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SURGICAL MANAGEMENT OF A PARARENAL PSEUDOCYST IN A FERRET (MUSTELA PUTORIUS FURO)
Accepted Manuscript
Surgical management of a pararenal pseudocyst in a ferret (Mustela putorius furo) Ana¨ıs Sailler DVM , Emmanuel Risi DVM , Juliette Magrans DVM , Hel Kolb DVM , Sophie Segond DVM , ´ ene ` Jean-Philippe Billet DVM Dip ECVS PII: DOI: Reference:
S1557-5063(18)30147-2 https://doi.org/10.1053/j.jepm.2018.11.010 JEPM 50191
To appear in:
Journal of Exotic Pet Medicine
Please cite this article as: Ana¨ıs Sailler DVM , Emmanuel Risi DVM , Juliette Magrans DVM , Hel Kolb DVM , Sophie Segond DVM , Jean-Philippe Billet DVM Dip ECVS , Surgical manage´ ene ` ment of a pararenal pseudocyst in a ferret (Mustela putorius furo), Journal of Exotic Pet Medicine (2018), doi: https://doi.org/10.1053/j.jepm.2018.11.010
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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SURGICAL MANAGEMENT OF A PARARENAL PSEUDOCYST IN A FERRET (MUSTELA PUTORIUS FURO) Anaïs Saillera, DVM, Emmanuel Risia, DVM, Juliette Magransb, DVM,, Hélène Kolbc, DVM, Sophie Segondc, DVM, Jean-Philippe Billetc, DVM, Dip ECVS. a FauneVET, 22 rue René Viviani, 44200 Nantes, France. b Present address: Clinique Vétérinaire des Rochettes, 7 route de Nantes, 85600 Montaigu, France. c Centre Hospitalier Vétérinaire Atlantia, 22 rue René Viviani, 44200 Nantes, France. Adress correspondence to: Anaïs Sailler, DVM, FauneVET, 22 rue René Viviani, 44200 Nantes, France. E-mail: [email protected] Phone number +33240474009 Abstract A 9-month-old neutered female ferret (Mustela putorius furo) was presented for a recurring cystic abdominal mass. An ovariohysterectomy was performed 7 months earlier. Ultrasonography, tomodensitometry and fine-needle puncture revealed right hydronephrosis, hydroureter and a voluminous pararenal pseudocyst. Surgery consisted in unilateral nephrectomy, urinoma opening and omentalisation. The right ureter was blind. That cystic lesion had certainly been induced by ligation and transection of the ureter during early ovariohysterectomy. Two years postoperatively, the ferret remained healthy and no sign of recurrence was observed. This is the first case of a pararenal pseudocyst surgical management in a ferret. Key words: Ferret, hydronephrosis, ovariohysterectomy, surgery, urinoma
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Clinical case A 9-month-old neutered female ferret (Mustela putorius furo) with a 7-month history of cystic abdominal mass was presented for further examination. The owners reported a good appetite and no deterioration in activity level or behavior. Between 100 mL and 200 mL were drawn off every three weeks at the beginning and then weekly, during seven months. A laparotomy was performed two months before the presentation: a biopsy of the cyst wall revealed an abdominal epithelial cyst with osteoid metaplasia but the origin of the cyst remained unknown. The animal was surgically neutered at 2-month-old and implanted subcutaneously with a GnRH agonist (deslorelin acetate, Suprelorin 4.7 mg, Virbac France, Carros, France). She was fed with ferret pellets and lived alone. On physical examination, the ferret was active and her body condition score was 3/5. A large non painful freely movable abdominal mass was felt on the right side on abdominal palpation. The remainder of the examination was unremarkable. Abdominal ultrasounds under general anesthesia (isoflurane 2%, 1 L/min oxygen, facemask) revealed a sharply marginated cystic structure displacing intestinal loops, severe right renal hydronephrosis and a right ureteromegaly (Fig. 1-2). The examination of the left kidney and ureter was unremarkable. An ultrasound-guided fine-needle paracentesis was performed. A clear yellow fluid was aspirated and its biochemical analysis was consistent with urine (BUN greater than 200 mg/dL, creatinine 107 mg/dL).
