Direct renal pelvicocystostomy using tube cystoplasty in a cat with ureteral obstruction

Abstract

We describe a surgical technique to re-establish urine flow in a 3-year-old Scottish Fold cat. A ureteral stent and subcutaneous urinary bypass failed after their placement due to rapid mineralisation of the lumen. Direct pelvicocystostomy anastomosis using a modified tube cystoplasty technique was performed. A wide rectangular apex-based full-thickness flap was created from the ventral aspect of the urinary bladder, which was sutured longitudinally to form a large-diameter tube. The resulting tube-shaped portion of the bladder was then directly anastomosed to the renal pelvis. No major postoperative complications were observed and no further recurrence of obstruction of the upper urinary tract was noted during follow-up. The cat died at home 481 days postoperatively from an undetermined cause. A pelvicocystostomy technique can be considered as an alternative salvage surgical technique for obstructive ureteral disease in cats.

Evaluation of two nephrocystostomy techniques for ureteral bypass in cats

“…Options for surgical management include direct repair or ureterotomy, ureteral resection and anastomosis, ureteral resection and neoureterocystostomy, ureteral resection and neoureterocystostomy with creation of a Boari flap, or pelvicocystostomy. [1][2][3] Surgical management of ureteral obstruction in cats has a relatively high morbidity and mortality rate ranging from 3% to 31% and 8% to 18%, respectively. 2,4 Because of challenges associated with surgical treatment, palliative interventional approaches using subcutaneous ureteral bypass devices (SUBs) and stents have gained favor.…”

“…Lesions of the proximal ureter in cats can be challenging to treat. Options for surgical management include direct repair or ureterotomy, ureteral resection and anastomosis, ureteral resection and neoureterocystostomy, ureteral resection and neoureterocystostomy with creation of a Boari flap, or pelvicocystostomy 1–3 . Surgical management of ureteral obstruction in cats has a relatively high morbidity and mortality rate ranging from 3% to 31% and 8% to 18%, respectively 2,4 .…”

Extravesicular, two‐layer, side‐to‐side ureteroneocystostomy combined with tension‐relieving techniques for feline proximal ureteral obstruction: A retrospective study

“…One option for treatment of very proximal ureteral obstruction includes the use of a Boari flap, 25,[30][31][32] which involves the extension of a tubularized bladder to the remaining ureteral orifice. Another option is the use of an ileal graft 33 that replaces the obstructed ureter with a vascularized segment of ileum.…”

“…Both techniques were developed to minimize tension at the ureteroneocystostomy site. Three successful [30][31][32] and one failed 25 cases of ureteroneocystostomy with a Boari flap in cats with proximal ureteral obstruction have been reported. There is one case report of an ileal graft technique (ileal-ureteral substitution), but the length of the ureter proximal to the stricture site was not included in the report.…”