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Clarke DL. Medical and Surgical Management of Ureteral Obstructions. Vet Clin North Am Small Anim Pract 2025; 55:503-523. [PMID: 40316374 DOI: 10.1016/j.cvsm.2025.02.004] [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] [Indexed: 05/04/2025]
Abstract
Many patients with ureteral obstructions are critically ill at the time of diagnosis, especially if there is dysfunction of the contralateral kidney. They may present with varying severities of uremia and acute kidney injury as well as systemic inflammation and sepsis secondary to infection. Medical management, which may consist of rehydration and restoration of intravascular volume with intravenous fluid therapy, osmotic diuresis, ureteral muscle relaxation, and antimicrobials for infection, is important in ureteral obstruction patients. Unstable patients may require more emergent intervention to relive the obstruction and address the life-threatening sequelae to acute kidney injury.
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Affiliation(s)
- Dana L Clarke
- Interventional Radiology & Critical Care, Department of Small Animal Clinical Sciences, University of Pennsylvania School of Veterinary Medicine, 3900 Spruce Street, Philadelphia, PA 19104, USA.
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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.
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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
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Eyral V, Pichard D, Mariaud V, Manassero M, Maurey C. Struvite ureterolithiasis associated with ureolytic bacterial pyelonephritis in a cat. JFMS Open Rep 2025; 11:20551169251316739. [PMID: 40115824 PMCID: PMC11924072 DOI: 10.1177/20551169251316739] [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: 03/23/2025] Open
Abstract
Case summary A 2-year-old female spayed domestic shorthair cat with a 1-week history of lethargy and dysorexia was presented to a veterinary teaching hospital. Physical examination identified severe left nephromegaly, hyperthermia and abdominal pain. Abdominal ultrasound revealed a left ureteral dilation due to obstruction by a ureterolith, associated with marked subcapsular effusion. Urinalysis showed alkaline urine with crystals of struvite. Culture of urine from the renal pelvis and the urinary bladder was positive for Staphylococcus pseudintermedius. An infected struvite ureterolith due to the presence of urease-producing bacteria was suspected. The ureterolith was removed via ureterotomy and a temporary ureteral stent was positioned in an antegrade fashion. Results of infrared spectroscopy showed pure struvite urolithiasis. The stent was removed via cystoscopy 35 days after surgery. The cat was still doing well at the 6-month follow-up. Relevance and novel information To the best of the authors' knowledge, this is the first case of a struvite ureterolith due to ureolytic pyelonephritis in a cat.
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Affiliation(s)
- Victor Eyral
- Service d'imagerie médicale, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Diane Pichard
- Service de médecine interne, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Vincent Mariaud
- Service d'imagerie médicale, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Mathieu Manassero
- Service de chirurgie, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Christelle Maurey
- Service de médecine interne, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
- INRAE, ANSES, École Nationale Vétérinaire d'Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, Maisons-Alfort, France
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Moosavian H, Masoudifard M, Zareh MB, Jamshidi S, Tamai IA. Significance of scattered small echogenic foci floating in urinary bladder as ultrasonography finding in dogs. BMC Vet Res 2024; 20:354. [PMID: 39118117 PMCID: PMC11308492 DOI: 10.1186/s12917-024-04008-9] [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: 01/21/2024] [Accepted: 04/07/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Despite the prevalence of echogenic foci floating in the urinary bladder seen in ultrasonography in dogs, surprisingly little has been written on its significance, including its potential association with urinalysis. The objective of the study was to determine the diagnostic value of the echogenic foci floating in urinary bladders in dogs. RESULTS - Cystosonography was performed on 45 dogs. Bladder contents were examined and divided into positive (containing echogenic particles) and negative (absent echogenic particles) groups according to the presence and absence of floating echogenic particles. Five mL of urine was collected via cystocentesis. Urine analysis and culture were done and the relationship between ultrasound evaluation and urinalysis results was investigated. In dogs with bladder echogenic particles in ultrasonography, the prevalence of hematuria, pyuria, bacteriuria, and lipiduria were 88.9%, 92.6%, 29.6%, and 70.3%, respectively. However, in dogs in which echogenic particles were not observed in their bladders, the prevalence of hematuria, pyuria, bacteriuria, and lipiduria was 77%, 50%, 5.5%, and 77%, respectively. There was a significant association between bladder debris and positive urine culture, with an odds ratio of 7.15 (95% confidence interval: 0.81-63.28) compared with matched controls. Furthermore, there was a significant relationship between the presence of floating echogenic particles with pyuria, and urine color ( p ≤ 0.05). CONCLUSION In conclusion, the present results showed the detection of bladder debris on ultrasound can be a predictor for pyuria and positive urine culture in dogs.