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To try to determine the precise origin of the cyst, a tomodensitometric exam was carried out. The visualization of a large cystic lesion (48*61*80 mm) occupying the vast majority of the abdominal cavity confirmed ultrasonographic results. The cyst fluid was homogenous with a low density (12 UH). A ionised iodine contrast product (2 mL/kg, Hexabrix 320, Guerbet, Roissy, France) was injected intravenously. Severe distension of the right ureter at its junction with the renal pelvis was noticed. After several acquisitions, a small volume of the contrast product was visible on the right side of the urinary tract. However, it remained very superficial to the lesion, preventing identification of the exact tract of the ureter from the kidney to the bladder (Fig. 3). Biochemical renal parameters were within normal limits (BUN 27 mg/dL; reference range 10–45 mg/dL, creatinine 0.25 mg/dL; reference range 0.2–1 mg/dL). According to fluid analysis and imaging results, a pararenal pseudocyst or urinoma is diagnosed. Surgery was planned four days later. The ferret was sedated with morphine (0.2 mg/kg intramuscularly; Morphine chlorhydrate Lavoisier, Laboratoires Chaix et du Marais, Paris, France) and medetomidine (40 µg/kg intramuscularly; Narcostart, Le Vet, Oudewater, Netherlands). A 26-gauge catheter was then aseptically placed in the left external cephalic vein and anesthesia was induced with propofol (3 mg/kg intravenously, Propovet, Zoetis, Malakoff, France). The ferret was intubated with a 2.5 mm endotracheal tube and isoflurane was used for maintenance of anesthesia. A perioperative fluid therapy was initiated with saline solution (10 mL/kg/h). The ferret was placed in dorsal recumbency, and the ventral abdomen was clipped and aseptically prepared for surgery. Monitoring equipment included an electrocardiogram, a capnograph and a pulse oximeter. A ventral midline incision, from the xiphoid process to the pubis, was made to approach the urinoma and abdominal structures that might have been involved. A firm rounded retroperitoneal mass was observed on the right side (Fig. 4). That urinoma was incised and the fluid was removed by suction. A complete excision was impossible because of numerous adhesions to the intestines. A partial ablation of the capsule and omentalisation were performed. The bladder showed no abnormality but the right ureter was blind about 2 cm from its opening into the bladder. The proximal right ureter stopped from several centimeters to its other section. The ureteral stump was ligated and the tip was transected. The right kidney was visualized by tearing off the falciform ligament and retracting the intestines to the opposite side. The perirenal fat around the hilus was dissected allowing isolation of renal vein and artery. They were then ligated and cut off. Electrosurgery was finally used to transect the retroperitoneal attachments of the kidney. Warm sterile saline was used for peritoneal and retroperitoneal lavage. The muscle wall was sutured with 3-0 polydioxanone in a simple continuous suture pattern, and the skin incision was closed with 4-0 poliglecaprone in a continuous suture pattern. The ferret recovered uneventfully from the anesthesia. Analgesia was provided by administration of morphine (0.2 mg/kg subcutaneously each 4h, Morphine chlorhydrate Lavoisier, Laboratoires Chaix et du Marais, Paris, France) for the first 12 hours and then buprenorphine (20 µg/kg twice daily subcutaneously, Bupaq, Richter Pharma, Wels, Austria)
ACCEPTED MANUSCRIPT during the full length of hospitalization. She was also given commercial carnivore diet syringe feeding (Carnivore care, Oxbow Animal Health, Murdock, NV USA), and meloxicam (0.1 mg/kg once daily subcutaneously, Metacam, 5 mg/mL; Boehringer Ingelheim, Vetmedica, Reims, France). The ferret remained lively as soon as she woke up and was discharged from the hospital 3 days after the surgery without any treatment. Two years postoperatively, the ferret remains healthy and no sign of relapse is observed by the owners.
