/pdf/placement-of-subcutaneous-ureteral-bypass-without-3z8ynj6ezf.pdf

Placement of Subcutaneous Ureteral Bypass without Fluoroscopic Guidance in Cats with Ureteral Obstruction

Abstract Background Cats presenting with upper urinary tract uroliths (UUTUs) and ureteral obstruction (“obstructive UUTU”) are typically younger than cats with idiopathic CKD that often have incidental nephroliths. Hypothesis Cats with upper urinary tract urolith have 2 clinical phenotypes; a more aggressive phenotype at risk of obstructive UUTU at a young age and a more benign phenotype in older cats, with reduced risk of obstructive UUTU. Objectives Identify risk factors for UUTU and for obstructive UUTU. Animals Eleven thousand four hundred thirty‐one cats were referred for care over 10 years; 521 (4.6%) with UUTU. Methods Retrospective VetCompass observational cross‐sectional study. Multivariable logistic regression models were performed to identify risk factors for a diagnosis of UUTU vs no UUTU and additionally, obstructive UUTU vs nonobstructive UUTU. Results Risk factors for UUTU included female sex (odds ratio [OR] 1.6, confidence interval [CI] 1.3‐1.9; P < .001), British shorthair, Burmese, Persian, Ragdoll or Tonkinese (vs non‐purebred ORs 1.92‐3.31; P < .001) breed and being ≥4 years (ORs 2.1‐3.9; P < .001). Risk factors for obstructive UUTU were female sex (OR 1.8, CI 1.2‐2.6; P = .002), having bilateral uroliths (OR 2.0, CI 1.4‐2.9; P = .002) and age, with the odds of obstructive UUTU increasing as age at diagnosis of UUTU decreased (≥12 years, reference category; 8‐11.9 years, OR 2.7, CI 1.6‐4.5; 4‐7.9 years, OR 4.1, CI 2.5‐7.0; 0‐3.9 years, OR 4.3, CI 2.2‐8.6; P < 0.001). Conclusions and Clinical Importance Cats diagnosed with UUTU at a younger age have a more aggressive phenotype with higher risk of obstructive UUTU compared to cats over 12 years of age diagnosed with UUTU.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jvim.16659

Risk factors for upper urinary tract uroliths and ureteral obstruction in cats under referral veterinary care in the United Kingdom

Abstract Background Placement of a subcutaneous ureteral bypass (SUB) device is an effective method to relieve all causes of ureteral obstruction in cats. Complications involving migration within the gastrointestinal tract have been seldomly described. Objectives To characterize transmural migration of SUB devices within the digestive tract in cats. Animals Eleven migrated SUB catheters identified in 8 cats between 2017 and 2021. Methods Retrospective review of medical records of cats with a SUB device in which migration into the gastrointestinal tract was identified. Results The median time from SUB device placement to implant migration was 928 days (201‐2298 days). Seven cats had obstruction of the SUB device and a positive urine culture at diagnosis. The migration was identified by ultrasound in 6/11, pre‐operative contrast radiography in 2/2, and only at time of surgery in 3 SUB devices. All cats underwent surgical correction. Four nephrostomy and 7 cystotomy catheters migrated. Migration occurred into the duodenum (3/11), jejunum (7/11), and colon (1/11). SUB devices were removed in 7 cats and replaced in 2 cats, with 1 cat diagnosed with 2 migration events. Gastrointestinal resection and anastomosis were performed in 7/8 cats and an enterotomy in 2 cats. Six cats survived to discharge. The median follow‐up time after migration diagnosis was 365 days (range, 0‐1114 days) and 2 cats are still alive. Conclusions and Clinical Importance Although a rare complication, migration of SUB device should be considered in cats with SUB device obstruction and a positive urine culture.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jvim.16511

Multicenter retrospective evaluation of transmural migration of subcutaneous ureteral bypass devices within the digestive tract in cats

Circumcaval ureter in two ferrets (Mustela putorius furo)

ABSTRACT
 Case history Medical records were reviewed for cats that underwent surgical treatment of traumatic ureteral rupture (TUR) using urinary diversion procedures between 2012 and 2019. Clinical findings and treatment Five cats had presented with injuries associated with road traffic accidents. These included three cats with abdominal hernias that required surgical management. At a median of 15 days after the accident, cats represented with lethargy, the presence of an abdominal mass or with lower urinary tract symptoms and in all cats contrast diagnostic imaging showed proximal unilateral TUR with associated para-ureteral urinoma. Four cats received subcutaneous ureteral bypass (SUB) device placement and one had ureteral anastomosis over a stent. Unilateral cyst-like retroperitoneal fluid consistent with para-ureteral urinoma was observed in all cats and a diffuse retroperitoneal haematoma was noticed in four cats. No immediate major complications occurred, and all cats had post-operative serum creatinine concentration within the reference interval. The cat that had received a ureteral stent subsequently required placement of a SUB following stent encrustation 15 months after surgery. Median follow-up time was 34 (min 28, max 58) months and renal function was normal in all cats at the last follow-up. Clinical relevance Urinary diversion procedures provided long-term stable renal function following proximal TUR in these five cats. Delayed, subtle non-specific clinical signs subsequent to high-energy blunt trauma causing abdominal hernia and associated diffuse retroperitoneal haematoma, should raise suspicion of TUR. Abbreviations AFAST: Abdominal focused assessment with sonography for trauma; SUB: Subcutaneous ureteral bypass; TUR: Traumatic ureteral rupture

Feline ureteral rupture with para-ureteral urinomas following blunt trauma: clinical presentation and long-term outcome after treatment by urinary diversion for five cases from 2012 to 2019

ObjectivesThe aim of this study was to document survival, complications and risk factors for the development of complications and mortality prior to discharge after placement of a subcutaneous uret...

Emily Vrijsen

Papers

Complications and survival after subcutaneous ureteral bypass device placement in 24 cats: a retrospective study (2016-2019).