Veterinary Endoscopy for the Small Animal Practitioner

5 Chapter 5Figure 5.1 Flexible endoscopes: a 3.7 mm and a 5 mm bronchoscope with three ...Figure 5.2 Bronchial mucosal folding indicating bronchospasm.Figure 5.3 An anesthesia “T” adapter attaches to the endotracheal tube and a...Figure 5.4 (a) One method used to provide oxygen supplementation during bron...Figure 5.5 Oxygen supplementation is provided during bronchoscopy by connect...Figure 5.6 Artist's representation of the canine tracheobronchial tree using...Figure 5.7 All necessary equipment is set out ahead of time in preparation f...Figure 5.8 Appearance of the normal canine glottic lumen and larynx followin...Figure 5.9 C‐shaped tracheal cartilaginous rings visible through the mucosa ...Figure 5.10 The presence of either edema as shown by the glistening appearan...Figure 5.11 Normal circular shape of the tracheal rings in a dog; note the t...Figure 5.12 Dorsoventral flattening of the trachea demonstrating a Grade 2–3...Figure 5.13 A misshapen and narrowed tracheal lumen associated with tracheal...Figure 5.14 Severe foaming of airway secretions that is commonly encountered...Figure 5.15 Appearance of the distal airway in a normal dog; note the smooth...Figure 5.16 A tracheal stricture causing altered airway caliber in a dog.Figure 5.17 An intraluminal tumor obstructing the trachea and thus altering ...Figure 5.18 External tracheal compression caused by a ventral mediastinal ma...Figure 5.19 Bronchiectasis and chronic severe bronchitis with inflammatory n...Figure 5.20 A structural or fixed collapse of the left principal bronchus ca...Figure 5.21 Decreased airway caliber in the dog due to dynamic tracheal coll...Figure 5.22 A normal dorsal tracheal membrane in a one‐year‐old German Sheph...Figure 5.23 An example of significant large airway collapse commonly seen se...Figure 5.24 The appearance of healthy tracheobronchial mucosa in a dog; note...Figure 5.25 Mucosal edema is visible in this dog with bronchiectasis as it i...Figure 5.26 Polypoid mucosal nodules, seen on the dorsal wall of the upper b...Figure 5.27 The appearance of excess secretions associated with bacterial pn...Figure 5.28 The appearance of secretions associated with allergic lung disea...Figure 5.29 The endobronchial appearance of bronchiectasis in a dog. Note th...Figure 5.30 A gross lung specimen from a dog with bronchiectasis following l...Figure 5.31 Mucosal irregularity (the granular appearance) and blood on the ...Figure 5.32 Large mucosal nodules just anterior to and nearly obstructing th...Figure 5.33 A bronchial foreign body (small rock) being retrieved with endos...Figure 5.34 Severe airway narrowing secondary to external compression due to...Figure 5.35 Mucosal involvement seen as a primary squamous cell carcinoma in...Figure 5.36 Typical appearance of primary lung tumors in dogs that start in ...Figure 5.37 Endoscopic view of the sharp “V” shaped appearance of a normal c...Figure 5.38 The endoscopic appearance of the normal carina in a cat. The muc...Figure 5.39 Hilar lymphadenopathy compressing the right mainstem bronchus in...Figure 5.40 Endoscopic appearance of normal spurs or bronchial bifurcations ...Figure 5.41 Appearance of a blunted spur in a dog. Blunting occurs when the ...Figure 5.42 Performing a BAL using 20 ml of sterile saline flushed through t...Figure 5.43 Performing a BAL using 20 ml of sterile saline and hand suction ...Figure 5.44 Photomicrograph of canine BALf; note the predominance of normal ...Figure 5.45 Photomicrograph of a squamous epithelial cell and two Simonsiell ...Figure 5.46 Blood agar culture plate with TNTC (too numerous to count) colon...

6 Chapter 6Figure 6.1 A continuous flow system for use with the 4.0 cystoscope with two...Figure 6.2 A deflecting bridge or Albarran lever is used with cystoscopes to...Figure 6.3 Transurethral viscous fluid injection instrument set for use with...Figure 6.4 The resectoscope system for transurethral cystoscopy in small ani...Figure 6.5 A close‐up picture of the cutting loop working tip of the bipolar...Figure 6.6 Irrigation system for transurethral cystoscopy using a one‐liter ...Figure 6.7 Anatomy drawing of the relationship of the vulva, vaginal vestibu...Figure 6.8 The vaginal vestibule distended with saline in an eight‐year‐old ...Figure 6.9 The vaginal vestibule distended with saline in a three‐year‐old s...Figure 6.10 The urethral papilla in an eight‐month‐old intact female Vizsla ...Figure 6.11 An example of a urethral tubercle typically seen in intact femal...Figure 6.12 When the cystoscope first enters the urethra during transurethra...Figure 6.13 As the telescope is passed through the urethra, fluid flow begin...Figure 6.14 Full distention of the urethra occurs in most cases as fluid flo...Figure 6.15 Yellow urine color with otherwise clear urine has minimal interf...Figure 6.16 Suspended debris of any kind in the urine creates an opacity tha...Figure 6.17 Hematuria, unless only microscopic, prevents any examination of ...Figure 6.18 Crystalluria also interferes with the visual field and may requi...Figure 6.19 Urine retention allows accumulation of sludge like debris in the...Figure 6.20 The details of normal and abnormal tissues are clearly visible w...Figure 6.21 The bladder of a 10‐year‐old spayed female Bouvier des Flanders ...Figure 6.22 An air–water interface interfering with examination of a bladder...Figure 6.23 Smoke produced by laser ablation of a transitional cell carcinom...Figure 6.24 Bleeding from microscopic mucosal tears in the bladder of a five...Figure 6.25 A Foley catheter with the bulb inflated positioned in the trigon...Figure 6.26 Five French flexible biopsy forceps passed through the operating...Figure 6.27 The biopsy forceps are opened and