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Discussion Cases of hydroureter and hydronephrosis remain poorly reported in ferret medicine and may be related with ligation of a ureter during ovariohysterectomy.1 However, authors described cases secondary to ureteral obstructions by stones, extraluminal ureteral compression by cysts or prostatomegaly in male ferrets and a bilateral congenital ureterovesical junction stenosis.2,3 Moreover, some cystic urogenital anomalies have been reported, mostly near the bladder and the proximal urethra, deriving from vestiges of the embryologic urogenital system.4 A urinoma is a retroperitoneal collection of extravasated urine confined in a fibrous sac. That urine extravasation results in lipolysis and fat necrosis, followed by a fibroblastic response. In five to twelve days, it will contain the urine and within three to six weeks, it will encapsulate the urine in a dense connective tissue shell.5,6 Several synonyms are used in literature to describe that lesion: urinoma, pararenal pseudocyst, paraureteral pseudocyst … Nevertheless, it has to be distinguished from perinephric pseudocysts which are fluid-filled sacs surrounding kidneys, often associated with chronic renal failure in old cats. One case had been reported in a male ferret suffering from polycystic kidneys.7 Urinomas are rarely described in humans, occurring secondarily to ureteral calculi, blunt or penetrating trauma or iatrogenic.8 Post-traumatic urinomas are rather well-known in cats. Dorsal or sublumbar swellings, abdominal pain and lethargy were the symptoms, appearing two to eight weeks after a road traffic accident.9-11 A cow developed a urinoma following dystocia and forced extraction of twin calves. Lack of urination for several days, abdominal pain and inappetence led to a decision of euthanasia. Trauma to the urogenital tract during the dystocia were presumed to be the most probable cause of the pararenal pseudocyst.12 In our case, the ferret showed no discomfort to abdominal palpation and remained alert before the surgery. No history of trauma was notified by the owners. Accidental ligation and transection of a ureter during ovariohysterectomy resulted in formation of a urinoma in a dog. Ultrasonography revealed unilateral hydronephrosis and hydroureter as in our case.5 Considering ferret’s anamnesis and surgical findings, especially right blind ureter, ligature and transection of that ureter during ovariohysterectomy is the most probable hypothesis leading to the urinoma creation. Diagnosis of urinoma is based on medical imaging. Ultrasonographically, it is anechoic, elliptical or indented by organs and has sharp margins.5 On the CT-scan, distal right ureter and urinoma were not highlighted by the contrast product. Excretory urography was used in dogs and cats with pararenal pseudocyst and no or very slight opacification of the lesion was seen.10,11 It may be due to the great dilution of the contrast product or unilateral renal excretion impairment. Repeated punctures are not sufficient and a surgical treatment was necessary. Authors reported successful surgical management in dogs and cats, including opening and partial
ACCEPTED MANUSCRIPT ablation of the urinoma as well as omentalisation with or without ureteronephrectomy.5,9-11 In this case, renal parameters were within normal limits and the left kidney was considered to have normal echogenicity and structure. No suspicion of contralateral renal dysfunction was considered, that is why a ureteronephrectomy was performed. Adhesions to intestinal loops are common and complete ablation of the shell of the urinoma is always impossible. Omentalisation provides a physiological drainage and helps to reduce dead space to avoid relapse.
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Pararenal pseudocysts are encapsulated collection of extravasated urine reported in several mammals: humans, dogs, cats and cattle. This is the first case description and surgical management in a pet ferret. Early surgical neutering (about 2 months) is a fairly common practice in pet shops but lots of complications may occur. Urinomas have to be included in the differential diagnosis of an abdominal mass on young neutered ferrets.
