Relatório de estágio, na utilização de uma técnica cirúrgica minimamente invasiva de cistolitotomia percutânea ("pccl - percutaneous cistolitotomy"), em quatro canídeos machos
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2022
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O presente relatório de estágio, tem como objetivo a demonstração da vantagem da utilização de técnicas minimamente invasivas, na resolução de casos graves de urolitíase obstrutiva e parcialmente obstrutiva. A urolitíase é uma doença do sistema urinário cada vez mais recorrente nos animais de companhia devido à mudança dos hábitos diários. Um estilo de vida mais sedentário, a diminuição da ingestão de água e a ingestão de dietas de menor qualidade, são fatores que contribuem para o aumento do número de casos de urolitíase. A primeira linha de tratamento deve ser sempre o maneio médico com a dissolução dos urólitos. A opção cirúrgica é usada nos casos de urólitos de oxalato de cálcio ou se há obstrução urinária com anúria concomitante. Atualmente, o aumento do cuidado e bem-estar animal leva os tutores a procurarem métodos de tratamento mais eficazes, menos invasivos e com menor tempo de recuperação. A Cistolitotomia Percutânea (PCCL), além de ser uma técnica pioneira, está internacionalmente reconhecida. como sendo a técnica ideal para a remoção de urólitos obstrutivos do trato urinário inferior, permitindo a intervenção cirúrgica em quase todo o tipo de animais, não apresentando limitações na sua execução relacionadas com a anatomia do animal e permite a confirmação da remoção total dos urólitos. As complicações associadas são a dificuldade da progressão do endoscópio em uretras de diâmetros reduzidos, a experiência necessária do cirurgião e um maior tempo cirúrgico. Os casos cirúrgicos descritos demonstram a resolução da urolitíase obstrutiva por urólitos de cistina, estruvite, oxalato de cálcio e apatita, através da PCCL, em conjunto com outras técnicas minimamente invasivas. Onde todos os procedimentos tiveram sucesso cirúrgico, devido à eficiência da técnica de PCCL e com como vantagens associadas a rápida recuperação, a inspeção pormenorizada do trato urinário inferior, confirmando a ausência de urólitos remanescentes, diminuição do dano vesical. Sendo que houve um caso de recorrência após um ano, devido à não castração do paciente, apesar de ter sido aconselhado aos tutores. Em conclusão a PCCL é a técnica predileta para uma resolução bem-sucedida da urolitíase, desde que seja igualmente solucionada a causa desta, através da prevenção de novos urólitos ou através da resolução médica ou cirúrgica das mesmas. Palavras-Chave: Cistolitotomia Percutânea (PCCL), mínima invasão, urolitíase, cirurgia, tratamento
This internship report aims to show the advantages of using minimally intrusive techie in the resolution of severe cases of obstructive and partially obstructive urolithiasis techniques. Urolithiasis is an increasingly recurrent manifestation of the urinary system in small animals, due to the change in the daily habits of the animals and their owners. A more sedentary lifestyle, decreased water intake and the intake of lower quality diets are factors that contribute to the increase in the number of cases of urolithiasis. The first line of treatment should be always the medical management with the dissolution of the uroliths. Surgical option is used in cases of calcium oxalate uroliths or if there is urinary obstruction with concomitant anuria. Currently, the increase in animal care and welfare leads tutors to look for more effective and less invasive treatment methods with shorter recovery times. In addition to being a pioneering technique, Percutaneous Cystolithotomy (PCCL) is internationally recognized as the ideal technique for removing obstructive uroliths in the lower urinary tract, allowing surgical intervention in almost any type of animals, with no complications due to the anatomy of the animal and allows the certification of the total removal of the uroliths. The associated complications being the difficulty of progression of the endoscope in urethras with reduce diameters, the necessity of an experienced surgeon and longer surgical time. The surgical cases described show the resolution of obstructive urolithiasis by cystine uroliths, struvitis, calcium oxalate and apatite, through PCCL, together with other minimally invasive techniques. Where all procedures were surgically successful, due to the efficiency of the PCCL technique and with the advantages associated with rapid recovery, detailed inspection of the lower urinary tract, confirming the absence of remaining uroliths, reduction of bladder damage. There was one case of recurrence after one year, due to the patient's non-castration, despite it being advised to the tutors. In conclusion, PCCL is the preferred technique for the successful resolution of Urolithiasis, as long as its cause is also resolved, by preventing new uroliths or by medically or surgically resolving them. Key Words: Percutaneous cystolithotomy (PCCL), minimal invasion, urolithiasis, surgery, treatment
This internship report aims to show the advantages of using minimally intrusive techie in the resolution of severe cases of obstructive and partially obstructive urolithiasis techniques. Urolithiasis is an increasingly recurrent manifestation of the urinary system in small animals, due to the change in the daily habits of the animals and their owners. A more sedentary lifestyle, decreased water intake and the intake of lower quality diets are factors that contribute to the increase in the number of cases of urolithiasis. The first line of treatment should be always the medical management with the dissolution of the uroliths. Surgical option is used in cases of calcium oxalate uroliths or if there is urinary obstruction with concomitant anuria. Currently, the increase in animal care and welfare leads tutors to look for more effective and less invasive treatment methods with shorter recovery times. In addition to being a pioneering technique, Percutaneous Cystolithotomy (PCCL) is internationally recognized as the ideal technique for removing obstructive uroliths in the lower urinary tract, allowing surgical intervention in almost any type of animals, with no complications due to the anatomy of the animal and allows the certification of the total removal of the uroliths. The associated complications being the difficulty of progression of the endoscope in urethras with reduce diameters, the necessity of an experienced surgeon and longer surgical time. The surgical cases described show the resolution of obstructive urolithiasis by cystine uroliths, struvitis, calcium oxalate and apatite, through PCCL, together with other minimally invasive techniques. Where all procedures were surgically successful, due to the efficiency of the PCCL technique and with the advantages associated with rapid recovery, detailed inspection of the lower urinary tract, confirming the absence of remaining uroliths, reduction of bladder damage. There was one case of recurrence after one year, due to the patient's non-castration, despite it being advised to the tutors. In conclusion, PCCL is the preferred technique for the successful resolution of Urolithiasis, as long as its cause is also resolved, by preventing new uroliths or by medically or surgically resolving them. Key Words: Percutaneous cystolithotomy (PCCL), minimal invasion, urolithiasis, surgery, treatment
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Orientação: Henrique Armés
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MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, MEDICINA VETERINÁRIA, VETERINARY MEDICINE, UROLITÍASE, UROLITHIASIS, CIRURGIA VETERINÁRIA, VETERINARY SURGERY, TERAPÊUTICAS, THERAPEUTICS