positioned over the selected b...Figure 6.28 The biopsy forceps are pushed forward into the tissue and closed...Figure 6.29 The biopsy site after tissue removal in the patient from Figure ...Figure 6.30 A 5 Fr polypectomy snare positioned on a polyp for partial excis...Figure 6.31 The polypectomy snare in Figure 6.30 is closed to trap and remov...Figure 6.32 A stone basket being used for extraction of a TCC mass after tra...Figure 6.33 A large bladder polyp with the patient positioned so that the le...Figure 6.34 The same polyp as Figure 6.33 with the patient repositioned so t...Figure 6.35 A polypectomy snare placed on the base of the polyp in Figure 6....Figure 6.36 The resection site of the polyp seen in the previous figures aft...Figure 6.37 The base of a large inflammatory bladder polyp with the patient ...Figure 6.38 An activated diode laser fiber in contact with the base of the l...Figure 6.39 Cut progression is assessed by stopping the laser and backing th...Figure 6.40 Completion of the cut leaves an area of cauterized tissue flush ...Figure 6.41 A small cystic calculus trapped with a stone basket in a dog wit...Figure 6.42 A weasel wire passed into an abnormal ureteral ostium prior to p...Figure 6.43 An image of the nondistended distal penile urethral lumen seen w...Figure 6.44 The distended distal penile urethral lumen seen when passing the...Figure 6.45 The narrowest point of the male dog urethra is at the caudal end...Figure 6.46 The urethra caudal to the os penis is slightly curved and is eas...Figure 6.47 Insufficient fluid flow allows the urethra to collapse, increasi...Figure 6.48 The increasing curvature of the urethra as it approaches and pas...Figure 6.49 Once the ischial arch is passed, the passage of the endoscope be...Figure 6.50 As the endoscope is passed into the prostatic urethra, distentio...Figure 6.51 The colliculus seminalis is seen as a prominent dorsal ridge and...Figure 6.52 The small flexible endoscopes suitable for transurethral cystosc...Figure 6.53 Adequate illumination is provided by these endoscopes for focal ...Figure 6.54 During examination of the ureteral openings, time is taken to ob...Figure 6.55 The ureteral openings are also visible from the cranial directio...Figure 6.56 Placing the tip of the endoscope close to the bladder wall provi...Figure 6.57 A urachal diverticulum in a male dog seen with the Flex‐XC with ...Figure 6.58 The distal urethra of a five‐year‐old intact male Irish Wolfound...Figure 6.59 The penile urethra of a male cat seen using a 1.0 mm diameter fi...Figure 6.60 The proximal penile urethra at the level immediately proximal to...Figure 6.61 The pelvic urethra of the same patient seen in Figure 6.60. The ...Figure 6.62 The abdominal segment of the urethra in a male cat examined duri...Figure 6.63 The bladder of a 10‐year‐old neutered male Domestic Shorthair ca...Figure 6.64 The right ureteral opening in the patient seen in Figure 6.63.Figure 6.65 A large quantity of sand in the bladder of a four‐year‐old neute...Figure 6.66 The bladder in the patient seen in Figure 6.65 after removal of ...Figure 6.67 Irrigation setup for prepubic percutaneous cystoscopy with a con...Figure 6.68 Puncture locations for prepubic percutaneous cystoscopy. The pun...Figure 6.69 (a) Trocar position and angle of intersection with the bladder w...Figure 6.70 The irrigation system setup with liquid inflow through the teles...Figure 6.71 Bladder and telescope position for placement of a second or oper...Figure 6.72 A standard open surgical suction tip placed into the bladder thr...Figure 6.73 Operating room setup drawing with the patient in dorsal recumben...Figure 6.74 Portal placement for laparoscopic‐assisted cystoscopy in a femal...Figure 6.75 After placement of both portals, the apex of the bladder is gras...Figure 6.76 The apex of the bladder is elevated into the operative portal ca...Figure 6.77 The cannula is removed, and the portal enlarged if needed. In th...Figure 6.78 Normal mucosa in a moderately distended bladder seen with laparo...Figure 6.79 The normal trigone in a 15‐year‐old neutered male Miniature Pood...Figure 6.80 The normal trigone seen through air from the cranial aspect duri...Figure 6.81 The right ureteral orifice on its papilla with a pulse of clear ...Figure 6.82 The right ureteral orifice seen with the bladder distended enoug...Figure 6.83 The caudal end of the pelvic urethra at the ischial arch in a ma...Figure 6.84 Examination of the pelvic urethra in a five‐year‐old neutered ma...Figure 6.85 Laparoscopic‐assisted cystoscopy also allows examination of the ...Figure 6.86 Examination of the urethra in a 16‐year‐old spayed female cat do...Figure 6.87 The colliculus seminalis seen during examination of the prostati...Figure 6.88 The openings of multiple prostatic ducts are visible on the righ...Figure 6.89 The pelvic urethra caudal to the prostate in an eight‐year‐old n...Figure 6.90 Examination of the pelvic urethra caudal to the prostate in a fo...Figure 6.91 Irrigation used during LAC dilates the pelvic urethra to form a ...Figure 6.92 Small sharp transverse circumferential ridges are occasionally s...Figure 6.93 Laparoscopic‐assisted cystoscopy for stone removal in a seven‐ye...Figure 6.94 A laser fiber passed through the operating channel of the 2.7 mm...Figure 6.95 A 5 Fr Foley urethral catheter visible in the pelvic urethra in ...Figure 6.96 The inflated bulb of an 8 Fr Foley urethral catheter in a 12‐yea...Figure 6.97 After completion of the procedure in the bladder, the cystotomy ...Figure 6.98 Multiple residual combination urate and oxalate calculi in the p...Figure 6.99 A large number of small amorphous silicate calculi in the pelvic...Figure 6.100 Fluorescence of a transitional cell carcinoma in the bladder