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References 1. Pollock G : Disorders of the urinary and reproductive system, in Quesenberry KE, Carpenter JW (eds): Ferrets, rabbits and rodents: Clinical medecine and surgery. St. Louis, MO, Elsevier/Saunders, 46-61, 2012 2. Orcutt CJ: Ferret urogenital diseases. Vet Clin Exot Animal 6:113-138, 2003. 3. Vilatla L, et al: Imaging diagnosis-radiography and ultrasonography of bilateral congenital ureterovesical junction stenosis causing hydronephrosis and hydroureter in a ferret. Vet Radiol Ultrasound, 1-6, 2016. 4. Li X, et al: Cystic urogenital anomalies in ferrets. Vet Pathol 33:2;150-158, 1996. 5. Tidwell AS, et al: Urinoma in a dog. Vet Radiol 31:4;203-206, 1990. 6. Yeh EL, Chiang L, Meade RC: Ultrasound and radionuclide studies of urinary extravasation with hydronephrosis. Journal of urology 125; 728-730, 1981. 7. Puerto DA, Walker LM, Saunders HM: Bilateral perinephric pseudocysts and polycystic kidneys in a ferret. Vet Radiol Ultrasound 39:4;309-312, 1998. 8. Titton RL, et al: Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics 23(5); 1133-1147, 2003. 9. Bacon NJ, Anderson DM, Baines EA, White RAS: Post-traumatic para-ureteral urinoma (uriniferous pseudocyst) in a cat. Veterinary Comparative Orthopaedics and Traumatology 15,123-126, 2002. 10. Moores AP, Bell AM, Costello M: Urinoma (para-ureteral pseudocyst) as a consequence of trauma in a cat. J small anim Pract. 43;213-216, 2002. 11. Worth AJ, Tomlin SC: Post-traumatic paraureteral urinoma in a cat. J small anim Pract. 45(8);413-416, 2004. 12. Lopèz A et al: Urinoma in a post-parturient cow. Can Vet J 36(4); 242-243, 1995.
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Figure 1: longitudinal ultrasound image of the cystic structure
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Figure 2: longitudinal ultrasound image of the severe right hydronephrosis
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Figure 3: longitudinal CT-scan image of the ferret’s abdomen. Notice that the lesion is taking half of the abdominal cavity.
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Figure 4: laparotomy of the ferret. A large urinoma (large arrow) displaces other organs. The right ureter (thin arrow) is blind.
Surgical management of a pararenal pseudocyst in a ferret (Mustela putorius furo) Ana¨ıs Sailler DVM , Emmanuel Risi DVM , Juliette Magrans DVM , Hel Kolb DVM , Sophie Segond DVM , ´ ene ` Jean-Philippe Billet DVM Dip ECVS PII: DOI: Reference:
S1557-5063(18)30147-2 https://doi.org/10.1053/j.jepm.2018.11.010 JEPM 50191
To appear in:
Journal of Exotic Pet Medicine
Please cite this article as: Ana¨ıs Sailler DVM , Emmanuel Risi DVM , Juliette Magrans DVM , Hel Kolb DVM , Sophie Segond DVM , Jean-Philippe Billet DVM Dip ECVS , Surgical manage´ ene ` ment of a pararenal pseudocyst in a ferret (Mustela putorius furo), Journal of Exotic Pet Medicine (2018), doi: https://doi.org/10.1053/j.jepm.2018.11.010
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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SURGICAL MANAGEMENT OF A PARARENAL PSEUDOCYST IN A FERRET (MUSTELA PUTORIUS FURO) Anaïs Saillera, DVM, Emmanuel Risia, DVM, Juliette Magransb, DVM,, Hélène Kolbc, DVM, Sophie Segondc, DVM, Jean-Philippe Billetc, DVM, Dip ECVS. a FauneVET, 22 rue René Viviani, 44200 Nantes, France. b Present address: Clinique Vétérinaire des Rochettes, 7 route de Nantes, 85600 Montaigu, France. c Centre Hospitalier Vétérinaire Atlantia, 22 rue René Viviani, 44200 Nantes, France. Adress correspondence to: Anaïs Sailler, DVM, FauneVET, 22 rue René Viviani, 44200 Nantes, France. E-mail: [email protected] Phone number +33240474009 Abstract A 9-month-old neutered female ferret (Mustela putorius furo) was presented for a recurring cystic abdominal mass. An ovariohysterectomy was performed 7 months earlier. Ultrasonography, tomodensitometry and fine-needle puncture revealed right hydronephrosis, hydroureter and a voluminous pararenal pseudocyst. Surgery consisted in unilateral nephrectomy, urinoma opening and omentalisation. The right ureter was blind. That cystic lesion had certainly been induced by ligation and transection of the ureter during early ovariohysterectomy. Two years postoperatively, the ferret remained healthy and no sign of recurrence was observed. This is the first case of a pararenal pseudocyst surgical management in a ferret. Key words: Ferret, hydronephrosis, ovariohysterectomy, surgery, urinoma
