Advice for a dog with urethral obstruction due to TCC

RE: Advice for a dog with urethral obstruction due to TCC

Andrew Kent — Tue, 09 Apr 2019 08:28:07 GMT

[quote user="Liz Barton"]I've seen recent case reports of intra-arterial chemo to treat prostatic neoplasia. They of the Fitzpatrick clan, but I think others too? Andrew Kent do you think there's any merit chasing this?[/quote]

Good question - the short answer is that it may be too early to say yet.

We (and others) offer various different intra-arterial procedures including IA chemo, chemoembolisation and bland embolisation. There is some early experience suggesting benefit in some situations (so bland embolisation is perhaps the most promising for prostates), chemoembolisation for livers but it is quite early days.

The problem with IA chemo is that it significantly increases the cost/complexity of administration and (to my knowledge) nobody has yet shown survival benefits over standard chemo approaches.

But work ongoing in various places to explore this further.....

Andy

RE: Advice for a dog with urethral obstruction due to TCC

Liz Barton — Mon, 08 Apr 2019 22:50:54 GMT

[quote user="Jenny Harris"]the prostate also looked a bit enlarged for a neutered male and felt very firm on rectal, so this may be involved too.[/quote]

I've seen recent case reports of intra-arterial chemo to treat prostatic neoplasia. They of the Fitzpatrick clan, but I think others too? Andrew Kent do you think there's any merit chasing this?

RE: Advice for a dog with urethral obstruction due to TCC

Jenny Harris — Fri, 05 Apr 2019 22:01:28 GMT

Thank you everyone- this has been a really interesting discussion, and I feel I have learned some things to help with future cases.

Gillian my dad had that too- the first doctor wanted to try a second round of the chemo instilled directly into the bladder but he sought a second opinion where they advised cystectomy- which was lucky as when they did histo the tumor had gone full thickness so this likely saved his life. They made a new bladder out of a bit of bowel and re-plumbed it all in- amazing really!

RE: Advice for a dog with urethral obstruction due to TCC

Gillian Mostyn — Fri, 05 Apr 2019 20:24:15 GMT

[quote user="Andrew Kent"]Humans tend to have much more superficial TCCs so topical therapy is often tried.[/quote]

Yeah...Dad's was too advanced...it didn't work.

[quote user="Andrew Kent"]We often do use prazosin/tamsulosin in urethral tumours. The team at Davies published a case series showing improvement in clinical signs, presumably because these cases get some degree of urethral spasm due to the tumour/straining. So I agree these are worth a go alongside your other therapies.[/quote]

Fair enough...I stand corrected. But, as you indicate, I assume medical therapy alone is unlikely to be enough?

RE: Advice for a dog with urethral obstruction due to TCC

Andrew Kent — Fri, 05 Apr 2019 19:48:29 GMT

Hi Jenny,

We manage a reasonable number of urethral tumours with various different methods. In the first instance I agree that laser debulking or stenting are both potential options. I will laser male dogs (this would likely be centre dependent as it requires specific equipment) but I only advocate this with very focal disease as my experiences with more diffuse disease is poor.

Urethral stenting is well tolerated and offers instant relief of clinical signs in the majority of patients. Main potential adverse effects include ongoing dysuria (relatively uncommon) and urinary incontinence (about 50% of cases) it is also reasonably expensive. Clearly there are some cases that have poor response due to aggressive progression of the tumour but use of this with appropriate adjunctive chemotherapy gives most dogs survival of 6-12 months which is not bad from the point of urethral obstruction.

Permanent cystostomy tube is another option but I agree there are ethical concerns with this.

Chemotherapy would be advised in all cases as well, the choice of agent is often down to opinion. I often use vinblastine first line but carboplatin or mitox are also options alongside the NSAID.

I would say of the cases we see about 50% go for euthanasia and about 50% go for stenting at the point of urethral obstruction.

[quote user="Gillian Mostyn"]My dad had reduced urine flow due to TCC and required frequent bladder lining ablations and had BCG instilled. No idea whether this is available in dogs? (It was unsuccessful, and he eventually had both kidneys, ureters, bladder and urethra surgically removed.)[/quote]

Humans tend to have much more superficial TCCs so topical therapy is often tried. Dogs are almost always invasive forms so these are not really advisable. But I like ablations in some cases (pedunculated masses, ball valve masses etc).

[quote user="Anthony Todd"]

This sounds as if it is the same as men get with "prostate enlargement", , and Tamsulosin dilates and relaxes the urethra giving good results.

It may be worth trying this, with a weight calculated dose if euthanasia is the only option.

It doesn't seem to have many serious side effects in men, but check on the net.

[/quote]

We often do use prazosin/tamsulosin in urethral tumours. The team at Davies published a case series showing improvement in clinical signs, presumably because these cases get some degree of urethral spasm due to the tumour/straining. So I agree these are worth a go alongside your other therapies.

Andy

RE: Advice for a dog with urethral obstruction due to TCC

Matt Hilary — Fri, 05 Apr 2019 18:11:37 GMT

Yes - we use prazosin (Hypovase) from the same family of drugs for muscle relaxation.

