Use of a subcutaneous ureteral bypass device for treatment of bilateral proximal ureteral injury in a 9-month-old cat

Abstract

Case summaryA 9-month-old male domestic longhair cat presented following iatrogenic ureteral trauma after an attempted laparoscopic ovariectomy. Prior to identifying that the cat was male, both ureters were transected approximately 4 mm from the renal pelves. Initial management involved a left-sided Boari flap neoureterocystostomy, cystonephropexy and right ureteronephrectomy. Thirty-six hours later, the cat developed uroabdomen due to leakage from the neoureterocystostomy site. At a tertiary referral institution, the ureter was reconstructed via end-to-end anastomosis and a left-sided subcutaneous ureteral bypass (SUB) device was placed in the event the anastomosis failed. Five weeks after SUB placement, the cat was dysuric and stranguric. A urine culture was negative and clinical signs were attributed to sterile cystitis secondary to device placement. Blood urea nitrogen (BUN) was 22 mg/dl and creatinine was 1.2 mg/dl. Contrast pyelography confirmed device patency, but no contrast was identified through the ureteral anastomosis. At 12 months, BUN and creatinine were 1.5 mg/dl and 25 mg/dl, respectively, and a subclinical urinary tract infection was identified (Enterococcus faecalis). Antibiotic therapy was not prescribed in order to prevent multidrug resistance. At 42 months, BUN was 38 mg/dl and creatinine was 2.0 mg/dl. The cat had occasional and intermittent signs of pollakiuria and stranguria but was otherwise doing well.Relevance and novel informationTo our knowledge, this is the first case report to describe the use of a SUB device for management of traumatic proximal ureteral injury in a cat with one kidney. The case outcome provides valuable information about the direct effect of the SUB device and the presence of chronic Enterococcus species infection on long-term renal function.

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

“…18 Subcutaneous ureteral bypass (SUB) device placement is an effective treatment option for BUO in cats. [6][7][8][9][10]12,14,20 A retrospective study of SUB device placement in 174 ureters of 134 cats demonstrates the advantages of SUB placement as a treatment of BUO in cats compared to other options with a 6% postoperative death rate and fewer long-term complications compared to other surgical options. 8 The aims of the study were to determine outcome and complications in a large cohort of cats undergoing SUB device placement had BUO at our hospital.…”

“…Benign ureteral obstruction (BUO) occurs in cats and can be secondary to ureterolithiasis, ureteral strictures, infection, dried solidified blood stones, retroperitoneal fibrosis after renal transplant, or iatrogenic ureteral ligation. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Obstructive calcium oxalate ureterolithiasis is the most frequent cause of BUO in cats. 8 , 9 , 10 , 11 Cats with BUO often have chronic kidney disease (CKD) and are azotemic at the time of presentation.…”

Multicenter retrospective evaluation of transmural migration of subcutaneous ureteral bypass devices within the digestive tract in cats

“…The subcutaneous ureteral bypass (SUB) device has been successfully used in cats to relieve ureteral obstruction, regardless of the underlying cause 4,6‐12 . SUB device placement is considered a safe and effective option in cats with ureteral obstruction 4,5,13,14 .…”

“…[2][3][4][5] The subcutaneous ureteral bypass (SUB) device has been successfully used in cats to relieve ureteral obstruction, regardless of the underlying cause. 4,[6][7][8][9][10][11][12] SUB device placement is considered a safe and effective option in cats with ureteral obstruction. 4,5,13,14 Long-term complications include occlusion of the device (blood clot, mineralization), kinking of the catheters, chronic urinary tract infection, and intermittent dysuria.…”

Transmural migration of a subcutaneous ureteral bypass into the intestine in three cats

“…2018, Sapora et al . 2019). Considering the poor outcome associated with medical management, early surgical treatment is advocated (Lulich et al .…”