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Clinical case A 9-month-old neutered female ferret (Mustela putorius furo) with a 7-month history of cystic abdominal mass was presented for further examination. The owners reported a good appetite and no deterioration in activity level or behavior. Between 100 mL and 200 mL were drawn off every three weeks at the beginning and then weekly, during seven months. A laparotomy was performed two months before the presentation: a biopsy of the cyst wall revealed an abdominal epithelial cyst with osteoid metaplasia but the origin of the cyst remained unknown. The animal was surgically neutered at 2-month-old and implanted subcutaneously with a GnRH agonist (deslorelin acetate, Suprelorin 4.7 mg, Virbac France, Carros, France). She was fed with ferret pellets and lived alone. On physical examination, the ferret was active and her body condition score was 3/5. A large non painful freely movable abdominal mass was felt on the right side on abdominal palpation. The remainder of the examination was unremarkable. Abdominal ultrasounds under general anesthesia (isoflurane 2%, 1 L/min oxygen, facemask) revealed a sharply marginated cystic structure displacing intestinal loops, severe right renal hydronephrosis and a right ureteromegaly (Fig. 1-2). The examination of the left kidney and ureter was unremarkable. An ultrasound-guided fine-needle paracentesis was performed. A clear yellow fluid was aspirated and its biochemical analysis was consistent with urine (BUN greater than 200 mg/dL, creatinine 107 mg/dL).
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To try to determine the precise origin of the cyst, a tomodensitometric exam was carried out. The visualization of a large cystic lesion (48*61*80 mm) occupying the vast majority of the abdominal cavity confirmed ultrasonographic results. The cyst fluid was homogenous with a low density (12 UH). A ionised iodine contrast product (2 mL/kg, Hexabrix 320, Guerbet, Roissy, France) was injected intravenously. Severe distension of the right ureter at its junction with the renal pelvis was noticed. After several acquisitions, a small volume of the contrast product was visible on the right side of the urinary tract. However, it remained very superficial to the lesion, preventing identification of the exact tract of the ureter from the kidney to the bladder (Fig. 3). Biochemical renal parameters were within normal limits (BUN 27 mg/dL; reference range 10–45 mg/dL, creatinine 0.25 mg/dL; reference range 0.2–1 mg/dL). According to fluid analysis and imaging results, a pararenal pseudocyst or urinoma is diagnosed. Surgery was planned four days later. The ferret was sedated with morphine (0.2 mg/kg intramuscularly; Morphine chlorhydrate Lavoisier, Laboratoires Chaix et du Marais, Paris, France) and medetomidine (40 µg/kg intramuscularly; Narcostart, Le Vet, Oudewater, Netherlands). A 26-gauge catheter was then aseptically placed in the left external cephalic vein and anesthesia was induced with propofol (3 mg/kg intravenously, Propovet, Zoetis, Malakoff, France). The ferret was intubated with a 2.5 mm endotracheal tube and isoflurane was used for maintenance of anesthesia. A perioperative fluid therapy was initiated with saline solution (10 mL/kg/h). The ferret was placed in dorsal recumbency, and the ventral abdomen was clipped and aseptically prepared for surgery. Monitoring equipment included an electrocardiogram, a capnograph and a pulse oximeter. A ventral midline incision, from the xiphoid process to the pubis, was made to approach the urinoma and abdominal structures that might have been involved. A firm rounded retroperitoneal mass was observed on the right side (Fig. 4). That urinoma was incised and the fluid was removed by suction. A complete excision was impossible because of numerous