Ch 115 Ureter Flashcards
Jacobsen JAVMA 2022
Cystoscopic-guided scissor transection of intramural ectopic ureters as a novel alternate minimally invasive treatment option to laser ablation in female dogs: 8 cases (2011–2020)
To evaluate the safety and efficacy of cystoscopic-guided scissor transection of ectopic ureters (CST-EU) in female dogs.
ANIMALS 8 incontinent female dogs with intramural ectopic ureters.
RESULTS Ectopic ureters were bilateral in 4 of the 8 dogs, and all dogs had other urogenital tract anomalies.
Owner questionnaire follow-up was available for 7 dogs, and results indicated 6 dogs had improved urinary continence immediately following the procedure. At the last follow-up (44 to 3,384 days after CST-EU), 3 of the 7 dogs were completely continent with CST-EU alone, 3 others became continent or were markedly improved with the addition of medications for urethral sphincter mechanism incompetence, and 1 required ureteroneocystostomy, colposuspension, and an artificial urethral sphincter to become fully continent.
Owners of 5 of the 7 dogs reported that they considered the outcome of CST-EU as good to excellent, and all owners reported that they would consider having CST-EU performed again should they have another incontinent dog.
Complications were minor, and only 3 dogs showed transient lower urinary tract signs after CST-EU.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated CST-EU could provide a safe, effective, minimally invasive alternative in the absence of laser technology for the treatment of intramural ectopic ureters in female dogs.
Clark JSAP 2018
Management of Feline Ureteral Obstructions
Medical Part 1
Surgery Part 2
Read the papers in the folder
Lorange Vet Surg 2020
Postoperative outcomes of 12 cats with ureteral obstruction treated with ureteroneocystostomy
To report complications and long-term outcomes of cats with benign ureteral obstruction treated with ureteroneocystostomy and to determine the effects of double pigtail catheter (DPT) placement on postoperative outcomes.
Study design: Retrospective study. Animals: Twelve client-owned cats with ureteral urolithiasis treated with ureteroneocystostomy.
Cats were divided into two groups; in one group, a DPT was placed at the time of ureteroneocystostomy, and, in the other group, a DPT was not placed at the time of ureteroneocystostomy (NDPT).
Results: A DPT was placed in six of 12 cats. The NDPT group included four cats with temporary catheters and two cats with no catheter. Median creatinine concentration decreased from 10.4 mg/dL (range, 1.6-20.3) to 2.2 mg/dL (range, 1.1-3.6) at the time of discharge (P = .015) in all cats.
Two cats in the NDPT group required revision surgery for uroabdomen.
Eleven cats were discharged from the hospital.
Long-term complications (hematuria, pollakiuria, urinary tract infections) were more common in the DPT group (P = .047).
Seven cats were alive a median of 329 days (range, 8-1772) after surgery. Median creatinine concentration was 2.0 mg/dL (range, 0.6-6.4) at a median of 157 days (range, 43-1772) after surgery.
Conclusion: Ureteroneocystostomy resulted in acceptable long-term outcomes in 11 of 12 cats. The placement of a DPT did not influence the long-term outcome in this small population. Clinical significance: Ureteroneocystostomy with or without intraoperative placement of a DPT should be considered to relieve benign ureteral obstructions in cats.
Plater JSAP 2020
Treatment and outcomes of ureter injuries due to ovariohysterectomy complications in cats and dogs
Objectives: To describe the presentation, treatment and outcome of unilateral and bilateral ureter injuries resulting from ovariohysterectomy complications in cats and dogs.
Results: Fourteen female cats and five female dogs were included. Eleven (58%) exhibited clinical signs immediately after recovery from ovariohysterectomy, six (32%) had a median onset of clinical signs of 3 days (range 1 to 16 days), and two (10%) were referred immediately because of a known complication during surgery.
Five of seven animals with bilateral ureter injury presented with anuria. Three animals died or were euthanased without definitive surgery.
Surgical repair included ureteroneocystostomy (eight cats, one dog), ureteronephrectomy (four cats, two dogs), subcutaneous ureteral bypass placement (three cats) and ureteral stent (one cat).
