1
|
Habib Y, Vachon C, Juette T, Dunn M. Assessing Ureteral Patency by Fluoroscopy and Ultrasonography After Subcutaneous Ureteral Bypass Device Placement for the Treatment of Benign Ureteral Obstruction in Cats. J Vet Intern Med 2025; 39:e70078. [PMID: 40293127 PMCID: PMC12035871 DOI: 10.1111/jvim.70078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 03/10/2025] [Accepted: 03/11/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Limited information on the patency of native ureters after subcutaneous ureteral bypass (SUB) device placement is available. OBJECTIVE Evaluate the patency of native ureters in cats treated with SUB device placement for benign ureteral obstruction. ANIMALS Cats with SUB presented for routine evaluation. METHODS Routine ultrasound-guided SUB irrigations were performed, focusing on ureteral irrigation in the trigone and proximal urethra. Cats with obstructed nephrostomy catheters or subcutaneous ports were excluded. Fluoroscopic-guided SUB irrigations with iodinated contrast then were used to assess patency. Ureters were deemed patent if contrast filled the lumen evenly along their length, and obstructed if the contrast column was interrupted on consecutive images. Intraoperative fluoroscopy was reviewed to confirm the cause and location of the obstructions. RESULTS Overall, 18 cats (18 SUBs; 10 unilateral, 8 bilateral) were included. The causes of obstruction were ureteroliths (23 ureters) and presumed stricture (3 ureters). A trigonal irrigation was visible in 14/18 cats (77%; 95% confidence interval [CI]: 54.8%-91.0%); the patent side in bilateral SUBs could not be differentiated. Three ureters were excluded (nondiagnostic study, n = 1; obstructed nephrostomy, n = 2). Of the remaining 23 ureters, 19 (82.6%; 95% CI: 62.9%-93.0%) were patent: 16/20 patent ureters were obstructed with ureteroliths (80%; 95% CI: 58.4%-91.9%) and 3/3 with presumed stricture (100%; 95% CI: 43.9%-100%). Ureteral irrigations at the trigone were associated with patency. CONCLUSIONS A high patency rate of native ureters after SUB placement was observed. Ureteral irrigations at the trigone reliably indicate patency. Supraphysiologic SUB irrigations may result in underdiagnosed persistent partial obstructions.
Collapse
Affiliation(s)
- Yassmina Habib
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Catherine Vachon
- Department of Clinical Sciences, School of Veterinary MedicineUniversity of MontrealSaint‐HyacintheQuebecCanada
| | - Tristan Juette
- Department of Clinical Sciences, School of Veterinary MedicineUniversity of MontrealSaint‐HyacintheQuebecCanada
| | - Marilyn Dunn
- Department of Clinical Sciences, School of Veterinary MedicineUniversity of MontrealSaint‐HyacintheQuebecCanada
| |
Collapse
|
2
|
Dunn M, Merindol I, Vachon C. Response to letter regarding "Benign feline ureteral obstruction in cats: Outcome with medical management". J Vet Intern Med 2024; 38:14-15. [PMID: 37948629 PMCID: PMC10800225 DOI: 10.1111/jvim.16910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Marilyn Dunn
- Department of Clinical SciencesSchool of Veterinary Medicine, University of MontrealSaint‐HyacintheQuebecCanada
| | - Isabelle Merindol
- Department of Clinical SciencesSchool of Veterinary Medicine, University of MontrealSaint‐HyacintheQuebecCanada
| | - Catherine Vachon
- Department of Clinical SciencesSchool of Veterinary Medicine, University of MontrealSaint‐HyacintheQuebecCanada
| |
Collapse
|
3
|
Duval V, Dunn M, Vachon C. Use of tetrasodium EDTA acid for the treatment of intraluminal obstruction of subcutaneous ureteral bypass devices. J Feline Med Surg 2022; 24:e330-e337. [PMID: 35762269 PMCID: PMC9511240 DOI: 10.1177/1098612x221107795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy and tolerability of a 4% tetrasodium EDTA (tEDTA) infusion protocol in the subcutaneous ureteral bypass (SUB) devices of cats with intraluminal obstruction at a veterinary teaching hospital between July 2017 and April 2020. METHODS This was a retrospective controlled study. Cats with an obstructed SUB device underwent a 4% tEDTA infusion protocol. Obstruction of the device was diagnosed based on renal pelvic dilation, dilatation of the ureter, mineralized material within the device (cystostomy or nephrostomy catheters) seen on ultrasound, the absence of visible bubbles within the renal pelvis and/or urinary bladder following ultrasound-guided flushing of the device with saline. RESULTS A total of 16 tEDTA infusion protocols were performed in 14 cats. The infusion protocol was considered successful in 11/16 SUB devices (68.8%). Six devices (n = 6/11; 54.5%) had recurrence of obstruction with a median time of 87 days. One or more episodes of self-limiting pollakiuria and/or hematuria following infusion was seen in eight patients (n = 8/14; 57.1%). CONCLUSIONS AND RELEVANCE Infusions of 4% tEDTA successfully relieved intraluminal obstruction in patients with occluded SUB devices; however, the recurrence of obstruction was common. Additional studies evaluating case selection and optimal protocols are warranted.
