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Bussières MP, Grasso S, Jull P. Preliminary evaluation of an indwelling epidural catheter for repeat methylprednisolone administration in canine lumbosacral stenosis. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2024; 65:462-472. [PMID: 38694734 PMCID: PMC11017932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Objective To determine the complications, outcomes, and patency of a permanent epidural catheter and subcutaneous access port system (ECAPS) as part of conservative management of degenerative lumbosacral stenosis in dogs. Animals and procedure Medical records of 11 client-owned dogs that underwent an ECAPS insertion were evaluated retrospectively. Clinical signs, complications related to the procedure, and system patency are reported. Results All dogs had lumbosacral pain at their initial neurological assessment, with comfort levels adequately controlled following epidural infiltrations. None suffered from complications related to the ECAPS procedure. In 10 dogs, there were no malfunctions for the duration of the study. However, in 1 dog, there was a suspected leak at Day 814. The longest duration of patency reported in this study was 870 d (at the time of writing). Conclusion Placement of an ECAPS is a feasible technique and a viable option to permit repeated epidural injections of steroids in dogs with degenerative lumbosacral stenosis that is managed conservatively. Further studies are required to evaluate complication rates.
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Affiliation(s)
- Marie-Philippe Bussières
- The Veterinary Specialty Clinic for Anesthesia and Neurology (VSCAN), 2300 Carling Avenue, Ottawa, Ontario K2B 7G1
| | - Stefania Grasso
- The Veterinary Specialty Clinic for Anesthesia and Neurology (VSCAN), 2300 Carling Avenue, Ottawa, Ontario K2B 7G1
| | - Philip Jull
- The Veterinary Specialty Clinic for Anesthesia and Neurology (VSCAN), 2300 Carling Avenue, Ottawa, Ontario K2B 7G1
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Kurtz M, Pey PBM, Mortier J, Manassero M, Da Riz F, Canonne‐Guibert M, Maurey C, Benchekroun G. Usefulness of serum amyloid A for the diagnosis of pyelonephritis in cats: A prospective evaluation. J Vet Intern Med 2024; 38:1542-1552. [PMID: 38669563 PMCID: PMC11099735 DOI: 10.1111/jvim.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The diagnosis of pyelonephritis in cats is challenging and development of a noninvasive and accurate biomarker is needed. HYPOTHESES Serum amyloid A (SAA) is increased in cats with pyelonephritis, but not in cats with other urinary tract diseases. ANIMALS A cohort of 125 cats (149 observations). METHODS This was a prospective study. Group 1 included cats with a diagnosis of pyelonephritis either confirmed by bacterial culture of pelvic urine (Group 1a) or presumed (1b). Group 2 included cats for which pyelonephritis was ruled out (with certainty: Group 2a or judged unlikely: Group 2b). SAA concentration was compared between groups, and accuracy of SAA for the diagnosis of pyelonephritis was calculated using a Receiver Operating Characteristic (ROC) curve analysis. RESULTS Median SAA concentration was significantly higher in Group 1a (86.8 mg/L [73.3; 161.5]; n = 8) than in Group 2a (4 mg/L [1.8; 5.6], n = 19; P < .001) and in Group 2b (5.4 mg/L [3.1; 9.7], n = 113; P < .001). It was also significantly higher in Group 1b (98.8 mg/L [83.1; 147.3]; n = 9) than in Group 2b (P < .001) and Group 2a (P < .001). Optimal diagnostic cut-off for SAA concentration was 51.3 mg/L. yielding a sensitivity of 88% (95% confidence interval: [64%; 99%]) and a specificity of 94% (95% confidence interval: [88%; 97%]). CONCLUSIONS AND CLINICAL IMPORTANCE Measurement of SAA could be used to rule out pyelonephritis in the case of low suspicion of the disease. Increased SAA concentration is suggestive of pyelonephritis despite a lack of specificity.
