Feline double pigtail ureteric stents for management of ureteric obstruction: short- and long-term follow-up of 26 cats

Abstract

The objective of this study was to determine the outcome of cats with ureteric obstruction managed with double pigtail ureteric stents and to document the incidence of lower urinary tract signs at long-term follow-up. Data were obtained retrospectively from the medical records (2009-2012) of 26 cats that underwent ureteric stent placement. Owners were contacted for follow-up, and a quality of life questionnaire completed. Survival to discharge after stent placement was 85% (22/26). Prevalence of postoperative uroabdomen necessitating further surgery was 15% (4/26). Stents were replaced 4-28 months after the initial surgery in four cats because of migration, fracture, encrustation causing luminal obstruction or sterile cystitis, respectively. Nine cats were alive at follow-up, which was 3-28 months after the original surgery. Nine cats had azotaemic chronic kidney disease and nine had signs related to sterile cystitis; three of these cats were euthanased as a result of the severity of the signs. Preoperative serum creatinine of the survivors (9.4 mg/dl, n = 9) was not significantly different from that of the non-survivors (6.5 mg/dl, n = 13; P = 0.295). Quality of life was assigned a mean score of 8/10. Median survival of cats following discharge was 419 days (range 44-994 days). Signs consistent with sterile cystitis affected 35% of cats. It was concluded that ureteric stent placement in cats was associated with a 15% mortality rate before hospital discharge. Long-term management of ureteric stents is associated with a high rate of lower urinary tract signs.

Feline ureteral obstructions Part 2: surgical management

“…Ureteroscopy is not possible in cats due to small ureteral size. In cats, ureteral stents have been described for the management of ureterolithiasis, dried solidified blood stones, ureteral strictures, intraluminal bypass to facilitate healing after ureteral surgery or trauma, and neoplasia (Berent 2011, Zaid et al 2011, Berent et al 2012, Nicoli et al 2012, Horowitz et al 2013, Kulendra et al 2014, Manassero et al 2014, Steinhaus et al 2015, Culp et al 2016. Both temporary and long-term use are described for veterinary patients, which is in contrast to most uses in humans.…”

“…Ureteral stenting in cats is more challenging than in dogs due to the small size of the feline ureter. Retrograde cystoscopic placement has been described in female cats, but is extremely difficult and requires diffuse ureteral dilation since digital manipulation and assistance for ureteral dilation and stent passage is not possible (Zaid et al 2011, Berent et al 2012, Kulendra et al 2014. Percutaneous anterograde stenting is also rarely performed in cats.…”

“…The vast majority of cats require laparotomy for ureteral stent placement, which can be performed in both a retrograde or anterograde fashion, though anterograde surgical placement is preferred (Berent et al 2012, Culp et al 2016, Wormser et al ). Ureterotomy to facilitate stone removal and aid in wire and stent passage may be necessary, regardless of whether an anterograde or retrograde approach is used (Berent et al 2012, Kulendra et al 2014, Culp et al 2016. In both approaches, dilation with the tapered end of the provided 0·034ʺ pusher/dilator of any normal diameter ureter is often needed to facilitate stent placement.…”

“…Lateral and ventrodorsal images are taken with fluoroscopy to confirm final ureteral stent positioning. Intraoperative complications during ureteral stenting include the need for multiple pyelocentesis attempts, need for ureterotomy to facilitate wire or stent passage, ureteral tearing during dilator advancement, stent migration out of the nephrostomy access site, need for papillotomy (up to 40% of cases), ureteral perforation by the guidewire (up to 17% of cases) and urine leakage from the pyelocentesis, ureterotomy or cystotomy incisions (Berent et al 2012, Kulendra et al 2014, Manassero et al 2014, Culp et al 2016. Postoperative complications include urine leakage and uroabdomen (up to 8·7%), stent positioning in the renal parenchyma, pollakiuria and stranguria, congestive heart failure, pancreatitis, hepatic lipidosis, anaemia requiring packed red blood cell transfusion and cardiac arrest.…”

A retrospective study of anesthesia for subcutaneous ureteral bypass placement in cats: 27 cases

“…Surgical intervention is often required if obstruction does not resolve within 24–48 hr of medical management or if the cat shows signs of progressive hydronephrosis [5, 13, 16, 19, 20]. As an alternative to traditional surgical interventions for treatment of ureteral obstruction, the use of a subcutaneous ureteral bypass (SUB) device has been reported in cats [6, 13, 17].…”