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Monthly Insight June 2026: Pelvic Urethral Mass

History

This case presented to Highlands Animal Hospital in Sebastian, Florida under the care of Dr. Daniel Jutras. An 11-year-old spayed female canine presented for recurrent lower urinary tract signs including chronic/recurrent hematuria and previous episodes treated as urinary tract infection. Urinalysis was performed and Dr. Jutras performed a point-of-care ultrasound which identified moderate to marked thickening of the proximal urethra. A request was made for a complete SDEP ® abdominal ultrasound evaluation with Insight Imaging & Diagnostics.

SDEP® 3

  This image highlights why routine evaluation of the pelvic urethra is critical during complete abdominal ultrasound examinations. Distal to the cystourethral junction (CUJ), marked inflammation surrounds an expansive urethral mass extending through the pelvic canal. Mineralization within the lesion, severe inflammation, and loss of normal urethral mural detail were identified, findings that would be easily missed if pelvic urethral views were omitted. 

Pelvic Urethra

 Fan sweep performed across the same position showing extension of the lesion outside the urethra and into the pelvic canal. This view is particularly important because a single static image can underestimate disease extent. Regional inflammation, loss of normal tissue boundaries, and extramural extension (“tumor escape”) highlight the aggressive nature of this lesion and the importance of complete pelvic urethral evaluation during abdominal ultrasound examinations. 

Pelvic Urethral Video Clips from SDEP® Position 2 and 3

Cystourethral Junction

 Video clip of the cystourethral junction (CUJ) demonstrating the mass extending cranially from the urethra into the CUJ region. Dynamic imaging highlights loss of normal tissue boundaries, severe disruption of mural detail, and marked regional inflammation. Cine evaluation was particularly helpful for appreciating the extent of invasion and local tissue involvement. 

Mid Pelvic Urethra

 Complete abdominal ultrasound revealed a large expansive pelvic urethral mass originating near the cystourethral junction with extension into the pelvic canal and proximal urethra. Regional inflammation surrounded the lesion with internal mineralization present throughout portions of the mass. The mass measured approximately 2 cm in width and extended nearly 6 cm into the pelvic inlet, representing significant disease burden. 

SDEP® Position 3 Pelvic Urethra

Complete cine fan sweep through the pelvic urethra demonstrating the full extent of disease involvement. The mass is visualized escaping normal urethral boundaries with extension into the pelvic canal. Dynamic imaging highlights surrounding inflammation, disrupted tissue planes, and the locally invasive nature of this lesion more effectively than a single static image. 

Case Insight

This case highlights one of the major reasons every complete SDEP® abdominal examination includes evaluation of the pelvic urethra (SDEP® View 3). The pelvic urethra can be technically challenging to evaluate, particularly in medium and small breed patients, and light sedation often significantly improves image quality by reducing abdominal wall tension and improving positioning.


Complete abdominal ultrasound revealed a large expansive pelvic urethral mass originating near the cystourethral junction with extension into the pelvic canal and proximal urethra. Regional inflammation surrounded the lesion with internal mineralization present throughout portions of the mass. Additional findings included mild bladder overdistension, suspended debris, bladder sand accumulation, mild iliac lymphadenopathy, and secondary urinary tract changes including mild renal subcapsular fluid accumulation and retroperitoneal inflammation concerning for chronic obstruction effects. The mass measured approximately 2 cm in width and extended nearly 6 cm into the pelvic inlet, representing significant disease burden. 


Cases such as this emphasize that recurrent urinary signs should not automatically be attributed solely to infection. In geriatric patients presenting with chronic hematuria, stranguria, pollakiuria, recurrent UTIs, or persistent lower urinary tract signs despite treatment, complete abdominal ultrasound — including dedicated pelvic urethral evaluation — can significantly alter case management and patient outcomes.


Findings in this case were highly concerning for extensive urethral neoplasia, with transitional cell carcinoma considered a primary differential diagnosis. Oncology consultation and advanced diagnostics were recommended. 


Clinical Insight:
Do not skip the pelvic urethra. A normal appearing bladder does not exclude clinically significant lower urinary tract disease.

Additional Clips

Left Kidney

Iliac Lymph Node

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