of...Figure 6.101 The urethral tubercle and urethral orifice in a 16‐year‐old spa...Figure 6.102 The urethral orifice is usually seen as a closed or slightly op...Figure 6.103 This vaginal vestibule is distended enough to flatten all the m...Figure 6.104 A single small insignificant crypt of McCarthy in the lateral v...Figure 6.105 Three small insignificant crypts with easily visible deep walls...Figure 6.106 The lateral vestibular fossa of a seven‐year‐old spayed female ...Figure 6.107 A larger number of lateral vestibular fossa crypts involving a ...Figure 6.108 A double row of multiple crypts distorting the shape of the lat...Figure 6.109 A small deep crypt on the top of the urethral papilla adjacent ...Figure 6.110 A large deep crypt in the lateral ventricular fossa of a five‐y...Figure 6.111 The clitoral fossa in a seven‐month‐old spayed female Labrador ...Figure 6.112 The cranial wall of the clitoral fossa in a seven‐month‐old spa...Figure 6.113 The clitoris in a 13‐year‐old spayed female Schipperke. The cli...Figure 6.114 A particularly prominent vaginovestibular junction in a nine‐mo...Figure 6.115 The vaginal body of a seven‐month‐old spayed female Labrador Re...Figure 6.116 The vaginal body of a 13‐year‐old spayed female Schipperke with...Figure 6.117 The vaginal body in a three‐year‐old intact female 5.5 kg mixed...Figure 6.118 The vaginal body of a 10‐year‐old spayed female Springer Spanie...Figure 6.119 The vaginal body of a three‐year‐old spayed female Boxer dog on...Figure 6.120 The dorsal median fold seen as a prominent fixed ridge of tissu...Figure 6.121 The dorsal median fold in a seven‐month‐old spayed female Dober...Figure 6.122 A close‐up image of the cranial end of the dorsal median fold w...Figure 6.123 When first entering the urethra, when performing transurethral ...Figure 6.124 With fluid flow through the cystoscopy, the urethra fills to op...Figure 6.125 The completely distended urethra in a six‐month‐old intact fema...Figure 6.126 A distended urethra without residual mucosal ridges in a five‐y...Figure 6.127 A distended urethra with a large prominent dorsal mucosal ridge...Figure 6.128 An example of distinct narrowing of the cranial urethra in a 16...Figure 6.129 Partial dilation of an area of cranial urethral narrowing produ...Figure 6.130 An area of cranial urethral narrowing with blanched blood vesse...Figure 6.131 A single small urethral diverticulum in an 11‐month‐old intact ...Figure 6.132 Multiple small urethral diverticula in a five‐month‐old intact ...Figure 6.133 An unusual large urethral diverticulum in a three‐year‐old spay...Figure 6.134 The trigone of a collapsed bladder in a seven‐month‐old spayed ...Figure 6.135 The trigone of a collapsed bladder in an eight‐year‐old spayed ...Figure 6.136 A partially distended bladder with smooth mucosa and visible bl...Figure 6.137 A partially distended bladder in a three‐year‐old spayed female...Figure 6.138 A fully distended bladder with easily visible blood vessels wit...Figure 6.139 Multiple smoothly branching blood vessels seen in a distended b...Figure 6.140 Looking cranially with transurethral cystoscopy, the ureteral p...Figure 6.141 The left ureteral papilla and ostia seen looking cranially with...Figure 6.142 The left ureteral ostia in an overdistended bladder with the pa...Figure 6.143 A ureteral ostium appearing as an oval opening that does not ap...Figure 6.144 Normal urine flow from the right ureteral ostia seen looking cr...Figure 6.145 Normal urine flow from the left ureteral ostia in the same pati...Figure 6.146 The left ureteral papilla and ostium with bladder overdistentio...Figure 6.147 The normal trigone of the bladder in a four‐year‐old neutered m...Figure 6.148 Normal branching mucosal blood vessels seen with the Flex‐XC du...Figure 6.149 The urethra of a four‐year‐old neutered male Domestic Shorthair...Figure 6.150 The urethra of a three‐year‐old neutered male Domestic Shorthai...Figure 6.151 The prostatic urethra with a prominent colliculus seminalis in ...Figure 6.152 Glomerulations with scattered uniform distribution and size in ...Figure 6.153 A minimum number of glomerulations seen in the bladder of a sev...Figure 6.154 Glomerulations with size variation in the bladder of a 10‐year‐...Figure 6.155 A focal cluster of uniform‐sized glomerulations in a seven‐year...Figure 6.156 A sheet of glomerulations in the bladder of a seven‐year‐old sp...Figure 6.157 A small cluster of brown glomerulations indicating chronicity i...Figure 6.158 Glomerulations in the urethra of a 14‐year‐old spayed female Do...Figure 6.159 Close‐up magnified glomerulations with the appearance of petech...Figure 6.160 Close‐up magnified glomerulations with the appearance of a clus...Figure 6.161 Multiple hyperemic nodules in the bladder of a five‐year‐old sp...Figure 6.162 A single nodule in the bladder of a 11‐year‐old spayed female E...Figure 6.163 A close‐up view of nodules that are a combination of white and ...Figure 6.164 Three nodules of inflammatory tissue in the bladder of an eight...Figure 6.165 Multiple white nodules in the urethra of a six‐year‐old spayed ...Figure 6.166 Many mucosal colored nodules are present in this urethra of the...Figure 6.167 Numerous follicles in the vaginal vestibule of a dog with a rec...Figure 6.168 Multiple nodules in the vaginal vestibule and urethral orifice ...Figure 6.169 Scattered hyperemic nodules in a one‐year‐old intact female Col...Figure 6.170 A sheet of hyperemic nodules covering the dorsal median fold an...Figure 6.171 A large inflammatory polyp in the bladder of an eight‐year‐old ...Figure 6.172 An inflammatory polyp seen through air in a six‐year‐old intact...Figure 6.173 A small polyp in the bladder of 10‐year‐old spayed female Pug w...Figure 6.174 A