Subcutaneous ureteral bypass device placement in 81 cats with benign ureteral obstruction (2013‐2018)

Wuillemin, Florian; Vachon, Catherine; Beauchamp, Guy; Dunn, Marilyn

doi:10.1111/jvim.16280

Cited by 9 publications

(31 citation statements)

References 24 publications

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“…Additionally, depending on the onset and severity of obstruction, variable degrees of irreversible renal damage may have occurred in an already potentially compromised kidney because 80% of geriatric cats suffer from chronic kidney disease 33 . Thus, if obstruction remains after 24‐72 hours of MM, the standard of care remains renal decompression by SUB device placement as supported by the 95% success rates in 2 large retrospective studies 12,13 . In group MED, SUB device placement initially was declined by owners.…”

Section: Discussionmentioning

confidence: 99%

“…Twentytwo cats received prednisolone PO at a median starting dosage of 0.49 mg/kg/day (range, 0.3-1.3 mg/kg/day) for a median of 33 days (range, 3-106 days). Among them, 13…”

Section: Description Of Medical Management (Group Med)mentioning

confidence: 99%

“…Placement of a subcutaneous ureteral bypass (SUB) device is the standard of care considering hospital discharge rates of 94% and median survival times of 821‐827 days. Complications after SUB device placement include kinking of the device (3%‐10%), luminal mineralization (17%‐25%), and chronic infection (24%‐25%) 12,13 . However, the cost of the procedure and perceived necessity of evaluations to assess patency of the implant discourage some clients.…”

Section: Introductionmentioning

confidence: 99%

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Benign ureteral obstruction in cats: Outcome with medical management

Mérindol

Vachon

Juette

et al. 2023

Veterinary Internal Medicne

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Background Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO). Hypothesis Describe clinical characteristics and outcome of MM of BUO. Animals Seventy‐two client‐owned cats with 103 obstructed kidneys. Methods Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed. Results Seventy‐two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30‐21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3‐115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P = .05 and P = .01, respectively). Median survival times were 1188 days (range, 60‐1700 days), 518 days (range, 7‐1812 days), and 234 days (range, 4‐3494 days) for success, partial success, and failure, respectively. Conclusions and Clinical Importance We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1‐2 mm) were more likely to pass.

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Section: Discussionmentioning

confidence: 99%

“…Twentytwo cats received prednisolone PO at a median starting dosage of 0.49 mg/kg/day (range, 0.3-1.3 mg/kg/day) for a median of 33 days (range, 3-106 days). Among them, 13…”

Section: Description Of Medical Management (Group Med)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Benign ureteral obstruction in cats: Outcome with medical management

Mérindol

Vachon

Juette

et al. 2023

Veterinary Internal Medicne

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“…[4][5][6][7][8][9] A common complication of SUB placement is urinary tract infection (UTI), with bacteriuria found at some timepoint in 24%-54% of cats following SUB placement. [4][5][6][7][8][10][11][12] A UTI is thought to account for 43%-93% of positive culture results, with the remainder representing subclinical bacteriuria (SB). 6,7,10,11 Most commonly UTIs appear confined to the lower urinary tract despite the presence of a SUB; therefore, 'bacterial cystitis' (BC) is more appropriate terminology.…”

Section: Introductionmentioning

confidence: 99%

Analysis of lower urinary tract signs and bacteriuria in cats with subcutaneous ureteral bypass systems

Djoneva,

Lawson,

Rutherford

et al. 2023

Veterinary Record Open

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ObjectivesDistinguishing 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.MethodsClinical 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.ResultsTwo 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).ConclusionsA 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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“…In the remaining cases, placement of a subcutaneous ureteral bypass (SUB) device or ureteral stent is recommended to relieve obstruction (7). However, these procedures carry a 6-18% perioperative mortality rate and a 29-56% risk of long-term complications such as device occlusion, urinary tract infection, and, in the case of stents, lower urinary tract signs without infection (4,(8)(9)(10)(11). The high costs and specialized techniques required for placement of SUB devices or stents also limit availability of these options.…”

Section: Introductionmentioning

confidence: 99%

Development of a Burst Wave Lithotripsy System for Noninvasive Fragmentation of Ureteroliths in Pet Cats

Maxwell

Kim

Furrow

et al. 2022

Preprint

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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 minutes. Fourteen of 25 stones fragmented to <1 mm within the 30 minutes. 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 minutes. In the second experiment, 9 of 10 stones fragmented to <1 mm within the 50 minutes. 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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Subcutaneous ureteral bypass device placement in 81 cats with benign ureteral obstruction (2013‐2018)

Cited by 9 publications

References 24 publications

Benign ureteral obstruction in cats: Outcome with medical management

Benign ureteral obstruction in cats: Outcome with medical management

Analysis of lower urinary tract signs and bacteriuria in cats with subcutaneous ureteral bypass systems

Development of a Burst Wave Lithotripsy System for Noninvasive Fragmentation of Ureteroliths in Pet Cats

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