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Affiliation(s)
- Hamidreza Moosavian
- Department of Clinical Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
| | - Majid Masoudifard
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Maede Beiki Zareh
- Department of Clinical Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Shahram Jamshidi
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Iraj Ashrafi Tamai
- Department of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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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.
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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
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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: 13] [Impact Index Per Article: 3.3] [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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Almendros A. Use of a pleural access port for the treatment of pyothorax in a cat. Open Vet J 2021; 11:283-288. [PMID: 34307085 PMCID: PMC8288731 DOI: 10.5455/ovj.2021.v11.i2.12] [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: 03/30/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Pyothorax in cats is treated with intravenous fluids and antibiotics, and while thoracotomy and debridement are less commonly necessary, thoracostomy tubes are the treatment of choice when repeated drainage of the pleural cavity is needed. Case Description: An 11-month-old British short-haired cat was presented for a sudden onset of lethargy, dyspnea, and tachypnea, following an ovariohysterectomy 10 days prior to the treatment process. Pyrexia and muffled cardiac sounds on the left hemithorax were noted. A hemogram indicated the development of anemia and neutrophilia with a left shift. Radiography and ultrasonography confirmed a pleural effusion, and a CT scan ruled out the presence of any masses or perforating foreign bodies. A PCR on the pleural effusion ruled out feline coronavirus infection, and fluid analysis was confirmed as a septic exudate with Pasteurella multocida infection. A pleural access port was used to treat the pyothorax that successfully reduced hospitalization time and lowered overall financial outlay despite surgical implantation. Conclusion: The present report describes the successful use of a pleural port to treat pyothorax in one cat. This is the first time such a device has been reported for the treatment of pyothorax.
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Affiliation(s)
- Angel Almendros
- Veterinary Medical Center, City University of Hong Kong, Hong Kong SAR, China
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Wood MW, Lepold A, Tesfamichael D, Lasarev MR. Risk factors for enterococcal bacteriuria in dogs: A retrospective study. J Vet Intern Med 2020; 34:2447-2453. [PMID: 33009682 PMCID: PMC7694861 DOI: 10.1111/jvim.15916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/26/2020] [Accepted: 09/17/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In humans, Enterococcus spp. urinary tract infections (UTI) are commonly associated with urinary catheter-induced urothelial inflammation but this is not the case in dogs. HYPOTHESIS/OBJECTIVES To identify risk factors predisposing dogs to enterococcal bacteriuria. ANIMALS Seventy dogs with Enterococcus spp. bacteriuria (case) and 70 dogs with Enterococcus coli bacteriuria (control). METHODS A single center retrospective case-control study with subjects and controls identified by a medical records search for Enterococcus spp. (subject) or E coli (control) bacteriuria from January 1, 2014 to December 31, 2017. Cases and controls were balanced with respect to average age and weight. Binary logistic regression was used to estimate and test whether the odds of having Enterococcus spp. bacteriuria (instead of E coli) were associated with the presence of any given characteristic. RESULTS A history of recurrent bacteriuria was significantly more common in Enterococcus spp. cases than in E coli controls (odds ratio [OR]: 2.07; 95% confidence interval [CI]: 1.04-4.16, P = .04). Comorbidities associated with the presence of Enterococcus spp. bacteriuria included lower urinary tract (LUT) anatomic abnormalities (OR: 2.94; 95% CI: 1.17-8.10, P = .02), urolithiasis (P = .01), and the presence of LUT neoplasia (P = .04). Small frequencies (n = 12 and n = 6, respectively) compromise our ability to precisely estimate the genuine OR for the latter 2 characteristics. CONCLUSIONS AND CLINICAL IMPORTANCE If the identified risk factors promote Enterococcus spp. colonization in dogs via induced LUT inflammation similar to people then Enterococcus spp. bacteriuria could be a sentinel for underlying LUT inflammation.