Collapse
Affiliation(s)
- Valerie Duval
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montréal, Saint-Hyacinthe, QC, Canada
| | - Marilyn Dunn
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montréal, Saint-Hyacinthe, QC, Canada
| | - Catherine Vachon
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montréal, Saint-Hyacinthe, QC, Canada
| |
Collapse
|
4
|
Véran E, Vachon C, Byron J, Howard J, Berent A, Weisse C, Javard R, Spencer A, Gradilla S, Palm C, Culp W, Cléroux A, Dunn M. Multicenter retrospective evaluation of transmural migration of subcutaneous ureteral bypass devices within the digestive tract in catsone. J Vet Intern Med 2022; 36:1677-1685. [PMID: 35976072 PMCID: PMC9511080 DOI: 10.1111/jvim.16511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
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.
Collapse
Affiliation(s)
- Emilie Véran
- Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, Montreal, Québec, Canada
| | - Catherine Vachon
- Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, Montreal, Québec, Canada
| | - Julie Byron
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, Ohio, USA
| | - James Howard
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, Ohio, USA
| | - Allyson Berent
- Service of Interventional Radiology and Interventional Endoscopy, Animal Medical Center, New York City, New York, USA
| | - Chick Weisse
- Service of Interventional Radiology and Interventional Endoscopy, Animal Medical Center, New York City, New York, USA
| | - Romain Javard
- Département de médecine interne, Centre Vétérinaire DMV, Montréal, Québec, Canada
| | - Ashley Spencer
- Department of Veterinary Clinical Sciences, North Carolina State Veterinary Medicine, Raleigh, North Carolina, USA
| | - Sarah Gradilla
- Department of Emergency and Critical Care, Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Carrie Palm
- Surgical and Radiological Sciences, UC Davis Veterinary Medicine, Davis, California, USA
| | - William Culp
- Surgical and Radiological Sciences, UC Davis Veterinary Medicine, Davis, California, USA
| | - Andréanne Cléroux
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marilyn Dunn
- Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, Montreal, Québec, Canada
| |
Collapse
|
5
|
Boullenger J, Lafuma F, Baudin Trehiou C, Blond L, Gibert S, Kulendra N. Transmural migration of a subcutaneous ureteral bypass into the intestine in three cats. J Small Anim Pract 2022; 63:792-796. [PMID: 35419828 DOI: 10.1111/jsap.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
Subcutaneous ureteral bypass™ is a device placed in cats with ureteral obstruction. The most common complications include system occlusion, urinary tract infection and sterile cystitis. In this case series, we describe three cats with subcutaneous ureteral bypass devices placed where transmural migration of subcutaneous ureteral bypass catheters into the small intestine resulted in gastrointestinal signs, urinary infection and subcutaneous ureteral bypass occlusion. The system was changed in one case and removed in the other two. In all cases, an intestinal resection and anastomosis was performed. All cats had a good medium-term outcome, and urinary infection persisted in the case for which the subcutaneous ureteral bypass system was changed. Transmural migration of the device should be considered in cats with subcutaneous ureteral bypass presenting with persistent urinary tract infection, gastrointestinal signs or device obstruction, even if imaging studies such as ultrasound or contrast studies do not demonstrate any abnormalities.