adhesions to the intestines. A partial ablation of the capsule and omentalisation were performed. The bladder showed no abnormality but the right ureter was blind about 2 cm from its opening into the bladder. The proximal right ureter stopped from several centimeters to its other section. The ureteral stump was ligated and the tip was transected. The right kidney was visualized by tearing off the falciform ligament and retracting the intestines to the opposite side. The perirenal fat around the hilus was dissected allowing isolation of renal vein and artery. They were then ligated and cut off. Electrosurgery was finally used to transect the retroperitoneal attachments of the kidney. Warm sterile saline was used for peritoneal and retroperitoneal lavage. The muscle wall was sutured with 3-0 polydioxanone in a simple continuous suture pattern, and the skin incision was closed with 4-0 poliglecaprone in a continuous suture pattern. The ferret recovered uneventfully from the anesthesia. Analgesia was provided by administration of morphine (0.2 mg/kg subcutaneously each 4h, Morphine chlorhydrate Lavoisier, Laboratoires Chaix et du Marais, Paris, France) for the first 12 hours and then buprenorphine (20 µg/kg twice daily subcutaneously, Bupaq, Richter Pharma, Wels, Austria)
ACCEPTED MANUSCRIPT during the full length of hospitalization. She was also given commercial carnivore diet syringe feeding (Carnivore care, Oxbow Animal Health, Murdock, NV USA), and meloxicam (0.1 mg/kg once daily subcutaneously, Metacam, 5 mg/mL; Boehringer Ingelheim, Vetmedica, Reims, France). The ferret remained lively as soon as she woke up and was discharged from the hospital 3 days after the surgery without any treatment. Two years postoperatively, the ferret remains healthy and no sign of relapse is observed by the owners.
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Discussion Cases of hydroureter and hydronephrosis remain poorly reported in ferret medicine and may be related with ligation of a ureter during ovariohysterectomy.1 However, authors described cases secondary to ureteral obstructions by stones, extraluminal ureteral compression by cysts or prostatomegaly in male ferrets and a bilateral congenital ureterovesical junction stenosis.2,3 Moreover, some cystic urogenital anomalies have been reported, mostly near the bladder and the proximal urethra, deriving from vestiges of the embryologic urogenital system.4 A urinoma is a retroperitoneal collection of extravasated urine confined in a fibrous sac. That urine extravasation results in lipolysis and fat necrosis, followed by a fibroblastic response. In five to twelve days, it will contain the urine and within three to six weeks, it will encapsulate the urine in a dense connective tissue shell.5,6 Several synonyms are used in literature to describe that lesion: urinoma, pararenal pseudocyst, paraureteral pseudocyst … Nevertheless, it has to be distinguished from perinephric pseudocysts which are fluid-filled sacs surrounding kidneys, often associated with chronic renal failure in old cats. One case had been reported in a male ferret suffering from polycystic kidneys.7 Urinomas are rarely described in humans, occurring secondarily to ureteral calculi, blunt or penetrating trauma or iatrogenic.8 Post-traumatic urinomas are rather well-known in cats. Dorsal or sublumbar swellings, abdominal pain and lethargy were the symptoms, appearing two to eight weeks after a road traffic accident.9-11 A cow developed a urinoma following dystocia and forced extraction of twin calves. Lack of urination for several days, abdominal pain and inappetence led to a decision of euthanasia. Trauma to the urogenital tract during the dystocia were presumed to be the most probable cause of the pararenal pseudocyst.12 In our case, the ferret showed no discomfort to abdominal palpation and remained alert before the surgery. No history of trauma was notified by the owners. Accidental ligation and transection of a ureter during ovariohysterectomy resulted in formation of a urinoma in a dog. Ultrasonography revealed unilateral hydronephrosis and hydroureter as in our case.5 Considering ferret’s