A Novel Surgical Hybrid Approach to Neoplastic Lesions in the Distal Part of the Urethra: A Pilot Series of Clinical Cases

SIMPLE SUMMARY: Distal urethral neoplasms in female dogs are difficult to treat, due to their anatomical location and often late diagnosis. Transitional cell carcinomas are among the most recognized tumors. Available surgical techniques are difficult to perform when the tumors occupy most of the urethral length, because of the lack of adequate tissue margin and high tissue tension. Another approach is purely palliative treatment. In this article the authors propose a solution to this surgical problem with the aforementioned tumors, which is a novel hybrid technique, developed on cadaver female dogs, involving the combination of laparoscopy and open surgery. In this technique, the changed urethra is removed along with the female genitalia, with gives the opportunity to radically excise the tumor and to perform the prepubic urethrostomy. This paper presents the clinical outcomes after the treatment of urethral tumors using the hybrid technique in three female dogs. All procedures were successful, with no major complications during surgery, and the average survival time was 9 months. ABSTRACT: All the surgical approaches described to date for the removal of distal urethral tumors have some technical difficulties that make these tumors difficult to treat. The article presents for the first time the treatment results of three female dogs, diagnosed with transitional cell carcinomas of the distal urethra, operated with a newly developed hybrid surgical method—a combination of laparoscopy and open surgery. This technique uses vulvovaginectomy, combined with resection of the distal urethra and prepubic urethrostomy. All of the procedures were possible to perform, without the need to carry out a laparotomy conversion. Histopathology revealed transitional cell carcinoma in all cases, with a margin of healthy tissues maintained in two out of three cases, which meant reoperation of the urethrostomy site in the remaining one case. The mean survival time was nine months. Among minor complications, recurrent cystitis was found. After the first surgery, all dogs retained full control over urination immediately after recovery from anesthesia. In one case that required reoperation, complete urinary incontinence occurred after the second procedure. The present findings suggest that hybrid surgery can be used to treat distal urethral tumors. Qualification for surgery must be limited to bitches with tumors of the distal urethra and without metastases, without the possibility of using other surgical methods, and with the owner’s full acceptance of the risk of complications.