Of the 16 operated animals, seven (44%) that were discharged from the hospital experienced major complications requiring one or more additional surgeries.
Overall outcome was excellent in 13 (68%), good in one (5%), fair in one (5%) and poor in four (22%) animals.
Clinical Significance: A key indicator of a ureteric injury is an animal failing to recover normally or becoming unwell shortly after ovariohysterectomy. Anuria is likely in animals with bilateral ureter injury. Excellent outcomes are possible following surgical treatment.
Hoey Vet Surg 2021
Long-term outcome of female dogs treated for intramural ectopic ureters with cystoscopic-guided laser ablation
Objective: To report the complications and long-term outcome of female dogs with
intramural ectopic ureter(s) (iEU) undergoing cystoscopic-guided laser ablation
(CLA) and determine the effect of post-CLA neutering on urinary continence.
Study Design: Retrospective clinical study.
Animals or Sample Population: Thirty-four client-owned dogs.
Methods: Medical records of female dogs that had iEU-CLA were reviewed.
A 10-point continence score was assigned before, immediately after, and at a
minimum of 12 months postprocedure via owner telephone contact. Neutering
status prior to and postprocedure was recorded.
Results: Continence scores increased in all dogs after CLA (p < .0001, mean
duration of follow-up: 63.9 ± 5.7 months) with an increase of the median score
from 2 (preprocedure) to 10 (postprocedure).
A urethral tear occurred in 2/34
dogs immediately after the procedure, successfully managed conservatively.
Mild hematuria was present in 2/34, lasting less than 48 h. Postoperative urinary
tract infections were documented in 6/34 dogs. Two dogs died of urinaryrelated
issues at 1 and 5 months after CLA.
Complete and near-complete
urinary continence (scores 9 and 10/10) was achieved in 26/32 dogs including
3 dogs requiring medical (2) or surgical interventions (1). Post-CLA neutering
did not affect continence scores (p = .44).
Conclusion: A large proportion of dogs regained and maintained full continence
after CLA alone. Subsequent medical or surgical therapy allowed further
improvements when needed. Post-CLA neutering did not negatively impact
urinary continence score.
Clinical Significance: The beneficial effect of iEU-CLA in female dogs is long
standing and not affected by postprocedural neutering.
Dekerle Vet Surg 2022
Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation
Abstract Objective: To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic-guided laser ablation (CLA) in female dogs.
Study design: Retrospective study from 2011 to 2018. Animals: Twenty-five female dogs.
Continence status was scored subjectively (1 = completely incontinent to 10 = fully continent).
Results: Fifteen dogs had bilateral EU and 24 had intramural EU (iEU). Open surgical correction included 13 neoureterostomies, 2 neocystoureterostomies, and a combination of these in 2 dogs.
Eight dogs underwent CLA.
Eighteen dogs experienced minor complications (72%),
[Hematuria 60% (15/25) Pollakiuria 20% (5/25) Dysuria 12% (3/25) Stranguria 8% (2/25)]
and 2 experienced major complications (8%).
{Depending on the technique, the minor complication rate and duration were 100% (13/13) lasting 9 (5-10) days after neoureterostomy, and 13% (1/8) lasting 0 (0- 0) day after CLA (Table 1). Lower urinary tract symptoms were more frequent after neoureterostomy compared to CLA (P < .0001), and their duration was longer after neoureterostomy compared to CLA (P < .01). Urinary- related major complications following EU correction occurred in 1/25 (4%) cases diagnosed with a uroabdomen after neocystoureterostomy. Intestinal intussusception after neoureterostomy also occurred in 1 dog (Table 1). Major complications were reported in 2/25 (8%) cases, and all had a successful surgical revision.}
One-month postoperative continence was achieved in 20/25 (80%) dogs (median score of 10).
Incontinence recurred at a median time of 24.9 months in 5 dogs but responded to medical treatment. Overall, dogs remained continent for 66 months (median) and 22/25 (88%) dogs achieved continence with adjunction of medical/surgical treatment in incontinent ones.