cluster of small polyps around the left ureteral ostium of a ...Figure 6.175 A cluster of small polyps in and around a urachal diverticulum ...Figure 6.176 Multiple polyp‐like lesions on the surface of a transitional ce...Figure 6.177 One of several multipart inflammatory polyps in the bladder of ...Figure 6.178 Multiple individual polyps of variable size and appearance in t...Figure 6.179 One of the polyps in the patient in Figure 6.178 with typical n...Figure 6.180 A small bladder polyp with an unusual blood blister appearance....Figure 6.181 A small inflammatory polyp seen during transurethral cystoscopy...Figure 6.182 Mild early cystitis in an eight‐year‐old spayed female wirehair...Figure 6.183 More pronounced blood vessel tortuosity in the bladder of a sev...Figure 6.184 An increase in blood vessel numbers in the bladder of a five‐ye...Figure 6.185 An irregular vascular pattern with a combination of tortuosity,...Figure 6.186 A focal area of bladder wall vascular pattern change with incre...Figure 6.187 An increased number of small blood vessels in the proximal uret...Figure 6.188 Increased size and number of blood vessels with increased branc...Figure 6.189 An overwhelming increase in blood supply in the urethra of an 1...Figure 6.190 An example of bladder wall edema seen in a five‐year‐old neuter...Figure 6.191 An “C” shaped area of bladder wall edema that matches the shape...Figure 6.192 A large area of hemorrhage in the bladder wall of a five‐year‐o...Figure 6.193 Ecchymosis in the bladder mucosa of a five‐year‐old neutered ma...Figure 6.194 Marked hyperemia in the pelvic urethral mucosa of a 13‐year‐old...Figure 6.195 An area of mild mucosal hyperemia in the urethra of a six‐year‐...Figure 6.196 Early cellular change in the bladder mucosa of a six‐year‐old s...Figure 6.197 When seen with the telescope angle position to view the bladder...Figure 6.198 Early cellular change in the urethral mucosa with similar irreg...Figure 6.199 Partial loss of visible blood vessels in the pelvic urethra of ...Figure 6.200 Roughening of the mucosa in the urethra of a seven‐year‐old spa...Figure 6.201 Irregular patchy areas of mucosal thickening in the proximal ur...Figure 6.202 Thickened mucosa forming a ridge of abnormal tissue rather than...Figure 6.203 With progressive chronicity and severity, mucosal involvement e...Figure 6.204 Continued inflammatory activity produces further proliferation ...Figure 6.205 An area of the bladder in a seven‐year‐old spayed female Doberm...Figure 6.206 Large mucosal ridges covered with thickened inflamed mucosa and...Figure 6.207 A chronically inflamed end‐stage bladder in a 10‐year‐old neute...Figure 6.208 Visible fibrous bands in the urethra of a five‐year‐old neutere...Figure 6.209 A mucosal ulcer in the bladder of a 15‐year‐old neutered male M...Figure 6.210 A less obvious area of ulceration in the trigone area of the pa...Figure 6.211 An ulcer in the bladder of a seven‐month‐old spayed female Dobe...Figure 6.212 Free mucoid exudate in the bladder of a five‐month‐old intact f...Figure 6.213 Free mucoid exudate coming from the urethral orifice into the v...Figure 6.214 Voluminous mucopurulent exudate coming from the vaginal body th...Figure 6.215 Inspissated mucopurulent material in the vaginal body of a one‐...Figure 6.216 Adherent exudate in the bladder of a six‐year‐old spayed female...Figure 6.217 An adherent pseudomembrane of mucopurulent exudate in the ureth...Figure 6.218 A pseudomembrane of mucopurulent exudate on the floor of the va...Figure 6.219 Mucopurulent exudate seen in the vaginal body through the vagin...Figure 6.220 A urethral stricture in a 5‐year‐old spayed female 19 kg mixed‐...Figure 6.221 A mature urethral stricture of unknown etiology in a four‐year‐...Figure 6.222 A silicate calculus deeply imbedded in the urethral mucosa at t...Figure 6.223 Mucosal damage and reaction at the stone site in Figure 6.222 a...Figure 6.224 Urethral injury examined after a stone lodged in the urethra wa...Figure 6.225 Radiographs of a seven‐year‐old intact male Pug with a history ...Figure 6.226 A mature stricture was present at the caudal end of the os peni...Figure 6.227 Urethra mucosal deformity at the caudal end of the os penis fro...Figure 6.228 A distal urethral stricture not associated with a history or fi...Figure 6.229 A urethral stricture at the level of the prostate in a male dog...Figure 6.230 A urethral calculus lodged immediately proximal to a urethrocut...Figure 6.231 The stone was removed with a stone basket.Figure 6.232 Chronic urethral changes are seen here at the site where the st...Figure 6.233 A transitional cell carcinoma mass in the cranial bladder of a ...Figure 6.234 The trigone area of the patient in Figure 6.233 with large fimb...Figure 6.235 The proximal urethra in this same patient with complete replace...Figure 6.236 The distal urethra in the same patient that is also completely ...Figure 6.237 This image is with the telescope in the vaginal vestibule looki...Figure 6.238 Tumor tissue with a uniform layer of small fimbria in the right...Figure 6.239 Tumor tissue from the same patient in the left vestibular fossa...Figure 6.240 A solid sheet of TCC covering a large area of the vaginal body ...Figure 6.241 A small transitional cell carcinoma seen as an incidental findi...Figure 6.242 Flat round TCC lesion with a central indentation in a 10‐year‐o...Figure 6.243 A small round smooth raised white TCC lesion in the bladder wit...Figure 6.244 A small smooth oval satellite lesion in the bladder of an eight...Figure 6.245 A lobulated recurrent TCC lesion in the bladder of the nine‐yea...Figure 6.246 Tumor tissue spreading out onto the bladder wall from a raised ...Figure 6.247 A cystic‐appearing area of a large diffuse transitional