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Affiliation(s)
- Michael W Wood
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Adam Lepold
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Dahlia Tesfamichael
- College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Griffin S. Feline abdominal ultrasonography: What's normal? What's abnormal? Renal pelvis, ureters and urinary bladder. J Feline Med Surg 2020; 22:847-865. [PMID: 32845227 PMCID: PMC11135665 DOI: 10.1177/1098612x20941786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the urinary tract provides important information useful in the investigation of several conditions including ureteral obstruction and cystitis. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as lipid droplets in the bladder, and pathological changes can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased renal pelvis, ureters and urinary bladder. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. Ultrasound examination of the kidneys and perinephric space was discussed in an article published in May 2020. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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Hemasri S, Okene IAA, Goni MD. Feline hemotropic mycoplasmosis concurrent with bacterial cystitis in a domestic shorthair cat. J Adv Vet Anim Res 2019; 5:490-495. [PMID: 31453163 PMCID: PMC6702915 DOI: 10.5455/javar.2018.e304] [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: 06/20/2018] [Revised: 09/03/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022] Open
Abstract
Objective: The main aim of this case report is to present a case of feline hemotropic mycoplasmosis that occurred concurrently with bacterial cystitis following the bite. Material and methods: A 3-year-old intact male domestic shorthair cat weighing 3.7 kg was referred to the Universiti Malaysia Kelantan Veterinary Clinic with clinical signs of hematuria and dysuria. History revealed that it was managed outdoor, fed with kibbles and wet food, but with no vaccination and deworming. Upon physical examination, the cat had a dull appearance, pale mucous membrane, normal respiratory rate, hypothermia, and bradycardia. Upon the examination of the urogenital system, there were urine burns at the anal region, necrotized penile tip, and presence of bite wound observed at the perineal region. Turgid and enlarged urinary bladder was identified upon palpation. Results: Diagnostic investigation revealed the hemotropic mycoplasmosis via microscopy, while urine culture was positive for Escherichia coli infection. The cat was successfully treated symptomatically. Conclusion: However, the prognosis of this cat was guarded given that the anemia was unresolved at the point of discharge.
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Affiliation(s)
- Sukumaran Hemasri
- Faculty of Veterinary Medicine, University Malaysia Kelantan, Kota Bharu, Malaysia
| | | | - Mohammed Dauda Goni
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Malaysia
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Borchert C, Berent A, Weisse C. Subcutaneous ureteral bypass for treatment of bilateral ureteral obstruction in a cat with retroperitoneal paraganglioma. J Am Vet Med Assoc 2019; 253:1169-1176. [PMID: 30311526 DOI: 10.2460/javma.253.9.1169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 7-year-old female domestic shorthair cat was referred for evaluation of azotemia and unilateral hydronephrosis. CLINICAL FINDINGS Abdominal ultrasonography revealed right-sided hydronephrosis and dilation of the proximal aspect of the ureter; the left kidney was small with irregular margins. A highly vascular, irregular retroperitoneal mass, not clearly associated with the ureteral obstruction, was also visualized. Surgical exploration confirmed a retroperitoneal mass involving the caudal mesenteric artery and both ureters, with hydroureter on the right side. TREATMENT AND OUTCOME A subcutaneous ureteral bypass (SUB) device was surgically implanted to treat right ureteral obstruction, and the mass was biopsied. Shortly after surgery, progressive azotemia and hyperkalemia were detected; ultrasonographic examination revealed left-sided hydronephrosis and hydroureter, which was suspected secondary to inflammation of the mass causing a left-sided ureteral obstruction. A second surgery was performed to place an SUB device for the left kidney and remove the retroperitoneal mass; both ureters were ligated at the mid- and distal aspects and then transected and removed with the mass. A neuroendocrine paraganglioma was identified by histopathologic evaluation of the mass. Hydronephrosis improved (right kidney) or resolved (left kidney) after surgery, and azotemia improved. Chemotherapeutic intervention was declined. Markers of renal function were static during the 14-month follow-up period. At the last follow-up evaluation, the patient was reportedly doing well, and both SUB devices were patent. CLINICAL RELEVANCE This was the first report of retroperitoneal paraganglioma in a domestic cat causing bilateral ureteral obstruction. Bilateral SUB device placement enabled en bloc mass resection and provided long-term relief of ureteral obstruction.
