Therapeutic use of tetrasodium ethylenediaminetetraacetic acid solution for treatment of subcutaneous ureteral bypass device mineralization in cats

Abstract

Background Subcutaneous ureteral bypass (SUB) device placement is an increasingly popular treatment option for decompression of ureteral obstruction in cats. Mineralization occlusion of the device occurs in a minority of cases but is the most common complication. Objective To evaluate a 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) solution for treatment of mineralization occlusion in cats with SUBs. Animals Six client‐owned cats (8 obstructed devices). Methods Case series. Each cat was found to have device occlusion based on a combination of ultrasound examination, SUB irrigation, and failure to identify another cause of device obstruction. Each SUB was drained, irrigated using sterile saline, and infused with 1‐2 mL of 2% tEDTA solution. Success was defined as normalization of flow during subsequent ultrasound visualization while irrigating. The volume and frequency of tEDTA instillations, time to achieve device patency, follow‐up biochemical and ultrasound findings, and future reobstruction events were recorded. Results Resolution of mineralization was documented in all 8 SUBs. Reobstruction events occurred in 2 cats, all of which resolved after additional tEDTA infusions, but 1 cat ultimately required device exchange at 356 days from the first tEDTA infusion. In 1 cat, a single infusion was prematurely discontinued because of persistent pelvic dilatation after 1.25 mL of tEDTA had been instilled. No complications were observed. Conclusions and Clinical Importance Tetrasodium EDTA infusions can be safely considered as a treatment option for mineralized SUB devices in cats. This solution was easily infused, well tolerated, and avoided the need for SUB device exchange in the majority of cats in which it was used.

Intestinal perforation involving the Dacron cuff of nephrostomy tubes following subcutaneous ureteral bypass system implantation for ureteral obstructions in two cats

“…As mentioned previously, published short-term postoperative complications include implant occlusion from blood clots and urolith material, device leakage, tube kinking, haemorrhage, dysuria and UTIs. 2 , 7 Mineralisation of the cystotomy tube is the most commonly reported long-term complication with known risk factors including the use of a small port, silicone-based catheters and postoperative ionised hypercalcaemia. 3 , 7 To our knowledge, at the time of publication, there have been no reported gastrointestinal complications relating to SUB implant systems or other ureteral decompressive surgeries.…”

“…2,7 The most significant long-term complication is mineralisation of the SUB device, most commonly the cystostomy tube. 3,7 Other reported long-term complications include migration of the cystostomy catheter and extrusion of the SC access port. 8,9 To our knowledge, at the time of publication, there have been no reported long-term gastrointestinal complications with SUB system implantation in cats.…”

“…2 , 3 , 5 , 6 The reported short-term postoperative complications associated with SUB implantation include implant occlusion from blood clots and urolith material, device leakage, tube kinking, haemorrhage, dysuria and urinary tract infections (UTIs). 2 , 7 The most significant long-term complication is mineralisation of the SUB device, most commonly the cystostomy tube. 3 , 7 Other reported long-term complications include migration of the cystostomy catheter and extrusion of the SC access port.…”

Infection and extrusion of a subcutaneous access port in a cat: a long-term postoperative complication of a subcutaneous ureteral bypass device

“…The use of a tetrasodium EDTA acid flush solution through the subcutaneous shunting port in order to demineralise and restore patency of the SUB device has already been established in veterinary medicine. 14 Moreover, the antimicrobial and anti-biofilm properties of EDTA in wounds and indwelling catheters have been studied. 15–17 In a recent study, it was shown that the implementation of routine irrigation of the SUB device using tetrasodium EDTA solution appeared to decrease infection rates associated with SUB devices in cats.…”

“…15–17 In a recent study, it was shown that the implementation of routine irrigation of the SUB device using tetrasodium EDTA solution appeared to decrease infection rates associated with SUB devices in cats. 14 However, large clinical studies are required to establish the effectiveness of tetrasodium EDTA acid flush solution to prevent and treat biofilms in SUB devices, and to manage chronic SUB system infections, before this becomes common practice in veterinary medicine.…”