cell ca...Figure 6.248 A cystic‐appearing area of a large TCC at the trigone in a 13‐y...Figure 6.249 A large transitional cell carcinoma with necrotic fimbria in th...Figure 6.250 Necrosis of the top of a smooth round transitional carcinoma of...Figure 6.251 A large mineralized TCC in the bladder of a 15‐year‐old neutere...Figure 6.252 A large transitional cell carcinoma in the trigone of a nine‐ye...Figure 6.253 A small smooth raised mucosal lesion on the bladder mucosa that...Figure 6.254 A small satellite TCC lesion having the dark purple blood‐fille...Figure 6.255 One of many extensions with the dark purple appearance of infla...Figure 6.256 A blood‐covered TCC mass in the bladder of an eight‐year‐old sp...Figure 6.257 A large free blood clot in the bladder of a dog with a large tr...Figure 6.258 A well‐organized blood clot protruding from the urethral orific...Figure 6.259 A trigonal and proximal urethral TCC in the bladder of a 15‐yea...Figure 6.260 Local extension of a large transitional cell carcinoma in the b...Figure 6.261 Local extension of a large TCC in the bladder of an 11‐year‐old...Figure 6.262 Extensive fimbriation of a urethral TCC in a 10‐year‐old spayed...Figure 6.263 A smooth raised white TCC lesion in the urethra of an 11‐year‐o...Figure 6.264 A transitional cell carcinoma with a lobulated appearance in th...Figure 6.265 Necrotic TCC tissue in the urethra of a six‐year‐old spayed fem...Figure 6.266 Small areas of mineralized TCC tissue at the proximal end of th...Figure 6.267 TCC in a 12‐year‐old Norfolk Terrier with diffuse involvement o...Figure 6.268 A large transitional cell carcinoma in the caudal bladder of a ...Figure 6.269 A large multipart lobulated TCC in an 11‐year‐old spayed female...Figure 6.270 A mass in the pelvic urethra of an 11‐year‐old neutered male Ge...Figure 6.271 TCC in the bladder of a 14‐year‐old neutered male Labrador Retr...Figure 6.272 Another area of the bladder mass in the dog in Figure 6.271 sho...Figure 6.273 Transurethral examination of the bladder in an eight‐year‐old n...Figure 6.274 A transitional cell carcinoma in the trigone of a 12‐year‐old n...Figure 6.275 A large transitional cell carcinoma at the trigone of an eight‐...Figure 6.276 Assessment of the prostatic urethral mucosa caudal to the main ...Figure 6.277 The trigonal TCC in the Golden Retriever seen in the previous i...Figure 6.278 Transitional carcinoma lesions in the pelvic urethra of a 12‐ye...Figure 6.279 A prostatic mass in a 10‐year‐old neutered male Pug. Histopatho...Figure 6.280 A solitary smooth well‐defined transitional cell carcinoma of t...Figure 6.281 A diffuse smooth slightly lobulated and indistinctly defined TC...Figure 6.282 A lobulated transitional cell carcinoma involving the trigone o...Figure 6.283 Proximal urethral involvement with TCC in a five‐year‐old spaye...Figure 6.284 Unusual fimbriation of a bladder wall TCC in a 10‐year‐old spay...Figure 6.285 A diffuse irregular transitional cell carcinoma involving a lar...Figure 6.286 Another portion of the tumor seen in Figure 6.285 with a smooth...Figure 6.287 A nine‐year‐old intact female Labrador Retriever with a large b...Figure 6.288 The appearance of the bladder wall in the patient in Figure 6.2...Figure 6.289 A small cell lymphoma of the bladder seen in a 16‐year‐old spay...Figure 6.290 A close‐up of a single nodule of the small cell lymphoma seen i...Figure 6.291 A vascular irregular transmissible venereal tumor (TVT) in the ...Figure 6.292 A vascular irregular TVT in the vaginal body of the same patien...Figure 6.293 A round transmissible venereal tumor seen in vaginal body throu...Figure 6.294 The TVT in Figure 6.293 following distention of the vaginal bod...Figure 6.295 Further distention of the vagina allowed it to be determined th...Figure 6.296 A polypectomy snare was placed at the base of this TVT lesion, ...Figure 6.297 The resection site following transection of the TVT stalk with ...Figure 6.298 A leiomyoma in the vaginal body in an eight‐year‐old intact fem...Figure 6.299 Sample collection for histopathology is done by excision of the...Figure 6.300 The base of the lesion transected flush with the surrounding mu...Figure 6.301 Vaginoscopy of a 12‐year‐old intact female Pomeranian with a ma...Figure 6.302 A polypectomy snare was placed over the mass and positioned usi...Figure 6.303 Examination of the resection site after transection using the s...Figure 6.304 Multiple small masses were also found in the vaginal body as in...Figure 6.305 Another area of the vaginal body had a cluster of individual ma...Figure 6.306 Multiple samples were collected with a polypectomy snare for hi...Figure 6.307 A large round intraluminal vaginal mass seen in a 12‐year‐old i...Figure 6.308 This mass appeared very similar to a vaginal hyperplasia lesion...Figure 6.309 Multiple individual sharp calcium oxalate monohydrate crystals ...Figure 6.310 A cluster of adherent sharp calcium oxalate crystals forming a ...Figure 6.311 A cluster of adherent rounded calcium oxalate crystals forming ...Figure 6.312 Multiple irregular calcium oxalate calculi in the bladder of a ...Figure 6.313 Multiple smooth round calculi seen in the bladder of a 10‐year‐...Figure 6.314 A large irregular calcium oxalate calculus that appears to be f...Figure 6.315 A single large calcium oxalate calculus formed as an aggregate ...Figure 6.316 A tubular calcium oxalate calculus formed from an aggregate of ...Figure 6.317 Fine calcium oxalate sand in the bladder of a 10‐year‐old spaye...Figure 6.318 A white calcium oxalate calculus formed as a cluster of adheren...Figure 6.319 A smooth round struvite calculus in a seven‐year‐old spayed fem...Figure 6.320 A large oval struvite calculus in a six‐year‐old neutered male ...Figure 