eg polyp, cancer). Using electrocautery or diode laser, the size of an inflammatory polyp or a tracheal tumor can be significantly reduced resulting in significant improvement in the breathing. Foreign material can be retrieved using various forceps or snares. 

Patients with nasopharyngeal stenosis have problems breathing due to scarring or malformation of the back of the nose.  The best treatment option for affected patients is a combination of balloon dilation to open up the region followed by placement of a nasopharyngeal stent.  We often use different medical imaging modalities including CT images, fluoroscopy and endoscopy to assess the lesion, widen the space and place a stent.   Nasopharyngeal stents will hold the affected area open and make the patient much more comfortable.  Please call us if you think you may have a patient with this frustrating condition. 

Deep-seated pulmonary lesions can be difficult to visualize on ultrasound.  Our interventional radiology service has developed a new technique using fluoroscopy to obtain samples for those difficult to reach pulmonary nodules.  The technique is safe and effective in obtaining diagnostic samples in both dogs and cats.  Sampling of pulmonary lesions is an important step prior to recommending more invasive procedures such as surgery. 

Difficulty swallowing and regurgitation due to benign esophageal strictures is an important cause of morbidity and mortality in dogs and cats.  Balloon dilation or bougienage are most currently used to dilate esophageal strictures. Unfortunately, such procedures need to be repeated several times with, most often, only partial improvement in the clinical signs.  We recommend a one-stage esophageal balloon dilation of esophageal strictures which appears to be a very effective single-procedure alternative to repeated balloon dilation. 

Strictures are a narrowing of the colonic or rectal opening due to scarring after injury of the intestinal wall from foreign bodies or trauma, inflammatory diseases or neoplasia.  Treatment of benign strictures include balloon dilation +/- placement of a colonic stent. Rectal stenting may also be used for recurrent strictures or cancer if surgical resection is not an option or associated with significant morbidity.

Inflammatory polyps or tumors of the rectum/colon are uncommon but can be associated with significant clinical signs (ie difficulty defecating). Surgery is often recommended when the lesions are relatively close to the anus.  However, when located deeper into the rectum, surgical removal of rectal/colonic masses often becomes more invasive and associated with significantly more morbidity. The combination of electrocautery and endoscopy can be used to remove or debulk inflammatory polyps or even neoplasia.