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Sapora JA, Hardie RJ, Evans N. Use of a subcutaneous ureteral bypass device for treatment of bilateral proximal ureteral injury in a 9-month-old cat. JFMS Open Rep 2019; 5:2055116919831856. [PMID: 30886728 PMCID: PMC6415474 DOI: 10.1177/2055116919831856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 9-month-old male domestic longhair cat presented following iatrogenic ureteral trauma after an attempted laparoscopic ovariectomy. Prior to identifying that the cat was male, both ureters were transected approximately 4 mm from the renal pelves. Initial management involved a left-sided Boari flap neoureterocystostomy, cystonephropexy and right ureteronephrectomy. Thirty-six hours later, the cat developed uroabdomen due to leakage from the neoureterocystostomy site. At a tertiary referral institution, the ureter was reconstructed via end-to-end anastomosis and a left-sided subcutaneous ureteral bypass (SUB) device was placed in the event the anastomosis failed. Five weeks after SUB placement, the cat was dysuric and stranguric. A urine culture was negative and clinical signs were attributed to sterile cystitis secondary to device placement. Blood urea nitrogen (BUN) was 22 mg/dl and creatinine was 1.2 mg/dl. Contrast pyelography confirmed device patency, but no contrast was identified through the ureteral anastomosis. At 12 months, BUN and creatinine were 1.5 mg/dl and 25 mg/dl, respectively, and a subclinical urinary tract infection was identified (Enterococcus faecalis). Antibiotic therapy was not prescribed in order to prevent multidrug resistance. At 42 months, BUN was 38 mg/dl and creatinine was 2.0 mg/dl. The cat had occasional and intermittent signs of pollakiuria and stranguria but was otherwise doing well. Relevance and novel information To our knowledge, this is the first case report to describe the use of a SUB device for management of traumatic proximal ureteral injury in a cat with one kidney. The case outcome provides valuable information about the direct effect of the SUB device and the presence of chronic Enterococcus species infection on long-term renal function.
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Affiliation(s)
- Joseph A Sapora
- University of Wisconsin School of Veterinary Medicine, Madison, WI, USA
| | - Robert J Hardie
- Department of Surgical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA
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Maurey C, Boulouis HJ, Canonne-Guibert M, Benchekroun G. Clinical description of Corynebacterium urealyticum urinary tract infections in 11 dogs and 10 cats. J Small Anim Pract 2019; 60:239-246. [PMID: 30653665 DOI: 10.1111/jsap.12973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/01/2018] [Accepted: 11/14/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine the clinical signs, laboratory findings, possible predisposing factors, antimicrobial sensitivity and outcomes of dogs and cats diagnosed with urinary tract infection caused by Corynebacterium urealyticum. MATERIALS AND METHODS Retrospective, observational study of dogs and cats that were diagnosed with urinary tract infection caused by C. urealyticum. RESULTS This report concerns a total of 11 dogs and 10 cats. All cats had a history of urethral catheterisation, and six cats had undergone urological surgery before diagnosis of this specific infection. Dogs had history of neurogenic urinary incontinence (n=5), urethral catheterisation (n=4), urological surgery (n=4), lower urinary tract disease (n=2) or prostatic disease (n=1). In seven animals, previous urine culture was negative. Median urine pH was 8.6 (interquartile range 7.5 to 9), and 19 animals had pyuria and struvite crystalluria. Encrusted cystitis was diagnosed by abdominal ultrasound in nine animals. All but one isolate were resistant to at least three antimicrobial classes. Thirteen isolates were sensitive to tetracyclines. There was bacterial and clinical resolution of the infection in nine dogs and seven cats. Two animals died from sepsis and two cats were euthanased because of clinical deterioration. CLINICAL SIGNIFICANCE Urinary tract infection caused by C. urealyticum should be suspected in animals with pre-existing urinary disorders, especially if urine is alkaline and there is struvite crystalluria, negative routine urine culture and encrusted cystitis.