Fewer minor complications and postoperative recurrences of incontinence were documented after CLA than neoureterostomy (P < .01 and P < .05).
Conclusion: Ectopic ureter correction by open surgery or CLA resulted in a subjectively good prognosis, most dogs reaching continence within a month of surgery, although incontinence occasionally recurred in the long term. CLA was associated with fewer complications and incontinence recurrences than neoureterostomy. Clinical significance: Cystoscopic-guided laser ablation should be preferred to correct iEU to prevent short-term complications and the recurrence of incontinence. Further studies should investigate the cause of postoperative recurrence of urinary incontinence.
Gibson JAVMA 2021
Removal and repositioning of urinary tract implants by use of an endovascular snare system in dogs and cats (2013–2019)
OBJECTIVE To report the fluoroscopic removal or repositioning of urinary tract implants in dogs and cats by use of an endovascular snare system (ESS) and to report procedural usefulness and complications in dogs and cats. ANIMALS 3 cats and 14 dogs. PROCEDURES A medical records review was performed to identify dogs and cats that underwent removal or repositioning of urinary tract foreign bodies or implants by use of an ESS with fluoroscopic guidance at a veterinary teaching hospital from 2013 to 2019. RESULTS Dogs had a median weight of 25 kg (55 lb) with a range of 3.5 to 60.6 kg (7.7 to 133.3 lb), and cats had a median weight of 5 kg (11 lb) with a range of 4.2 to 5.4 kg (9.2 to 11.9 lb). By use of an ESS, 12 patients (2 cats and 10 dogs) underwent transurethral retrieval of retained vesicourethral implants or ureteral stents, 2 dogs underwent transurethral ureteral stent repositioning, 1 cat and 2 dogs underwent transnephric retrieval of ureteral stents, and 1 dog underwent cystoscopic-assisted transureteral ureteral stent retrieval. All procedures were successfully performed, and there were no associated procedural complications. CONCLUSIONS AND CLINICAL RELEVANCE Retained vesicourethral implants or ureteral stents were successfully retrieved by use of an ESS in dogs and cats transurethrally or with an open or percutaneous transnephric approach and fluoroscopic guidance. These techniques should be considered as an alternative or adjunct to more invasive methods for implant retrieval or manipulation. ( J Am Vet Med Assoc 2021;258:983–990)
Russell JAVMA 2023
Persistent urinary incontinence in female Golden Retrievers following laser ablation of intramural ectopic ureters may be associated with the presence of historical urinary tract infection
OBJECTIVE
To identify predictive factors for postoperative continence in female Golden Retrievers following cystoscopic-guided laser ablation of intramural ectopic ureters (CLA-EU).
ANIMALS
41 client-owned female entire Golden Retrievers with uni- or bilateral intramural ectopic ureter(s) were retrospectively enrolled.
METHODS
Patients were diagnosed with ectopic ureters with a combination of ultrasonography and cystoscopy. CLA-EU was performed for all dogs so that each ureteral opening was considered to be in an appropriate position by a single operator. All dogs had short-term follow-up 4 weeks and long-term follow up > 10 weeks after the procedure via telephone, which included urinary continence scoring. Clinical factors and ultrasonographic and cystoscopic findings from initial presentation were evaluated to identify predictive factors for postoperative continence.
RESULTS
Short-term urinary continence was achieved in 46.3% of dogs with no additional medical therapies. Presence of historical urinary tract infections prior to CLA-EU (OR, 0.130; 95% CI, 0.020 to 0.621; P = .018) was negatively correlated
and ureteral dilatation (OR, 34.260; 95% CI, 1.813 to 2,143; P = .043) was positively correlated with likelihood of urinary continence.
Long-term urinary continence was achieved in 63.4% of dogs, and presence of historical urinary tract infections was negatively prognostic (OR, 0.173; 95% CI, 0.023 to 0.856; P = .048).
CLINICAL RELEVANCE
Female Golden Retrievers undergoing CLA-EU have similar outcomes to those reported for other mixed-breed cohorts with > 30% of dogs failing to regain urinary continence. Historical urinary tract infections were significantly associated with both short- and long-term urinary continence in our population.
