Contributors: Barbara J Watrous
Species: Canine | Classification: Techniques
- Allows visualization of vagina and urethra.
- Investigation of lower urinary tract disease:
- Investigation of vaginal discharge.
- Investigation of urinary incontinence Urinary incontinence.
- Investigation of physical vaginal abnormalities, eg neoplasia stenosis.
- Simple and quick to do.
- Requires general anesthesia General anesthesia: overview.
- Vaginourethral endoscopy (requires specialized equipment not readily available in practice).
- 15 min.
- 10 min (plus time for general anesthesia).
Criteria for choosing test
- Is the examination appropriate?
- Can you make the diagnosis without it?
- Will your management of the case be affected by the outcome of the examination?
- Procedure carries minimal risk above that of anesthesia.
- Reported increased risk of vaginal rupture in Shelties and Rough Collies.
- X-ray machine.
- Radiographic cassette.
- Processing facilities.
- Protective clothing (lead apron) for radiographer.
- Positioning aids (sandbags and ties).
- Method of labelling film.
- Ability to process films during procedure so that repeat radiographs can be taken during course of study if required.
- High output x-ray machine.
- High definition screen.
- Grid for examination of large dog.
- Tongue clamps or Allis tissue forceps.
- Vaginal speculum may be helpful for bladder catheterization in bitch.
- Radiographic film.
- Contrast agent.
- Three way stopcock.
- Foley catheter.
If patient is a very small dog, an angiographic, flow-directed balloon-catheter, eg Swan-Gante, may be used because of smaller gauge. (May have access to this type of catheter through a radiology department of a local human hospital.
To prevent tip of catheter occluding urethral orifice cut tip off Foley catheter beyond bulb but ensure bulb of catheter still inflates
- Withhold food from animal for 12 hours prior to anesthesia.
- General anesthesia required.
Step 1 - Control films
- Check exposure settings and processing.
- Confirm positioning adequate (dogs should be positioned in lateral recumbency).
- Confirm diagnosis not apparent without contrast study.
Step 2 - Additional radiographic contrast studies - optional
- Catheterize bladder Urethral catheterization: female and perform pneumocystogram Radiography: double contrast cystography.
Only distend bladder moderately to allow for further distension by contrast agent.
- Remove catheter after this procedure.
Step 3 - Instill positive contrast agent
- Prefill the Foley catheter and syringe with contrast media.
- Insert catheter into vestibule of vagina and inflate bulb of Foley catheter with water/saline.
- Apply tongue/Allis tissue forceps to vulval lips next to catheter to prevent reflux of contrast.
- Gently pull catheter caudally so that bulb of catheter is at entrance to vagina to avoid obstructing urethral orifice.
- Inject contrast up to 1 ml/kg. In larger dogs a contrast medium may be administered in sequential 10 ml aloquats until adequately distended.
Stop injection if resistance felt or reflux of contrast from vagina.
Step 4 - Obtain radiographic views
- Make lateral radiographic Radiography: abdomen exposure at end of injection.
Step 1 - Assess radiographs
Step 2 - Additional radiographic procedures
- Repeat exposure after additional contrast added if necessary.
Step 3 - Remove catheter
- Remove clamps.
- Deflate catheter bulb.
- Withdraw Foley catheter.
- Provided sterile technique used antibiotics are not required.
- Vaginal rupture has been reported as a consequence of vaginourethrography.
Rough Collies and Shelties appear to be at greater risk of this complication.
- Conservative management should be sufficient if vaginal rupture occurs.
- A reduced dose may be required in incontinent bitches.
- Over-distension of bladder can lead to bladder rupture or inflammatory bladder disease.
- Iatrogenic urinary tract infections have been reported.
Reasons for Treatment Failure
- Failure to seal vulval lips results in leakage of contrast and inadequate filling of vagina and urethra.
- Recent references from PubMed and VetMedResource.
- Holt P E, Gibbs C & Latham J (1984) An evaluation of positive contrast vaginourethrography as a diagnostic aid in the bitch. JSAP 25 (9), 531-549 Wiley Online Library.
- Johnston G R, Stevens J B, Jessen C R et al (1983) Complications of retrograde contrast urethrography in dogs and cats. Am J Vet Res 44 (7), 1248-1256 PubMed.
- Feeney D A, Thrall D E, Barber D L et al (1979) Normal excretory urogram - effect of dose, time and individual dog variation. Am J Vet Res 40 (11), 1596-1604 PubMed.
Other sources of information
- Silverman S & Long C D (2000) The diagnosis of urinary incontinence and abnormal urination in dogs and cats. Vet Clin North Am Small Anim Pract 30 (2), 427-48 PubMed.