6.321 A large oval struvite stone in a four‐year‐old spayed female Mi...Figure 6.322 Struvite sludge in a six‐year‐old neutered male Domestic Shorth...Figure 6.323 Multiple urate calculi seen in the caudal pelvic urethra of an ...Figure 6.324 A small smooth urate calculus in the pelvic urethra of a one‐ye...Figure 6.325 Two round urate stones with a roughened surface seen in the sam...Figure 6.326 A large single urate calculus in the bladder of a 13‐year‐old n...Figure 6.327 A classic “jackstone” silica calculus in the bladder of a six‐y...Figure 6.328 Multiple silica calculi seen in the urethra of a nine‐year‐old ...Figure 6.329 A cluster of individual white irregular silica calculi in the p...Figure 6.330 A small oxalate calculus protruding from the ureteral ostium in...Figure 6.331 Multiple small struvite calculi imbedded in the mucosa of an 11...Figure 6.332 An unusual finding of a single small silica calculus lodged in ...Figure 6.333 A small struvite calculus trapped in mucosal folds of the vagin...Figure 6.334 A silica calculus lodged in the urethra at the level of the cau...Figure 6.335 A silica calculus deeply imbedded in the urethral mucosa at the...Figure 6.336 A linear calculus covering a strand of suture material still at...Figure 6.337 Multiple free linear calculi in an eight‐year‐old spayed female...Figure 6.338 Residual clearly visible suture tracts at a cystotomy incision ...Figure 6.339 A different view of the suture tracts in the previous case show...Figure 6.340 A strand of suture material seen in the bladder lumen where it ...Figure 6.341 A very thin vaginal web seen as a very thin hairlike strand of ...Figure 6.342 A simple vaginal web seen as a band of tissue extending dorsove...Figure 6.343 A thick vaginal septum in a seven‐month‐old spayed female Labra...Figure 6.344 The vaginal septum from Figure 6.343 seen at an oblique angle a...Figure 6.345 The vaginovestibular junction of an eight‐month‐old spayed fema...Figure 6.346 The same patient as Figure 6.345 with a weasel wire passed thro...Figure 6.347 The same patient as Figures 6.345 and 6.346 with the endoscope ...Figure 6.348 A bizarre vaginovestibular junction in a seven‐month‐old intact...Figure 6.349 Ectopic ureteral ostia with normal appearance but are minimally...Figure 6.350 A left ectopic ureteral ostium that is minimally displaced but ...Figure 6.351 Bilateral minimally displaced ectopic ureters with prominent mu...Figure 6.352 An enlarged deformed ectopic ureteral ostium in the proximal en...Figure 6.353 An enlarged deformed ectopic ureter opening at the midpoint of ...Figure 6.354 A moderately enlarged ectopic ureter opening at the very distal...Figure 6.355 A full‐length urethral septum separating an intramural ureteral...Figure 6.356 A large fenestration in an ectopic ureter with the ostium at th...Figure 6.357 A small fenestration in the septum between the ectopic ureter a...Figure 6.358 A large cranial ectopic ureter opening in the proximal urethra ...Figure 6.359 The cranial end of the caudal segment of the ectopic ureter see...Figure 6.360 The caudal end of an intramural urethral ectopic ureter opening...Figure 6.361 The caudal opening of an ectopic ureter in an 18‐month‐old spay...Figure 6.362 Endoscopy of the dilated ectopic ureter that was large enough t...Figure 6.363 Further passage of the rigid cystoscope into the dilated ureter...Figure 6.364 A depression in the mucosa in a dog with bilateral ectopic uret...Figure 6.365 The site where a ureteral opening would normally occur with a d...Figure 6.366 Urine flow through an opening at a normal ureteral ostium site ...Figure 6.367 The normal right ureteral ostium in an 18‐month‐old spayed fema...Figure 6.368 Bilateral ectopic ureteral ostia with mild asymmetry in a four‐...Figure 6.369 Urethral diverticula at the caudal end of a bifurcating ridge o...Figure 6.370 A multipart transverse band of mucosa in an 11‐week‐old intact ...Figure 6.371 A small urethral wall indentation appearing to be a diverticulu...Figure 6.372 The urethral indentation seen in Figure 6.372 was explored, and...Figure 6.373 A right‐side ureterocele in a six‐month‐old intact female Chino...Figure 6.374 The ectopic right ureteral ostium in the patient in Figure 6.37...Figure 6.375 The inside of a ureterocele with a weasel wire passed through w...Figure 6.376 The lumen of a ureterocele seen at its exit point through the o...Figure 6.377 The ostium of an ectopic ureter seen using the Flex‐XC flexible...Figure 6.378 The normal contralateral right ureteral ostium in the same pati...Figure 6.379 The same normal contralateral right ureteral ostium seen in Fig...Figure 6.380 With the retroflexed endoscope looking caudally at the normal l...Figure 6.381 With enlarged ectopic ureteral openings and hydroureter, both p...Figure 6.382 In this image, the flexible endoscope has been passed cranially...Figure 6.383 The ectopic ureter opening in the pelvic urethra seen from the ...Figure 6.384 An 8 Fr red rubber catheter seen passing from the urethra into ...Figure 6.385 Examination of the ureteral ostia from the cranial aspect using...Figure 6.386 With further bladder distention, the abnormalities become more ...Figure 6.387 Observation of pulsatile urine flow revealed that there was uri...Figure 6.388 Further investigation of the dorsal mucosal ridge extending cau...Figure 6.389 A small ureterocele seen in a six‐month‐old neutered male Labra...Figure 6.390 The opening of the left ectopic ureter from Figure 6.389 is see...Figure 6.391 A small distinct urachal diverticulum in a five‐month‐old spaye...Figure 6.392 A small distinct urachal diverticulum in a six‐month‐old neuter...Figure 6.393 A urachal diverticulum seen on the outside of the bladder as an...Figure 6.394 A very small urachal