Long-term outcome after resection and reconstruction using vaginourethroplasty for distal urethral leiomyosarcoma in a female dog.

Vaginourethroplasty via combined ventral and perineal approach achieves long-term local control of distal urethral leiomyosarcoma while preserving urinary function.

This case report describes the successful surgical management of distal urethral leiomyosarcoma in a 10-year-old spayed female mixed-breed dog using a novel vaginourethroplasty technique. Diagnosis was established via retrograde urethrovaginography and contrast-enhanced CT, which identified a 17 × 17 × 24 mm distal urethral mass without evidence of distant metastasis. Blind biopsy was nondiagnostic, and progressive stranguria prompted surgical intervention 20 days after presentation. A two-phase surgical approach was employed under a single anesthetic: a ventral approach facilitated end-to-end anastomosis of the proximal urethra to the vaginal stump with concurrent bladder neck cystopexy, followed by a perineal approach for en bloc resection of the distal urethra, mass, and adjacent vaginal mucosa, with subsequent vaginal reconstruction and vulvoplasty. Histopathology initially identified the tumor as undifferentiated sarcoma; immunohistochemical reevaluation reclassified it as leiomyosarcoma with a mitotic index of 12 per 10 high-power fields and minimal distal margins. Postoperatively, the dog maintained voluntary urine storage and voiding, with mild urinary incontinence managed medically. At 13 months post-surgery, a right inguinal lymph node consistent with metastasis was excised. At 49 months post-presentation, no local recurrence or new distant metastasis was detected. This case demonstrates that combined ventral and perineal vaginourethroplasty can achieve long-term local tumor control while preserving urinary continence in dogs with distal urethral leiomyosarcoma.

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