Collapse
Affiliation(s)
- J Boullenger
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - F Lafuma
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - C Baudin Trehiou
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - L Blond
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - S Gibert
- Centre Hospitalier Vétérinaire Languedocia, 34080 Montpellier, France
| | - N Kulendra
- North Downs Specialist Referrals, Bletchingley, RH1 4QP, UK.,Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, Hertfordshire, AL97TA, UK
| |
Collapse
|
6
|
Kennedy AJ, White JD. Feline ureteral obstruction: a case-control study of risk factors (2016-2019). J Feline Med Surg 2022; 24:298-303. [PMID: 34076537 PMCID: PMC10812244 DOI: 10.1177/1098612x211017461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Ureteral obstruction (UO) in cats causes acute kidney injury and typically requires surgical intervention. Information is required about potentially modifiable risk factors to inform prevention strategies. METHODS A case-control study was performed to assess risk factors associated with feline UO. Cases were defined as cats with either of the following: (1) ureteral obstruction (ureteroliths: 13/18; unknown: 5/18) confirmed with pyelography; or (2) a creatinine concentration >140 µmol/l with both UO (ureteroliths: 6/10; blood clots: 3/10; pyonephrosis: 1/10) and pyelectasia ⩾5 mm on abdominal ultra sonography. Controls were defined as cats without evidence of UO on history, physical examination and abdominal ultrasound. Age, sex, breed (domestic shorthair/longhair), diet (predominantly dry, mixed or predominantly moist food), housing (indoors or mixed) and plasma total calcium were evaluated for their association with UO using multivariable logistic regression. A receiver operator characteristic (ROC) curve was created to evaluate the predictive ability of the final model. RESULTS In total, 168 cats (28 cases, 140 controls) were included. Age, sex, breed, housing and total calcium were not significantly associated with UO; however, diet was. Compared with cats eating a predominantly moist food diet, cats fed a predominantly dry food diet were 15.9 times more likely to develop a UO (95% confidence interval 2.9-295; P = 0.009). There was no difference in the association between diet and UO in cats fed a mixed diet vs cats fed a predominantly moist food diet (P = 0.25). The area under the ROC curve was 72%. CONCLUSIONS AND RELEVANCE Changes in diet formulation could provide a simple and economical method to reduce the risk of UO.
Collapse
|
7
|
Hoshi K, Hosoya K, Takagi S, Kim S, Okumura M. Direct renal pelvicocystostomy using tube cystoplasty in a cat with ureteral obstruction. J Small Anim Pract 2022; 63:635-641. [DOI: 10.1111/jsap.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/14/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- K. Hoshi
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine Hokkaido University, Kita 19 Nishi 11, Kita‐ku Sapporo Hokkaido 060‐0819 Japan
| | - K. Hosoya
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine Hokkaido University, Kita 19 Nishi 11, Kita‐ku Sapporo Hokkaido 060‐0819 Japan
- Laboratory of Veterinary Advanced Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine Hokkaido University, Kita 19 Nishi 11, Kita‐ku Sapporo Hokkaido 060‐0819 Japan
| | - S. Takagi
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine Hokkaido University, Kita 19 Nishi 11, Kita‐ku Sapporo Hokkaido 060‐0819 Japan
- Laboratory of Veterinary Advanced Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine Hokkaido University, Kita 19 Nishi 11, Kita‐ku Sapporo Hokkaido 060‐0819 Japan
| | - S. Kim
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine Hokkaido University, Kita 19 Nishi 11, Kita‐ku Sapporo Hokkaido 060‐0819 Japan
| | - M. Okumura
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine Hokkaido University, Kita 19 Nishi 11, Kita‐ku Sapporo Hokkaido 060‐0819 Japan
| |
Collapse
|
8
|