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Affiliation(s)
- Maxime Kurtz
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Pascaline Bénédicte Marie Pey
- Antech Imaging ServicesIrvineCaliforniaUSA
- Veterinary Hospital “I Portoni Rossi,” Anicura, Zola Predosa (BO)BolognaItaly
| | - Jérémy Mortier
- Ecole Nationale Vétérinaire d'Alfort, CHUVAService D'Imagerie MédicaleMaisons‐AlfortFrance
| | - Mathieu Manassero
- École Nationale Vétérinaire d'Alfort, CHUVAService de ChirurgieMaisons‐AlfortFrance
| | - Fiona Da Riz
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Morgane Canonne‐Guibert
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'Alfort, CHUVAService D'Imagerie MédicaleMaisons‐AlfortFrance
| | - Christelle Maurey
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Ghita Benchekroun
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'AlfortUniv Paris Est Créteil, INSERM, IMRBMaisons‐AlfortFrance
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Aronson L, Schmiedt C, Bartges J, Monnet E, Hardie R. Letter regarding "Benign ureteral obstruction in cats: Outcome with medical management". J Vet Intern Med 2024; 38:12-13. [PMID: 37945320 PMCID: PMC10800177 DOI: 10.1111/jvim.16909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Lillian Aronson
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chad Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Joe Bartges
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Eric Monnet
- Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Robert Hardie
- School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Djoneva L, Lawson J, Rutherford L, Geddes R. Analysis of lower urinary tract signs and bacteriuria in cats with subcutaneous ureteral bypass systems. Vet Rec Open 2023; 10:e69. [PMID: 37534374 PMCID: PMC10393289 DOI: 10.1002/vro2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives Distinguishing bacterial cystitis from subclinical bacteriuria is necessary for feline treatment protocols and antimicrobial stewardship. This can be challenging in cats with subcutaneous ureteral bypass (SUB) systems because they may present with lower urinary tract signs without bacteriuria. We investigated the relationship between positive urine culture and lower urinary tract signs in cats with SUBs, including factors associated with each. Methods Clinical records were retrospectively reviewed to identify cats presenting with ureteral obstruction that underwent placement of a SUB device(s). The relationship between a positive urine culture and lower urinary tract signs was determined by chi-squared analysis. Univariable and multivariable logistic regression models were performed to identify factors associated with positive urine cultures and lower urinary tract signs. Results Two hundred and thirty visits were recorded for 61 cats, with 36 of 230 (16%) positive cultures in 21 of 61 (34%) cats. Lower urinary tract signs were documented at 97 of 230 (42%) visits, with 37 of 61 (61%) cats demonstrating lower urinary tract signs at some point. No relationship was found between culture results and lower urinary tract signs. Risk factors for a positive culture were higher urine pH, higher urine white blood cells and the presence of bacteriuria on microscopy. Risk factors for lower urinary tract signs were younger age and being a purebred cat (vs. non-purebred). Conclusions A high proportion of cats with SUBs exhibited sterile lower urinary tract signs, making differentiation between bacterial cystitis and subclinical bacteriuria difficult. This highlights the need for clearer guidelines on when to treat bacteriuria in cats with SUBs.
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Affiliation(s)
- Luba Djoneva
- Royal Veterinary CollegeNorth MymmsHatfieldHertfordshireUK
| | - Jack Lawson
- Royal Veterinary CollegeNorth MymmsHatfieldHertfordshireUK
| | | | - Rebecca Geddes
- Royal Veterinary CollegeNorth MymmsHatfieldHertfordshireUK
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Maxwell AD, Kim GW, Furrow E, Lulich JP, Torre M, MacConaghy B, Lynch E, Leotta DF, Wang YN, Borofsky MS, Bailey MR. Development of a burst wave lithotripsy system for noninvasive fragmentation of ureteroliths in pet cats. BMC Vet Res 2023; 19:141. [PMID: 37660015 PMCID: PMC10474658 DOI: 10.1186/s12917-023-03705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Upper urinary tract stones are increasingly prevalent in pet cats and are difficult to manage. Surgical procedures to address obstructing ureteroliths have short- and long-term complications, and medical therapies (e.g., fluid diuresis and smooth muscle relaxants) are infrequently effective. Burst wave lithotripsy is a non-invasive, ultrasound-guided, handheld focused ultrasound technology to disintegrate urinary stones, which is now undergoing human clinical trials in awake unanesthetized subjects. RESULTS In this study, we designed and performed in vitro testing of a modified burst wave lithotripsy system to noninvasively fragment stones in cats. The design accounted for differences in anatomic scale, acoustic window, skin-to-stone depth, and stone size. Prototypes were fabricated and tested in a benchtop model using 35 natural calcium oxalate monohydrate stones from cats. In an initial experiment, burst wave lithotripsy was performed using peak ultrasound pressures of 7.3 (n = 10), 8.0 (n = 5), or 8.9 MPa (n = 10) for up to 30 min. Fourteen of 25 stones fragmented to < 1 mm within the 30 min. In a second experiment, burst wave lithotripsy was performed using a second transducer and peak ultrasound pressure of 8.0 MPa (n = 10) for up to 50 min. In the second experiment, 9 of 10 stones fragmented to < 1 mm within the 50 min. Across both experiments, an average of 73-97% of stone mass could be reduced to fragments < 1 mm. A third experiment found negligible injury with in vivo exposure of kidneys and ureters in a porcine animal model. CONCLUSIONS These data support further evaluation of burst wave lithotripsy as a noninvasive intervention for obstructing ureteroliths in cats.
