A 4-year-old female spayed mixed breed dog was presented to NC State Veterinary Hospital with a 2-year history recurrent hematuria along with painful urination characterized by straining and vocalizing. The dog initially presented to the primary care veterinarian for inappropriate urination, lethargy, and decreased appetite. Concentrated urine (USG, 1.050) and proteinuria (1+) were found on urinalysis. A commercial ELISA test (Snap 4Dx, Idexx Laboratories, Westbrook, Maine) was positive for Borrelia burgdorferi; treatment with doxycycline (5 mg/kg PO q12h for 14 days) was initiated. Lethargy and hyporexia improved, but painful urination, recurrent malodorous urine and hematuria persisted. Diagnostic tests performed over a course of 2 years by the primary care veterinarian included repeated urinalyses, urine cultures, abdominal radiographs, abdominal ultrasound examination, and a PCR-based genetic test (Cadet BRAF, Antech Diagnostics, Fountain Valley, California) for detection of BRAF mutation based on poor clinical response to attempted treatment. Therapeutic interventions in the year before presentation included enrofloxacin, amoxicillin-clavulanic acid, cefpodoxime, and feeding a diet for urinary tract disease (Urinary SO, Royal Canin, St. Charles, Missouri). Each antibiotic course was continued for 7 days. No response was noted to these treatments. Other medical history included atopic dermatitis and chronic intermittent vomiting of undetermined etiology. The dog was bright, alert, and responsive but anxious during examination. Abnormal physical examination findings included vulvar erythema, moderate perivulvar skin folding covering approximately 60% of the vulva, erythematous skin over the nasal planum, periocular, and interdigital regions, as well as dry and crusted ear pinnae. The bladder was large, and immediately after palpation the dog voided a small volume of urine while vocalizing. When taken outside to observe urination, the dog appeared reluctant to urinate, and eventually urinated small volumes multiple times whereas vocalizing. Post-voiding urine residual volume measurements using a 3-D ultrasound device (BladderScan Prime Plus, Verathon, Bothell, Washington) were normal (<1 mL/kg). Results of a CBC and biochemistry profile were within reference range except for mild hypophosphatemia (1.6 mg/dL; reference range [RR], 2.6-5.3) and hypomagnesemia (1.7 mg/dL; RR, 1.9-2.5). Urinalysis of a cystocentesis sample disclosed hyposthenuria (USG 1.007) and bacteriuria (2+) in the absence of pyuria. The remainder of the urinalysis was unremarkable. Abnormalities detected during ultrasound examination limited to the urinary tract included cranioventral bladder wall thickening (0.63 cm in width) suggestive of cystitis and mild left medial iliac lymphadenopathy (0.67 cm). To further investigate the patient's condition, cystourethroscopy was performed with the dog under general anesthesia. To minimize the likelihood of contamination during the procedure, the external perivulvar area was aseptically prepared, the vestibule was irrigated with betadine solution, and the endoscopist wore sterile gloves. Upon passage of the scope into the urethra, purulent material was released from the right aspect of the urethral papilla. Further examination of this site disclosed a rounded expansion of the epithelial tissue, similar in appearance to an inflamed cyst or abscess. Digital examination identified a small but palpable, firm structure in that location. Direct swabs of the site were collected for bacterial culture. Attempts were made to further drain the structure by passage of a needle through the endoscope's biopsy channel, but, no additional purulent material was expelled, and the structure remained intact. Mild iatrogenic trauma and self-limiting hemorrhage occurred. No other abnormalities were noted in the vestibule. The endoscope was passed through the urethra and into the bladder; no urethral abnormalities were appreciated. The bladder wall appeared diffusely edematous and 2 small sites of hyperemia and mild mucosal hemorrhage were noted. Biopsy samples were obtained from the ventral bladder wall for histopathological examination and aerobic culture. Urine was collected for Ureaplasma culture. Anesthetic recovery was uneventful. Histopathology of the bladder biopsy sample identified hyperplastic bladder mucosa with multifocal areas of edema within the epithelium. Scattered intraepithelial lymphocytes and a few neutrophils were present. The superficial submucosa was expanded by edema, mild hemorrhage with erythrocyte fragmentation, and scattered macrophages. Mild hemorrhage extended through the mucosa. These findings were suggestive of chronic inflammation in the bladder. Both the direct swab of the periurethral lesion and the culture of bladder wall tissue yielded growth of Staphylococcus pseudintermedius and Proteus mirabilis. Fewer than 10 colony-forming units of each organism were grown from the bladder wall, whereas the direct swab yielded 1+ growth of S. pseudintermedius and <10 colonies of P. mirabilis. Both organisms had a broad antimicrobial susceptibility profile. These findings were consistent with inflammation in the area of the lesser vestibular paraurethral glands. However, because there was no ultrasonographic or computed tomographic imaging of the lesion itself, it cannot be definitively stated that the gland was involved. A therapeutic plan was made based on typical treatments used in women with skenitis. The dog was discharged with instructions to be given enrofloxacin (10 mg/kg PO q24h) for 42 days and carprofen (4.4 mg/kg PO q24h) for 14 days. The previously prescribed gabapentin was continued. Transition to a hydrolyzed diet was directed given the patient's concurrent dermatologic and gastrointestinal disease. The dog did not urinate until the day after the procedure, at which point straining, vocalization, and hematuria were not noted. Follow-up communication several weeks later indicated complete resolution of the presenting complaints. The owner reported that the dog frequently leaked urine at rest. Because other causes for urinary incontinence were not identified during evaluation, a diagnosis of urethral sphincter mechanism incompetence was made, and the dog was treated with diethylstilbesterol (0.02 mg/kg PO) daily for 5 days and then decreased to twice weekly dosing; urinary incontinence reportedly resolved. Although the patient previously had been treated with enrofloxacin, the duration of treatment was limited to 7 days. We elected to try a 42-day course based on similar recommendations for urinary tract infections associated with prostatitis. A non-steroidal anti-inflammatory drug was prescribed primarily for discomfort, but decreased inflammation associated with the abscess may have facilitated resolution.