anamnesis and surgical findings, especially right blind ureter, ligature and transection of that ureter during ovariohysterectomy is the most probable hypothesis leading to the urinoma creation. Diagnosis of urinoma is based on medical imaging. Ultrasonographically, it is anechoic, elliptical or indented by organs and has sharp margins.5 On the CT-scan, distal right ureter and urinoma were not highlighted by the contrast product. Excretory urography was used in dogs and cats with pararenal pseudocyst and no or very slight opacification of the lesion was seen.10,11 It may be due to the great dilution of the contrast product or unilateral renal excretion impairment. Repeated punctures are not sufficient and a surgical treatment was necessary. Authors reported successful surgical management in dogs and cats, including opening and partial
ACCEPTED MANUSCRIPT ablation of the urinoma as well as omentalisation with or without ureteronephrectomy.5,9-11 In this case, renal parameters were within normal limits and the left kidney was considered to have normal echogenicity and structure. No suspicion of contralateral renal dysfunction was considered, that is why a ureteronephrectomy was performed. Adhesions to intestinal loops are common and complete ablation of the shell of the urinoma is always impossible. Omentalisation provides a physiological drainage and helps to reduce dead space to avoid relapse.
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Pararenal pseudocysts are encapsulated collection of extravasated urine reported in several mammals: humans, dogs, cats and cattle. This is the first case description and surgical management in a pet ferret. Early surgical neutering (about 2 months) is a fairly common practice in pet shops but lots of complications may occur. Urinomas have to be included in the differential diagnosis of an abdominal mass on young neutered ferrets.
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References 1. Pollock G : Disorders of the urinary and reproductive system, in Quesenberry KE, Carpenter JW (eds): Ferrets, rabbits and rodents: Clinical medecine and surgery. St. Louis, MO, Elsevier/Saunders, 46-61, 2012 2. Orcutt CJ: Ferret urogenital diseases. Vet Clin Exot Animal 6:113-138, 2003. 3. Vilatla L, et al: Imaging diagnosis-radiography and ultrasonography of bilateral congenital ureterovesical junction stenosis causing hydronephrosis and hydroureter in a ferret. Vet Radiol Ultrasound, 1-6, 2016. 4. Li X, et al: Cystic urogenital anomalies in ferrets. Vet Pathol 33:2;150-158, 1996. 5. Tidwell AS, et al: Urinoma in a dog. Vet Radiol 31:4;203-206, 1990. 6. Yeh EL, Chiang L, Meade RC: Ultrasound and radionuclide studies of urinary extravasation with hydronephrosis. Journal of urology 125; 728-730, 1981. 7. Puerto DA, Walker LM, Saunders HM: Bilateral perinephric pseudocysts and polycystic kidneys in a ferret. Vet Radiol Ultrasound 39:4;309-312, 1998. 8. Titton RL, et al: Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics 23(5); 1133-1147, 2003. 9. Bacon NJ, Anderson DM, Baines EA, White RAS: Post-traumatic para-ureteral urinoma (uriniferous pseudocyst) in a cat. Veterinary Comparative Orthopaedics and Traumatology 15,123-126, 2002. 10. Moores AP, Bell AM, Costello M: Urinoma (para-ureteral pseudocyst) as a consequence of trauma in a cat. J small anim Pract. 43;213-216, 2002. 11. Worth AJ, Tomlin SC: Post-traumatic paraureteral urinoma in a cat. J small anim Pract. 45(8);413-416, 2004. 12. Lopèz A et al: Urinoma in a post-parturient cow. Can Vet J 36(4); 242-243, 1995.
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Figure 1: longitudinal ultrasound image of the cystic structure
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Figure 2: longitudinal ultrasound image of the severe right hydronephrosis
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Figure 3: longitudinal CT-scan image of the ferret’s abdomen. Notice that the lesion is taking half of the abdominal cavity.
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Figure 4: laparotomy of the ferret. A large urinoma (large arrow) displaces other organs. The right ureter (thin arrow) is blind.