Use of a Boari flap and renal descensus as treatment for proximal ureteral rupture in a cat

Abstract

CASE DESCRIPTION A 6-year-old neutered male domestic shorthair cat was evaluated because of signs of abdominal pain and anuria of 12 hours' duration after vehicular trauma. CLINICAL FINDINGS Lethargy, mydriasis, bradycardia, abdominal distension, and signs of pain on abdominal palpation were observed. Abdominal ultrasonography revealed moderate urinary bladder distension without evidence of free abdominal fluid; hematologic evaluation revealed leukocytosis with high BUN and serum creatinine concentrations. TREATMENT AND OUTCOME The patient was hospitalized, medical stabilization was attempted, and an indwelling urinary catheter was placed. Urinary output was < 1 mL/kg/h (< 0.45 mL/lb/h), and signs of abdominal pain persisted despite treatment. The next day, ultrasonographic examination revealed fluid in the retroperitoneal space, and ureteral rupture was suspected. Exploratory laparotomy confirmed retroperitoneal fluid accumulation; a large hematoma surrounded the right kidney and perirenal structures. An abdominal drain was placed to aid patient stabilization. Three days later, IV pyelography revealed rupture of the proximal part of the right ureter. Ureteroneocystostomy was performed with elongated cystoplasty through a Boari flap and caudal transposition of the right kidney (renal descensus). On follow-up examination 18 months after treatment, the cat was free of clinical signs, and results of ultrasonography, CBC, and serum biochemical analysis were unremarkable. CLINICAL RELEVANCE Results suggested that a Boari flap procedure with renal descensus could be a feasible alternative in the management of proximal ureteral rupture in cats, but research is needed in this area.

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

“…The tube cystoplasty technique of the urinary bladder has been described in the literature as a cystoureteroplasty (or as a Boari flap), in which a pseudo-ureter was created by using a small flap of the bladder wall (Gordo et al 2016), where only a small portion of the bladder was used as a flap and the created bladder tube was anastomosed to the proximal ureteral end by end-toend fashion. A modification of this technique has been described by Aronson et al (2018), in which a large bladder tube similar to that in the current report was created and into which the proximal ureter was anastomosed in end-to-side fashion.…”

“…A different surgical option to treat feline ureteral disease by modifying a Boari flap technique reportedly used in human has been described in two cats: one with a proximal ureteral rupture and one with an obstruction (Gordo et al . 2016, Aronson et al . 2018).…”

“…Most are caused by the accumulation of mineralised material inside and/or outside of the stent and intracatheter mineralisation of the SUB system, necessitating surgical replacement of the device (Berent et al 2014(Berent et al , 2018. A different surgical option to treat feline ureteral disease by modifying a Boari flap technique reportedly used in human has been described in two cats: one with a proximal ureteral rupture and one with an obstruction (Gordo et al 2016, Aronson et al 2018. We present a case report of a salvage surgery using a tube cystoplasty and direct pelvicocystostomy performed in a cat with an early postoperative obstruction of a ureteral stent and SUB.…”

Interventions and experience after complicated total cystectomy in a dog with transitional cell carcinoma

“…Tension is often regarded as a risk factor for dehiscence and/or stricture, with techniques such as renal descensus reported to minimize tension . In this case, rather than perform bilateral renal descensus at the dog's first revision surgery after total cystectomy, we elected to shorten the course of the penile urethra, as previously described by Bacon et al…”

Urinary Tract Trauma in Cats: Stabilisation, Diagnosis and Management

“…30 Another option when the proximal ureter is short is ureteroneocystostomy performed after elongated cystoplasty through the creation of Boari flap and kidney transposition. 31 A case report of a successful replacement of the ureter in a cat, with the use of an ileal graft, has also been published. 32 Although the SUB (Norfolk Vet Products) system (see box on page 5) was designed for treatment of ureteral obstruction, there are known and published cases of its successful use in ureteral trauma patients.…”