Testault I, Gatel L, Vanel M. Comparison of nonenhanced computed tomography and ultrasonography for detection of ureteral calculi in cats: A prospective study. J Vet Intern Med 2021; 35:2241-2248. [PMID: 34258789 PMCID: PMC8478021 DOI: 10.1111/jvim.16210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Radiographs and ultrasound (US) are the primary imaging modalities used to assess ureteral calculi in cats. Reports describing the use of nonenhanced computed tomography (CT) are scarce. HYPOTHESIS/OBJECTIVES To compare US and nonenhanced CT for detection, number and localization of ureteral calculi in cats. ANIMALS Fifty-one cats with at least 1 ureteral calculus, and 101 ureters. METHODS Prospective case series. All cats underwent an US followed by a nonenhanced CT. Cats were included in the study if at least 1 ureteral calculus was diagnosed on either modality. Number of calculi and their localization (proximal, middle, and distal) were recorded on both modalities. Pelvic dilatation and maximal ureteral diameter were recorded with US. RESULTS More calculi were detected by nonenhanced CT (126) compared to US (90), regardless of localization (P < .001). More ureters were affected on nonenhanced CT (70) compared to US (57; P < .001). The number of calculi detected was significantly different between US and nonenhanced CT in the proximal (P = .02) and distal ureteral region (P < .001). Bilateral calculi were more frequent with nonenhanced CT (19 cats) compared to US (9 cats; P < .001). A pelvic size superior to 5 mm and a maximal ureteral diameter value superior to 3 mm were always associated with ureteral calculi. CONCLUSIONS AND CLINICAL IMPORTANCE Computed tomography is an emerging imaging modality in cats with a suspected ureteral obstruction. Combination of CT and US can be beneficial for case management.
Collapse
Affiliation(s)
| | - Laure Gatel
- Centre Hospitalier Vétérinaire Pommery, Reims, France
| | - Maïa Vanel
- Centre Hospitalier Vétérinaire Atlantia, Nantes, France.,Anicura TRIOVet, Rennes, France
| |
Collapse
|
9
|
Kulendra NJ, Borgeat K, Syme H, Dirrig H, Halfacree Z. Survival and complications in cats treated with subcutaneous ureteral bypass. J Small Anim Pract 2020; 62:4-11. [PMID: 32926426 DOI: 10.1111/jsap.13226] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report the complications and factors affecting outcome for cats following placement of a subcutaneous ureteral bypass (SUB™). MATERIALS AND METHODS In this retrospective study, complications, the presence of a urinary tract infection and survival time were recorded following subctutaneous ureteral bypass placement. Factors affecting survival time were assessed using a Kaplan Meier curve and log rank test. RESULTS Ninety-five cats had 130 subcutaneous ureteral bypasses placed. Ten cats did not survive to discharge. Forty cats died or were euthanised after discharge (42%); the median survival time of these cats was 530 days (range 7 to 1915). Minor complications occurred in 18 cats (19%) and major complications occurred in 46 cats (48%), the majority of which were after hospital discharge. Twenty-seven cats were diagnosed with a urinary tract infection (UTI) post-operatively. A significant association between long-term survival and creatinine at presentation was identified. The median survival time for cats presenting with creatinine concentration ≥440 μmol/L (International Renal Interest Society stage acute kidney injury (AKI) 4 and 5) was 530 days (95% CI 273-787 days), compared to a median survival time of 949 days (95% CI 655-1243 days; Log Rank P=0.024) for those cats presenting with creatinine <440 μmol/L (International Renal Interest Society stage AKI 1-3). CLINICAL SIGNIFICANCE In this population of cats, subcutaneous ureteral bypass placement was associated with an approximately 10% in-hospital mortality and a high complication rate. Most complications were manageable, resulting in an overall median survival time of over 2 years.
Collapse
Affiliation(s)
- N J Kulendra
- North Downs Specialist Referrals, Friesian Buildings 3&4, The Brewerstreet Dairy Buisiness Park, Brewer Street, Bletchingley, RH1 4QP, UK
| | - K Borgeat
- Department of Cardiology, Langford Vets Langford House, Langford, Bristol, BS40 5DU, UK
| | - H Syme
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, AL7 9TA, UK
| | - H Dirrig
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, AL7 9TA, UK
| | - Z Halfacree
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, AL7 9TA, UK
| |
Collapse
|