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Affiliation(s)
- C Maurey
- Ecole Nationale Vétérinaire d'Alfort, Unité de Médecine Interne, 94700 Maisons Alfort, France
| | - H-J Boulouis
- Ecole Nationale Vétérinaire d'Alfort, BioPôle Alfort, 94700 Maisons Alfort, France
| | - M Canonne-Guibert
- Ecole Nationale Vétérinaire d'Alfort, Unité de Médecine Interne, 94700 Maisons Alfort, France
| | - G Benchekroun
- Ecole Nationale Vétérinaire d'Alfort, Unité de Médecine Interne, 94700 Maisons Alfort, France
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McQuitty RG, Branter EM. Treatment of fungal pyelonephritis and ureterolithiasis with a subcutaneous ureteral bypass system and systemic antifungal medication in a cat. VETERINARY MEDICINE-RESEARCH AND REPORTS 2018; 9:73-78. [PMID: 30568915 PMCID: PMC6267714 DOI: 10.2147/vmrr.s179112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose We describe a case of ureteral obstruction and fungal pyelonephritis in a cat. The case was managed successfully with a subcutaneous ureteral bypass (SUB) device and systemic antifungal medication. Case summary A 9-year-old, male, neutered, domestic shorthair cat was referred for severe azotemia, ureteral obstruction, and sonographically identified progressive pyelectasia of the left kidney. A SUB device was placed. Cytology of the left kidney subsequently identified fungal organisms, and the cat responded clinically to treatment with fluconazole and supportive care. The cat survived for 11 months with intermittent fluconazole treatment. Conclusion Fungal pyelonephritis should be considered as a possible concurrent diagnosis in cats with ureteral obstruction. The successful clinical outcome in this case suggests that treatment with SUB placement, antifungal medication, and supportive care could be an effective treatment strategy.
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Affiliation(s)
- Rebecca G McQuitty
- Emergency and Critical Care Department, ACCESS Specialty Animal Hospital, Culver City, CA, USA,
| | - Erinne M Branter
- Interventional Radiology/Endoscopy Department, ACCESS Specialty Animal Hospital, Culver City, CA, USA
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15
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Berent AC, Weisse CW, Bagley DH, Lamb K. Use of a subcutaneous ureteral bypass device for treatment of benign ureteral obstruction in cats: 174 ureters in 134 cats (2009–2015). J Am Vet Med Assoc 2018; 253:1309-1327. [DOI: 10.2460/javma.253.10.1309] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Interventional Radiology and Interventional Endoscopy in Treatment of Nephroureteral Disease in the Dog and Cat. Vet Clin North Am Small Anim Pract 2018; 48:843-862. [PMID: 29909932 DOI: 10.1016/j.cvsm.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Interventional endoscopy and interventional radiology have led to the development of minimally invasive techniques for management of kidney and ureteral diseases in the dog and cat including idiopathic renal hematuria, ureteral obstruction, and ectopic ureters. Sclerotherapy is a renal-sparing chemical cauterization technique used in cases of idiopathic renal hematuria. Diagnosis of ureteral obstruction is challenging in some cases based on ultrasound alone and antegrade pyelography should be considered. Treatment options for obstructions include nephrostomy tubes, ureteral stents, and subcutaneous ureteral bypass devices. Treatment with cystoscopic-guided laser ablation provides similar outcomes to surgery in dogs with intramural ectopic ureters.
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