Surgical management of vesicoureteral reflux with recurrent urinary tract infection after renal transplantation in a dog

Abstract

CASE DESCRIPTION A 3-year-old male Cocker Spaniel renal transplant recipient was readmitted 39 weeks after transplantation because of acute clinical signs of pollakiuria, intermittent vomiting, decreased appetite, lethargy, and mild fever. CLINICAL FINDINGS Hydronephrosis and hydroureter were observed with ultrasonography and contrast cystography, and a diagnosis of vesicoureteral reflux (VUR) was made. Urinary tract infection (UTI) caused by Escherichia coli was also diagnosed on the basis of results of urine culture. TREATMENT AND OUTCOME Despite treatment of the UTI with an appropriate antimicrobial for 6 weeks, the VUR persisted and the UTI recurred 9 weeks after cessation of antimicrobial treatment. Therefore, surgical correction by means of revision extravesicular ureteroneocytostomy was performed. Both VUR and hydronephrosis resolved after surgery. No recurrences of clinical signs of urinary tract complications were observed during the subsequent 22-month follow-up period. CLINICAL RELEVANCE Results suggested that ureteral reimplantation with an extravesicular technique incorporating a long submucosal tunnel may be an effective treatment for VUR when medical management fails in canine renal transplant recipients with recurrent UTIs.

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“…Hence, the removal of the clitoris with its entire os-clitoris was done carefully. Urinary tract infection, which is common in such a surgical operation (Park et al, 2016), was successfully avoided.…”

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

“…8 and 10; Table S1 Serum creatinine concentrations over time), which may have been associated with VUR as reported in dogs. 35,36 The owners of these cats did not consent to further workup, and we could not confirm the presence of VUR. However, it is important to monitor for signs of UTI and pyelonephritis over the long term because they can be deleterious to residual renal function.…”

“…Two cats had chronic pyelonephritis after surgery, and their kidney disease progressed rapidly during the postoperative follow‐ups (nos. 8 and 10; Table S1 Serum creatinine concentrations over time), which may have been associated with VUR as reported in dogs 35,36 . The owners of these cats did not consent to further workup, and we could not confirm the presence of VUR.…”

The degree of major histocompatibility complex matching between purebred Maltese and mongrel dogs using microsatellite markers

“…Despite MHC-matched transplantation, many animal and human patients have suffered from chronic rejection and diverse complications of immunosuppressants. Infection, malignances, nephrotoxicity, hypertension, gingival overgrowth, diabetes mellitus have been reported as complications of post-transplant immunosuppression, which deteriorates the quality of life for recipients [25]. In order to improve the quality of life, development of new immunosuppressants or techniques with fewer side effects would be necessary.…”

“…However, survival after kidney transplantation in canine has been reported to be as low as 36% after 100-days, unlike in human clinical cases, wherein the 1-year patient survival rate is over 90% [24]. One of the major reasons leading to these unfavorable results in dogs might be insufficient pre-surgical tests that only screen for hyperacute rejection but not acute or chronic rejection caused by major histocompatibility complex (MHC) incompatibility [2356]. Experimentally, the survival rate of canine kidney transplantation in MHC-identical or haploidentical groups was significantly higher, at more than 4 years, with immunosuppressants [78].…”