Ch. 114-115: Kidney, Ureters Flashcards
Lorange Vet Sx 2020 PQ
Postoperative outcomes of 12 cats with ureteral obstruction treated with ureteroneocystostomy
- what are the 2 techniques for distal ureteral obstruction via UNC? What did they add in one group vs not other?
- what happened to creatinine conc? did tx group matter?
- % revision sx?
- % survival?
- long term comps more common in what group?
- % 1 year MST?
- conclusion re: outcome and DPT?
Intravesicular technique in 7 and extravesicular technique in 7
A DPT (double pigtail catheter) was placed in half of cats.
The NoDPT group included:
4 cats with temporary catheters
2 cats with no catheter
Median creatinine concentration decreased at the time of discharge in all cats. (Decreased 24 hours after surgery in all cats, Further decreased from this time to time of discharge)
No interaction between treatment group and time on reduction of creatinine concentration
Two cats in the NDPT group required revision surgery for uroabdomen (17%).
11/12 cats were discharged from the hospital. (~90%)
Long-term complications (hematuria, pollakiuria, UTIs) were more common in the DPT group
~60% were alive median 330 days post op
Conc: Ureteroneocystostomy resulted in acceptable long-term out-
comes in 11 of 12 cats. The placement of a DPT did not influence the long-term outcome in this small population.
Plater JSAP 2020
Treatment & outcomes of ureter injuries due to OHE complications in cats & dogs
- majority showed CS when?
- who was anuric?
- sx tx they did (4)?
- % with major post-op comps?
- what outcome in survivors?
60% had CS immediately after recovery from OHE, 32% median onset of CS of 3 d, and 2 (10%) referred immediately
5/7 animals with bilateral injury had anuria on presentation
4 diff sx tx: ureteroneocystostomy, ureteronephrectomy, SQ SUB, stent
Of those with surgery, 45% of those discharged from hospital had major complications needing 1 or more surgeries - (All 7 dogs with major comp– undergone neoureterostomy sx)
Overall outcome excellent in 70%
key points: anuria likely with bilateral injury, key indicator of ureteral injury is if they dont recover after spay, outcome can be excellent after sx tx
Rosenblum JAVMA 2022
Bilateral renal descensus and intravesicular ureteroneocystotomsy for treatment of bilateral ureteral ligation and transection that occurred during ovariohysterectomy in 2 cats
It happened, did bilateral, also nephropexy/cystopexy, see pics
Kennedy JFMS 2022
Feline ureteral obstruction: a case-control study of risk factors (2016-2019)
- effect of age, sex, breed, housing on risk for UO?
- effect of dry food diet?
Age, sex, breed, housing and total calcium were NOT significantly associated with UO
Compared with cats eating a predominantly moist food diet, cats fed a predominantly dry food diet were 15.9 times more likely to develop a UO.
There was no difference in the association between diets and UO in cats fed a mixed vs predominantly moist food diet.
–> Cats fed a predominantly dry food diet had an increased likelihood of UO than cats fed a moist or mixed diet.
Hsu JFMS 2022
Upper urolithiasis in cats with chronic kidney disease: prevalence and investigation of serum and urinary calcium conc.
- prevalence of upper urolithiasis in cats with CKD?
- 3 sig factors for upper urolithiasis? OR for 2?
cats with CKD, the prevalence of upper urolithiasis was 73%.
Among cats with CKD, being purebred (odds ratio=82) and being fed dry food only (OR=25) were identified as independent upper urolithiasis risk factors;
those with upper urolithiasis were more likely to be exclusively fed with urine-acidifying food and have increased serum ionised calcium (iCa) than cats with CKD without upper urolithiasis.
–> Cats with CKD that were purebred, fed dry food and fed urine-acidifying food only often had upper urolithiasis. A higher UCa:Cr may be a result of increased serum iCa and may cause upper urolithiasis.
Geddes JVIM 2023
Risk factors for upper urinary tract uroliths (UUTUs) and ureteral obstruction (obstructive UUTU) in cats under referral veterinary care in the United Kingdom
- obstructive UUTU - 3 risk factors?
- non obs UUTU - 3 RF?
- conclusion for younger cats vs older cats?
Risk factors for obstructive UUTU:
Female
Bilateral uroliths (2.0X)
Age: increased odds with decreased age at diagnosis
highest - 0-4 yrs (OR 4)
Risk factors for UUTU (non obs) included:
Female
British shorthair, Burmese, Persian, Ragdoll or Tonkinese (ie. pure bred)
> 4 years old
Conclusion:
younger cats with UUTU = more aggressive phenotype with higher risk of obstructive UUTU
older cats over 12 years of age = Benign phenotype with reduced risk of obstructive UUTU
Lemieux JFMS 2021
Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012-2018)
- % unilateral vs bilatera UO?
- % UO due to stones?
- % with small vs larger renal pelvis dilation? therefore what?
60% cats had a unilateral UO
40% had a bilateral UO
UO secondary to stones in 70%
positive UCulture in 20%
Renal pelvis dilation:
25% had RP </4mm (10% <2mm)
75% had RP >4mm
therefore - smaller RP / lack of dilation does not rule out UO
McEntee JFMS 2022
Evaluation of preoperative ultrasonographic parameters to predict renal recovery in long-term survivors after treatment of feline ureteral obstructions: 2012-2019
- preop AUS and/or chemistry associated with long term creatinine?
- length of kidney associated with what but not what?
- conclusions re: can we predict long term renal fn with pre-op US/ severity of pre op findings?
No preoperative imaging characteristics or biochemical findings were found to be significantly associated with long-term serum creatinine concentrations.