RE: Advice for a dog with urethral obstruction due to TCC

Anthony Todd — Fri, 05 Apr 2019 17:44:43 GMT

[quote user="Matt Hilary"]Had a similar case in an 8yo MN Lab a few years back that had stenting + meloxicam. Euthanased within 2 months due to local issues.[/quote]

The condition may be commoner than we think and tamsulosin may be helpful in some so worth a try, independent of the name of of the tumour.............

Google it; lots of indications that it just might help; doesn't seem to be dangerous either.

RE: Advice for a dog with urethral obstruction due to TCC

Matt Hilary — Fri, 05 Apr 2019 17:22:33 GMT

Had a similar case in an 8yo MN Lab a few years back that had stenting + meloxicam. Euthanased within 2 months due to local issues.

[N=1 obviously]

RE: Advice for a dog with urethral obstruction due to TCC

Gillian Mostyn — Fri, 05 Apr 2019 16:56:46 GMT

[quote user="Anthony Todd"]Er, same as my friend although his is classed as benign....[/quote]

Never heard of a benign transitional cell carcinoma. I assume you mean benign prostatic hyperplasia? Which this dog may certainly have (although, being neutered, it is more likely to be neoplastic too). This may reduce urine flow but is very unlikely to be stopping it entirely.

RE: Advice for a dog with urethral obstruction due to TCC

Anthony Todd — Fri, 05 Apr 2019 14:19:47 GMT

[quote user="Gillian Mostyn"]This dog has a blocked urethra due to neoplastic growths.[/quote]

Er, same as my friend although his is classed as benign....

What's the harm in trying as there is plenty of evidence in men and it is non-invasive and painless??

He was catheterised initially too.

RE: Advice for a dog with urethral obstruction due to TCC

Gillian Mostyn — Fri, 05 Apr 2019 13:49:02 GMT

[quote user="Anthony Todd"]This sounds as if it is the same as men get with "prostate enlargement", , and Tamsulosin dilates and relaxes the urethra giving good results.[/quote]

Completely different. This dog has a blocked urethra due to neoplastic growths.

If the dog were able to urinate, I'd also try meloxicam, chemo etc. However, as it needs catheterisation I'd be reluctant to offer just medical treatment. Urinary retention is painful. I'd be looking to PTS.

My dad had reduced urine flow due to TCC and required frequent bladder lining ablations and had BCG instilled. No idea whether this is available in dogs? (It was unsuccessful, and he eventually had both kidneys, ureters, bladder and urethra surgically removed.)

RE: Advice for a dog with urethral obstruction due to TCC

Anthony Todd — Fri, 05 Apr 2019 13:39:38 GMT

This sounds as if it is the same as men get with "prostate enlargement", , and Tamsulosin dilates and relaxes the urethra giving good results.

It may be worth trying this, with a weight calculated dose if euthanasia is the only option.

It doesn't seem to have many serious side effects in men, but check on the net.

RE: Advice for a dog with urethral obstruction due to TCC

Jenny Harris — Fri, 05 Apr 2019 11:22:26 GMT

Thanks everyone for the replies, yes I have considered ethics etc but wanted to offer full range of options to the owner. i have spoken to them this morning and they feel the dog isn’t happy and I think want to go for PTS. I’m still very interested to hear any one else’s thoughts for future cases

thanks!

RE: Advice for a dog with urethral obstruction due to TCC

Utlendigur — Fri, 05 Apr 2019 11:02:14 GMT

[quote user="Jenny Harris"]

The dog has been on meloxicam- is it worth changing this to piroxicam or do most people feel now meloxicam should be just as good?

If the owners would consider chemo, I think mitoxantrone is suggested- where are people sourcing this as I cannot find it on NVS? It says to be given every 3 weeks- is that ongoing?

[/quote]

My own dog had TCC 2yrs ago. On advice from referral I had her on mitoxantrone every 3wks on-going from chemopet - but average survival is about 6mths because of the effects of local disease. She managed 6mnths and had virtually no side effects from the chemo. She was also on piroxicam. I got the impression there wasn't much to chose between piroxicam and meloxicam - piroxicam was probably slightly more effective, but more likely to give side effects. Ironically I had another case diagnosed at the same time with much worse problems (dysuria and severe bleeding from the TCC to the point of anaemia) whose owner elected to just give piroxicam because the dog was very fearful/difficult to handle would have been a nightmare for chemo. She is still going and symptom-free, although we haven't repeated the ultrasound for obvious reasons.

RE: Advice for a dog with urethral obstruction due to TCC

Sarah Keir — Fri, 05 Apr 2019 10:47:21 GMT

I believe it is the local disease that is life limiting in these cases. Have your thought about the ethics of a permanent cystotomy?

RE: Advice for a dog with urethral obstruction due to TCC

Joyce Whitehead — Thu, 04 Apr 2019 21:46:51 GMT

I can’t answer many of your questions, but if you go down the chemo route I’d strongly recommend Chemopet, they will supply you with all the drugs ready to give in the correct doses in safe packaging. And if you want will supply protective clothing etc.

Sad to say it sounds as though the dog may be doomed though...