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Affiliation(s)
- Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Ga Won Kim
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Eva Furrow
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Jody P Lulich
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Marissa Torre
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Brian MacConaghy
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Elizabeth Lynch
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Daniel F Leotta
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | | | - Michael R Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA.
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Khoo TX, Wang S, Chambers B, McMillan A, Yates G. Modified endoluminal ureteral stenting for the management of proximal ureteral obstruction in two cats. JFMS Open Rep 2023; 9:20551169231210449. [PMID: 38115862 PMCID: PMC10729628 DOI: 10.1177/20551169231210449] [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] [Indexed: 12/21/2023] Open
Abstract
Case series summary Two cases of placement of modified endoluminal ureteral stents are described, for revision of a subcutaneous ureteral bypass (SUB) and for primary treatment of obstructive ureterolithiasis. Modified endoluminal stents were inserted through the ureterotomy, anchored in the renal pelvis with a single pigtail and shortened to a length sufficient to span the proximal ureter and ureterotomy site. Relevance and novel information The advantages of this approach as a surgical option for feline obstructive ureterolithiasis are demonstrated, including the avoidance of disruption, or bypass, of the ureterovesicular junction, minimisation of implanted foreign material and avoidance of intravesicular stent mass, maintenance of the physiological route of urine flow, including preservation of active distal ureteral function, and limitation of the potential complications of ureterotomy. The clinical efficacy of this adaptation of the previously published endoluminal stenting technique is demonstrated with its applicability de novo and in the revision of other stenting procedures.
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Affiliation(s)
- Teng-Xiang Khoo
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Shaojing Wang
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Brenton Chambers
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Angus McMillan
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Guy Yates
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
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Wuillemin F, Vachon C, Beauchamp G, Dunn M. Subcutaneous ureteral bypass device placement in 81 cats with benign ureteral obstruction (2013-2018). J Vet Intern Med 2021; 35:2778-2786. [PMID: 34894007 PMCID: PMC8692180 DOI: 10.1111/jvim.16280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background Benign ureteral obstructions (BUOs) present a therapeutic challenge in cats. Hypothesis/Objectives The purpose of this study was to determine the outcome and complications associated with placement of subcutaneous ureteral bypass (SUB) device in cats. Animals Eighty‐one client‐owned cats (117 kidneys) with BUO treated by placement of a SUB. Methods Retrospective study. Medical records of cats with BUO and treated by SUB device placement between 2013 and 2018 were reviewed. Outcome and complications were documented. Results Hospital discharge rate was 94% (76/81). Serum creatinine on admission and at the time of discharge was 5.3 mg/dL (range, 1.2 to >15 mg/dL) and 2.1 mg/dL (range, 1.1‐12.5 mg/dL), respectively. Luminal obstructions were documented in 17% (18/109) of the SUB devices of 16 cats discharged from the hospital. Infection was documented in 26% (20/76) of discharged cats. Kink of the device was documented in 10% (12/117) of devices. Time to luminal obstruction and kink were 204 days (range, 21‐1678 days) and 58 days (range, 2‐601 days), respectively. Fourteen of 81 (17%) cats required a revision surgery in order to restore patency of the device. At the time of writing, 53% (43/81) of cats were alive, with a mean survival time of 821 days (range, 1‐2170 days) after surgery. Of those that died, 52% (20/38) died of urinary related causes. Conclusion and Clinical Importance This study suggests that SUB device placement is associated with good outcomes and could be considered for the treatment of BUO in cats.
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Affiliation(s)
- Florian Wuillemin
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Catherine Vachon
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Guy Beauchamp
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Marilyn Dunn
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
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