The length of the kidney was found to be associated with change in BUN and creatinine with decompression but not with long-term renal values.
Conclusions: long-term renal function based on preop ultrasound imaging findings could not be predicted in cats with unilateral ureteral obstruction, regardless of the severity of the biochemical parameters, renal pelvic dilation (large or small pelvis), kidney size or thickness of renal parenchyma assessed.
Rossi VRU 2023
Comparison of sonographic and CT findings for the identification of renal nodules in dogs and cats
- CT % lesions identified?
- US % lesions ID?
- conclusion re: US vs CT?
dogs and cats w/ uni- or bilateral renal nodules < 3cm
Using CT → lesions were identified in all 100% kidneys of dogs and cats.
Most were multiple, cortical, well-defined, iso-to hypo attenuating (precontrast), and moderately contrast enhancing
Using US → lesions were identified in 75% kidneys.
US sig. underestimated renal lesions compared to CT in 60% of kidneys
Nesser Vet Sx 2018 PQ
Radiographic distribution of ureteral stones in 78 cats
- single stone - most common where & %? second most common?
- multiple stones - most common 1 and 2 spots?
- what boney landmark on rads was most commonly marked stone location in cats? what did it indicate in cats with multiple stones?
- stones more common in males where?
- what affect on location did size have?
Among cats with a single stone (45%,), 45% had a stone in the Proximal Ureter, 40% had a stone in the Mid Ureter
(and 15% had a stone at the UVJ (ureterovesicular junction))
When multiple stones were present, 60% of cats had at least 1 stone located in the PU, 70% had at least 1 stone located in the MU (35% had at least 1 stone located at the UVJ)
The L4 vertebral body = most commonly marked stone location in cats w/ 1 stone and the most distal stone in cats w/ multiple stones.
Stones located at the UVJ site were more common in male (35%) than in female (10%) cats
Larger stone size was sig associated with a more proximal location
Conclusion: ureteral stones were more commonly located in the PU & MU than in the UVJ
Testault JVIM 2021 PQ
Comparison of nonenhanced CT and ultrasonography for detection of ureteral calculi in cats: a prospective study
- PQ which imaging modality better?
- Pelvic size and ureteral diameter associated with ureteral calculi?
More calculi, more affected ureters, more bilateral calculi - all detected better by nonenhanced CT compared to US regardless of localization
Pelvic size “superior” to 5 mm (greater than) & a maximal ureteral diameter value >3 mm always associated w/ ureteral calculi
Balsa JAVMA 2019
Factors associated with postobstructive diuresis (POD) following decompressive surgery w/ placement of ureteral stents or SUB systems for treatment of ureteral obstruction in cats: 37 cases (2010-2014)
- 5 pre-op serum values associated with POD duration & severity?
- 3 change in serum values associated with POD duration?
- affect of anuria?
- affect of bilateral vs unilateral UO?
- % survival?
Pre-op serum creatinine, potassium, phosphorus, and BUN positively correlated with duration and maximum severity of POD.
Absolute changes in serum creatinine, potassium, and BUN from before surgery to after surgery positively correlated with POD duration.
Cats with anuria before surgery had longer POD than did other cats;
there was no difference in POD duration or maximum severity with unilateral versus bilateral ureteral obstruction & unilateral vs bilateral did not affect survival
90% cats survived to hospital discharge
Berent JAVMA 2018
→ look at PICTURES!
These numbers are obviously lowest complications for all. compare to Wuillemin and Kulendra.
Use of a SUB device for tx of benign ureteral obstruction in cats – 174 ureters in 134 cats 2009 – 2015
- MC cause of UO and %?
- % with bilateral UO?
- 3 post op complications?
- what post-op serum electrolyte associated with SUB occlusion?
- % survival to dc?
- MC long term comp?
UO caused by ureterolithiasis (65%), stricture (15%), both ureterolithiasis and stricture (15%)
40% cats had bilateral ureteral obstruction.
Post op complications:
- device occlusion with blood clots (10%), device leakage (5%), and kinking of the device tubing (5%).
A high postoperative serum ionized calcium concentration was significantly associated with SUB device occlusion.
“Cats survived to hospital discharge after 95% hospital admissions”.
Weird way of saying 95% survival to dc?
most common long-term complication: catheter mineralization (25%), median of 460 days after device placement.
Vrijsen JFMS 2021
Complications and survival after subcutaneous ureteral bypass device placement in 24 cats: a retrospective study (2016-2019)
* compare numbers to Wuillemin*
- % comps overall? what 4? which MC comp?
- % died in hosp / % survival to dc?
- Overall MST?
- 1 RF for periop comp and in hosp death?
- 1 RF for short term comps?
80% complications, ranging from mild to fatal
- (partial) SUB obstruction (35%),
- lower urinary tract infection (20%)
- pyelonephritis (20%)
- sterile cystitis (15%).
25% underwent revision surgery
20% died prior to discharge
(80% survived to dc)
Overall MST 275 days
Older cats had an increased risk for periop complications and were less likely to survive to discharge
increased HCT at presentation was a risk factor for the occurrence of short-term complications
Wuillemin JVIM 2021
Subcutaneous ureteral bypass device placement in 81 cats with benign ureteral obstruction (2013-2018)
- % discharged from hospital?
- Overall MST?
- 4 reported complications? MC comp?
Hospital discharge rate 95%
MST 820 days
(SUBS have good outcome)
Infection 25% (Cats w/ positive U+ culture at the time of the sx were significantly more likely to have infection - consistent with other papers)
Luminal obstructions 15%
Kink 10%
Revision surgery needed in 15%