diverticulum surrounded with hyperemic tis...Figure 6.395 Inflammatory nodules surrounding a urachal diverticulum in a fo...Figure 6.396 A urachal diverticulum surrounded by thickened bladder wall for...Figure 6.397 A urachal diverticulum in a five‐month‐old intact female Bouvie...Figure 6.398 A large urachal diverticulum with a visible lumen in a four‐mon...Figure 6.399 Inflammatory polyps at the site of a urachal diverticulum in a ...Figure 6.400 Multiple small calculi trapped in the urachal diverticulum of a...Figure 6.401 An enlarged dysplastic blood vessel in the bladder of a 15‐year...Figure 6.402 An additional image of the same area of vascular dysplasia seen...Figure 6.403 Hyperemia of the urethra in a 13‐year‐old spayed female Dachshu...Figure 6.404 Petechia in the urethra of a three‐year‐old spayed female Jack ...Figure 6.405 Ecchymoses in the trigone of the Dachshund with pelvic fracture...Figure 6.406 An area of bladder wall contusion with swelling, hyperemia, and...Figure 6.407 Multiple linear mucosal tears in the bladder of the 13‐year‐old...Figure 6.408 A mucosal laceration in a two‐year‐old spayed female Lhasa Apso...Figure 6.409 A bladder mucosal laceration secondary to trauma with necrosis ...Figure 6.410 A necrotic flap of urethral mucosa in the two‐year‐old spayed f...Figure 6.411 A small bladder wall penetration with an attached blood clot. D...Figure 6.412 A small bladder penetration with necrosis of tissue margins and...Figure 6.413 A small bladder penetration obscured with sand‐sized calculi in...Figure 6.414 A pulse of clear urine coming from the right ureter in the dog ...Figure 6.415 A pulse of hematuria from the left ureter in the dog in the Fig...Figure 6.416 Blood coming from the right ureter of a one‐year‐old intact fem...Figure 6.417 Clear urine coming from the left ureter of the patient in Figur...Figure 6.418 Blood coming from the left ureteral ostia of a one‐year‐old int...Figure 6.419 The diode laser is used for correction of urachal diverticula b...Figure 6.420 Application of the diode laser fiber in noncontact mode for cor...Figure 6.421 Completion of urachal diverticulum ablation with the diode lase...Figure 6.422 An inflammatory polyp in the bladder of a six‐year‐old intact f...Figure 6.423 A polypectomy snare placed and ready for transection at the bas...Figure 6.424 The resection site after removal of the polyp seen in Figures 6...Figure 6.425 A diode laser fiber positioned over a small inflammatory polyp ...Figure 6.426 The ablation sites of two small polyps in the patient in Figure...Figure 6.427 A urethral stricture of unknown etiology after balloon dilation...Figure 6.428 After balloon dilation and stent placement for stricture manage...Figure 6.429 Biopsy of the small TCC lesion in the bladder of a nine‐year‐ol...Figure 6.430 The tumor site after collecting a biopsy sample with the 5 Fr b...Figure 6.431 The tumor site after ablation of the base and surrounding tissu...Figure 6.432 TUC was performed at three months to evaluate tumor recurrence....Figure 6.433 Examination at 11 months revealed early tumor regrowth, and the...Figure 6.434 Eighteen‐month evaluation with TUC determined that there was no...Figure 6.435 Early tumor growth was found at 27 months.Figure 6.436 Laser ablation was repeated at this time.Figure 6.437 Examination was not repeated for 15 months, 30 months after ini...Figure 6.438 The mass was transected at its base with the diode laser and re...Figure 6.439 Cloudy liquid interfering with continued laser ablation of a la...Figure 6.440 Smoke in an air‐filled bladder obscuring visibility during lase...Figure 6.441 A small satellite TCC lesion in the bladder with multiple satel...Figure 6.442 A laser fiber positioned for ablation of the TCC lesion in Figu...Figure 6.443 Completion of ablation of a small TCC mass seen through saline....Figure 6.444 Laser ablation of TCC lesions in the pelvic urethra of a 12‐yea...Figure 6.445 Completed ablation of the TCC lesions in the pelvic urethra of ...Figure 6.446 A large TCC mass in the bladder of a 10‐year‐old spayed female ...Figure 6.447 A pedunculated TCC mass with a narrow stalk that is accessible ...Figure 6.448 A transitional carcinoma in an 11‐year‐old neutered male Austra...Figure 6.449 Transection of the tumor base seen in Figure 6.448 with the dio...Figure 6.450 The resection site of the tumor seen in Figures 6.448 and 6.449...Figure 6.451 A large trigonal transitional cell carcinoma mass in a nine‐yea...Figure 6.452 The right ureteral ostium in the patient in Figure 6.451. The m...Figure 6.453 The left ureteral ostium in the patient in Figures 6.451 and 6....Figure 6.454 The polypectomy snare positioned on the base of the tumor. The ...Figure 6.455 The resection site after the contraction of the snare loop with...Figure 6.456 A free tumor mass that has been resected by transection of the ...Figure 6.457 The free tumor mass seen in Figure 6.456 is being grasped with ...Figure 6.458 Removal of a freed TCC mass from the bladder of an 11‐year‐old ...Figure 6.459 A urinary stone basket was used to remove a tumor mass that has...Figure 6.460 Transection of a tumor mass into pieces small enough to pass th...Figure 6.461 A large solitary transitional cell carcinoma in the cranial ure...Figure 6.462 The mass in Figure 6.461 was transected at its base with a diod...Figure 6.463 Necrotic tissue left in the urethra following laser ablation of...Figure 6.464 A urethral stricture interfering with urination seen two weeks ...Figure 6.465 The stricture in Figure 6.464 after balloon dilation for tempor...Figure 6.466 Balloon dilation in the previous case produced temporary improv...Figure 6.467 Narrowing of the urine stream developed 20 weeks after stent pl...Figure 6.468 The intrastent