Percutaneous cystoscopically and fluoroscopically guided sclerotherapy for treatment of renal hematuria in a cat.

Abstract

An 11-year-old male neutered domestic shorthair cat was evaluated for severe hematuria causing urethral obstruction and marked anemia. Percutaneous cystoscopy identified hemorrhagic jets of urine issuing from the right ureterovesical junction (UVJ), raising concern for renal hematuria. Focal bleeding was observed from the bladder wall and suspected to be iatrogenic. Under cystoscopic and fluoroscopic guidance, a 2.5 Fr nephrostomy tube was advanced retrograde over a guidewire to mid-ureter and used to infuse silver nitrate and povidone iodine into the renal pelvis. A urethral catheter was used to perform sclerotherapy in the bladder. The cat showed substantial improvement in microscopic hematuria, but recurrence of hematuria was observed 80 days later. Repeat percutaneous cystoscopy and examination of the UVJs showed multiple jets of normal urine and newly noted bladder wall nodules, diagnosed as urothelial carcinoma. We describe successful renal sclerotherapy that could be refined and used for future cases of renal hematuria in cats.