At Your Service: Internal Medicine

Internal Medicine Veterinary Specialty

The Internal Medicine Service at Tufts Foster Hospital for Small Animals is led by faculty who are board-certified by the American College of Veterinary Internal Medicine. Supporting them are trained technicians(many who are also board certified by the National Association of Veterinary Technicians in America), as well as interns, residents, students and staff, within a state-of-the-art facility for providing diagnosis and advanced patient care. Continue reading

Clinical Case Example

Solitaire had been living with her breeder since approximately 4 weeks of age and her breeder recognized that the pup was always “wet” along her back legs and perivulvar region.  Solitaire appears to be continuously dribbling urine, however she does urinate voluntarily as well. The breeder felt that the pup did not seem to be bothered by the incontinence. She was concerned about the strong “urine odor” and the risk of urine scald. Solitaire was seen by her referring veterinarian who suspected an ectopic ureter. She was treated with a 10 day course of Clavamox for a suspected urinary tract infection. She was also treated with a 7 day trial of phenylpropanolamine to treat urethral sphincter mechanism incompetence which did not seem to help with the incontinence. The degree of incontinence prevented Solitaire to be an acceptable indoor companion. Continue reading

Current Concepts

Interventional Endourology

MaryAnna Labato, DVM, DACVIM (SAIM)

Endourology is the branch of urologic surgery concerned with closed procedures for visualizing or manipulating the urinary tract. The techniques are typically reserved for disorders of the urethra, urinary bladder, ureters and the pelvis of the kidney. In human medicine endourology has advanced tremendously over the past 20-30 years; however, in veterinary medicine the discipline is just starting to develop.

Some of the more commonly performed procedures in veterinary medicine include urethral stenting for the treatment of neoplasia and strictures, nephrostomy tube placement, ureteral stenting, percutaneous nephrolithotomy and cystoscopic–guided laser ablation of ectopic ureters and urethral transitional cell carcinomas. Additionally, lasers and shock wave lithotripsy may be used for the treatment of upper and lower urinary tract calculi. Continue reading


Subcutaneous Ureteral Bypass Device

As veterinarians gain experience in the discipline of interventional endourology we find that there are challenges in some of our patients that are not experienced in human endourology. One of these challenges is the feline ureter.  In the healthy state it is a very thin and narrow structure averaging  about  0.4mm in diameter. Ureteral stents for felines are avialbale as small as 2 and 2.5 Fr and for dogs as large as 6 Fr. The obstructed ureter may distend to perhaps a centimeter at its widest point, but usually it is less than that and is often tortuous in nature.  Additionally the cause for ureteral obstructions is often calcium oxalate uroliths which may become embedded in the wall of the ureter making removal impossible, and also making passage of a stent around the stone quite challenging.  Another cause of ureteral obstruction is a stricture at a previous site of urolith lodgment or urolith removal. Continue reading