stricture was successfully treated with balloon ...Figure 6.469 Ingrowth of TCC tissue typically progresses with all stents eve...Figure 6.470 Reduced functional urethral lumen due to tissue ingrowth in a p...Figure 6.471 A large number of oxalate cystic uroliths in this 13‐year‐old s...Figure 6.472 A large number of small calculi in the bladder of a six‐year‐ol...Figure 6.473 Examination of the bladder with TUC after the first hydropropul...Figure 6.474 Reexamination of the bladder after the second hydropropulsion s...Figure 6.475 Mucoid sludge in the bladder of a three‐year‐old spayed female ...Figure 6.476 Removal of a small cystic calculus using a small grasping force...Figure 6.477 Removal of a single small cystic calculus from the bladder of a...Figure 6.478 Multiple small cystic calculi mixed with blood and held togethe...Figure 6.479 A lateral abdominal radiograph of a seven‐year‐old neutered mal...Figure 6.480 Laparoscopic‐assisted cystoscopy was performed to remove the cy...Figure 6.481 The large calculi were removed with grasping forceps.Figure 6.482 All large stones and small fragments were removed.Figure 6.483 Removal of a pelvic urethral calculus with 2 mm‐diameter rigid ...Figure 6.484 Removal of a pelvic urethral calculus using a 5 Fr stone basket...Figure 6.485 An oxalate calculus in the distal urethra of an eight‐year‐old ...Figure 6.486 Transurethral correction of ectopic ureters was first attempted...Figure 6.487 The opening of the right ectopic intramural ureter at the cauda...Figure 6.488 The ostium of the left ureter in the patient in Figure 6.487 in...Figure 6.489 The free wall of the ectopic ureter separating the ectopic uret...Figure 6.490 A 600 μm laser fiber was passed through the operating channel o...Figure 6.491 The free wall of the ectopic ureter was cut cranially into the ...Figure 6.492 The ectopic ureter was dilated throughout its length, thereby m...Figure 6.493 The vaginal vestibule of a seven‐month‐old intact female Chocol...Figure 6.494 The vaginal vestibule of an 11‐week‐old intact female Yellow La...Figure 6.495 An asymmetrical vaginal vestibule with the patient, a one‐year‐...Figure 6.496 The vaginal vestibule of a three‐year‐old spayed female Siberia...Figure 6.497 The small opening of a right‐side intramural ectopic ureter in ...Figure 6.498 A weasel wire was placed into the ectopic ureter to help identi...Figure 6.499 Transection of the thick septum between the vaginal ostium of a...Figure 6.500 An 8 Fr red rubber urinary catheter passed from the vaginal ope...Figure 6.501 An intramural ectopic ureter in the urethra of a dog with a lar...Figure 6.502 Transection of the ureteral free wall caudal to the defect furt...Figure 6.503 Progression of the free wall cut cranially reveals the size of ...Figure 6.504 The ureterocele free wall is cut to the level where the ureter ...Figure 6.505 The exit point of the ureter through the bladder wall is freque...Figure 6.506 The small opening of an intramural ectopic ureter in the caudal...Figure 6.507 Continuation of the very small intramural ectopic ureter lumen ...Figure 6.508 Thickening of the axial free wall of the ectopic ureter in the ...Figure 6.509 The weasel wire in this image has been passed cranially in the ...Figure 6.510 Extension of the ectopic ureter free wall cut beyond the crania...Figure 6.511 The ureteral free walls were cut with the laser in a five‐month...Figure 6.512 The location of the right ureter with no opening. The ureteral ...Figure 6.513 The healed left ureteral ostium 18 months after transurethral l...Figure 6.514 Transurethral examination of ectopic ureters corrected with tra...Figure 6.515 The left ureteral neostoma with a small visible lumen that was ...Figure 6.516 Urine flow was seen from the right ureteral neostoma, but there...Figure 6.517 An example of a healed ureteral ostium after transurethral ecto...Figure 6.518 Once the abnormal anatomy has been defined and the openings of ...Figure 6.519 The electrode is inserted into the ectopic ureteral opening, an...Figure 6.520 The electrode is activated to apply the radio‐frequency cutting...Figure 6.521 With radio‐frequency being active, the electrode is retracted c...Figure 6.522 The free wall of the ectopic ureter is cut to the normal level ...Figure 6.523 A modified narrow loop electrode was used in this patient with ...Figure 6.524 Small vaginal webs are transected easily with small flexible bi...Figure 6.525 Small flexible scissors passed through the operating channel of...Figure 6.526 The diode laser is used for transecting small vaginal webs when...Figure 6.527 Small thin vaginal webs can be broken with pressure from the ti...Figure 6.528 Prior to the availability of the diode laser, large thick vagin...Figure 6.529 Mild bleeding was seen following the transection of large thick...Figure 6.530 Examination of the cut vaginal septum seen in Figures 6.528 and...Figure 6.531 A diode laser fiber that has been passed through the operating ...Figure 6.532 The thick vaginal septum seen in Figure 6.531 while being cut w...Figure 6.533 Completed transection of the vaginal septum seen in Figures 6.5...Figure 6.534 Preparation for bulking agent injection with the cystoscope pos...Figure 6.535 Placement of the needle is critical. It is inserted parallel to...Figure 6.536 Injection is initiated and observed for the creation of a visib...Figure 6.537 Injection is continued slowly while observing the increase in t...Figure 6.538 Injection is discontinued when the desired quantity of material...Figure 6.539 The same steps are repeated twice to produce three injection si...Figure 6.540 The desired end result is three equal‐sized projections of coll...Figure 6.541 A patient initially treated for ectopic ureters with transureth...