Contributors: Barbara J Watrous

 Species: Canine   |   Classification: Techniques

Introduction Requirements Preparation Procedure Aftercare Outcomes Further Reading

Introduction

  • Allows visualization of vagina and urethra.

Uses

  • Investigation of lower urinary tract disease:
  • Investigation of vaginal discharge.
  • Investigation of urinary incontinence Urinary incontinence.
  • Investigation of physical vaginal abnormalities, eg neoplasia Urethra neoplasia  stricture -  retrograde vaginourethrogram Vagina neoplasia - retrograde vaginourethrogram stenosis.

Advantages

  • Simple and quick to do.

Disadvantages

Alternative Techniques

  • Vaginourethral endoscopy (requires specialized equipment not readily available in practice).

Time Required

Preparation

  • 15 min.

Procedure

  • 10 min (plus time for general anesthesia).

Decision Taking

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?

Risk assessment

  • Procedure carries minimal risk above that of anesthesia.
  • Reported increased risk of vaginal rupture in Shelties and Rough Collies.

Requirements

Materials Required

Minimum equipment

  • X-ray machine.
  • Radiographic cassette.
  • Processing facilities.
  • Protective clothing (lead apron) for radiographer.
  • Positioning aids (sandbags and ties).
  • Method of labelling film.

Ideal equipment

  • 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.

Minimum consumables

  • Radiographic film.
  • Contrast agent.
  • Syringe.
  • 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

Preparation

Dietary Preparation

  • Withhold food from animal for 12 hours prior to anesthesia.

Restraint

  • General anesthesia required.

Procedure

Approach

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

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

 

Core Procedure

 

Step 1 - Assess radiographs

 
  • Check radiograph to ensure adequate distension of vagina Urethra normal retrograde vaginourethrogram (female) - lateral.

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.

Aftercare

Immediate

Antimicrobial therapy

  • Provided sterile technique used antibiotics are not required.

Potential complications

  • 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.

Outcomes

Reasons for Treatment Failure

  • Failure to seal vulval lips results in leakage of contrast and inadequate filling of vagina and urethra.

Further Reading

Publications

Refereed papers

  • 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.