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

Abstract

Objectives The 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 ureteral bypass (SUB) device in cats. Methods The medical records of cats with SUB placement between January 2016 and August 2019 were retrospectively analysed. The development of complications (overall, intraoperative, perioperative, short- and long-term complications) and risk factors for mortality prior to discharge were statistically assessed with univariate binary logistic regression. All variables with a P value ⩽0.10 in the univariate analysis were assessed in a multivariate model. Variables were significant if P <0.05. Results Twenty-four cats were included; 12 (50.0%) received a unilateral SUB, 11 (45.8%) a bilateral nephrostomy tube with single cystostomy catheter and the remaining cat (4.2%) two unilateral SUBs. Nearly 80% of the cats developed complications, ranging from mild to fatal, including (partial) SUB obstruction (33.3% of complications), lower urinary tract infection (20.8%), pyelonephritis (20.8%) and sterile cystitis (12.5%). Five cats (20.8%) died prior to discharge. Six cats (25.0%) underwent revision surgery. The overall median survival time (MST) was 274 days (range 1–311 days). Complications were most common in the long-term period (14/16 cats), followed by the short-term (9/18 cats), perioperative (10/23 cats) and intraoperative (4/24 cats) periods. Older cats had an increased risk for developing perioperative complications ( P = 0.045) and were less likely to survive to discharge ( P = 0.033). An increased haematocrit at presentation was a risk factor for the occurrence of short-term complications ( P = 0.03). Conclusions and relevance Although complications similar to those previously described were observed, the complication rate was higher and the MST shorter than previously reported in cats undergoing SUB placement. Despite good short-term survival, the development of complications may necessitate regular and intensive control visits. Owners that consider SUB placement should be informed that follow-up can be strenuous and expensive.

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

“…This retrospective study documents 8 cats that experienced SUB catheter migration within the digestive tract. Complications reported with placement of SUB devices include luminal obstruction (5.3%‐33.3%), UTI (8%‐30.8%), intermittent dysuria (12.5%‐38.5%), device leakage (3.5%), and kinking of the catheter(s; 4%‐12.5%) 4,5,13,14,21 . Mineralization of the device is the most common long‐term complication, recorded in 25% of cases in 1 study, with luminal occlusion of the device in about 12% 4 .…”

“…4,[6][7][8][9][10][11][12] SUB device placement is considered a safe and effective option in cats with ureteral obstruction. 4,5,13,14 Long-term complications include occlusion of the device (blood clot, mineralization), kinking of the catheters, chronic urinary tract infection, and intermittent dysuria. 4,5,[13][14][15] Transmural migration of foreign bodies is well documented in humans and most commonly occurs as a result of a forgotten surgical sponge or as a complication after surgical implants such as a hernia mesh.…”

“…The subcutaneous ureteral bypass (SUB) device has been successfully used in cats to relieve ureteral obstruction, regardless of the underlying cause 4,6‐12 . SUB device placement is considered a safe and effective option in cats with ureteral obstruction 4,5,13,14 . Long‐term complications include occlusion of the device (blood clot, mineralization), kinking of the catheters, chronic urinary tract infection, and intermittent dysuria 4,5,13‐15 …”

“…4,5,13,14 Long-term complications include occlusion of the device (blood clot, mineralization), kinking of the catheters, chronic urinary tract infection, and intermittent dysuria. 4,5,[13][14][15] Transmural migration of foreign bodies is well documented in humans and most commonly occurs as a result of a forgotten surgical sponge or as a complication after surgical implants such as a hernia mesh. 16,17 The transmural migration of abdominally retained foreign bodies into the gastrointestinal tract is seldomly reported in dogs and cats.…”

Ureterneozystotomie bei der Katze – der aktuelle Fallbericht

“…Bei der Implantation eines SUBs wird eine Umgehung der Ureterobstruktion durch das Einsetzen eines Nephrostomiekatheters in das Nierenbecken und die Verbindung über einen Konnektor mit einem in die Harnblase gesetzten Zystostomiekatheter geschaffen. In 80 % der Fälle kommt es dabei zu Komplikationen wie Obstruktion, Infektion oder Zystitis [10] Fazit Ureterolithen bei Katzen bestehen meistens aus Kalziumoxalat, das nicht durch eine medikamentelle Therapie oder diätetische Maßnahmen auflösbar ist. Die chirurgische Intervention von Ureterolithen ist nach Studienlage zwar relativ häufig mit Komplikationen wie Strikturbildung, lokalen Ödemen oder Harnleckagen verbunden, sie sollte aber nicht von vorneherein ausgeschlossen werden.…”