Beeston JSAP 2023
Clinicopathologic and ultrasound findings in azotemic cats with suspected ureteral obstruction
Renal pelvis dilation 39 times more likely to have an obstruction; other factors included hyporexia, hypercalcemia and hypokalemia
Hardie Vet Surg 2023
Evaluation of two nephrocystostomy techniques for ureteral bypass in cats
Objective: To describe two techniques for nephrocystostomy (NCT) in cats. Study design: Experimental study. Animals: Twelve, adult, purpose-bred, cats. Methods: A simple NCT (n = 3) or bladder cuff NCT (n = 9) was performed in the right or left kidneys. For simple NCT, an 8F catheter was placed through the caudal pole into the renal pelvis and the bladder was sutured around the catheter. For bladder cuff NCT, a 6 mm defect was removed from the caudal pole and a cuff of bladder mucosa was advanced and sutured into the renal pelvis. A 10F catheter was placed through the defect into the renal pelvis and the bladder wall was sutured around the catheter. Catheters were removed 41–118 days post-surgery. Computed tomography (CT) was performed 25 days after catheter removal for the simple NCT and 30 (n = 6) and 90 (n = 3) days after catheter removal for bladder cuff NCT. Histological evaluation of the nephrocystostomy site was performed. Results: All simple NCTs became obstructed after catheter removal. All bladder cuff NCTs were patent, and CT revealed contrast flow into the bladder. Hematuria, clot-associated urethral obstruction, catheter dislodgement, and bladder infection occurred variably after surgery. Histological findings consisted of smooth epithelialization of the NCT and degenerative changes in the caudal pole of the kidney. Conclusion: Bladder cuff NCT was feasible in normal cats and remained patent for 90 days. Methods to limit nephrostomy track hemorrhage should be investigated. Degenerative changes may be related to vascular impairment from the bladder cuff sutures. Clinical significance: Complete ureteral bypass was possible in cats using only native tissues.
Oyamada Vet Surg 2023
Extravesicular, two-layer, side-to-side ureteroneocystostomy combined with tension-relieving techniques for feline proximal ureteral obstruction: A retrospective study
Objective: To describe the surgical technique for extravesicular, two-layer, sideto- side ureteroneocystostomy combined with tension-relieving techniques (ETSUTT) for feline proximal ureteral obstruction and report clinical outcomes. Study design: Retrospective case series. Animals: Ten privately-owned cats with ureteral obstruction near the ureteropelvic junction (UPJ). Methods: Medical records were retrospectively reviewed for cats with ureteral obstruction close to the UPJ that underwent ETSUTT (2018–2021). The ETSUTT procedure consisted of a modified extravesicular technique (twolayer, side-to-side ureteroneocystostomy) and tension-relieving techniques (renal descensus, ureterocystopexy, and nephrocystopexy). Results: All cats survived through discharge. In all cats, postoperative blood urea nitrogen and creatinine concentrations were decreased, compared with preoperative concentrations. Perioperative complications included ureteral catheter dislodgement (3), transient pollakiuria (2), and dysuria (1), but no specific treatments were required. Urinary tract infection was observed postoperatively in three of the 10 cats. The median follow-up was 648 days (min–max: 86–1229 days). Seven of the 10 cats were alive without recurrent ureteral obstruction at the end of this retrospective study. Conclusion: The ETSUTT procedure was successfully performed without major complications in cats with ureteral obstruction occurring near the UPJ. Use of ETSUTT provided a fair-to-good, long-term prognosis in cats that were otherwise difficult to manage. Clinical significance: This novel procedure, ETSUTT, was feasible, safe, and could be a viable treatment option for feline proximal ureteral obstruction, including the UPJ, especially for obstructions caused by stricture.
Song Vet Surg 2023
Receiver operating characteristics of computed tomography (CT) compared to cystoscopy in diagnosis of canine ectopic ureters: Thirty-five cases
Results: The ability of CT to identify a normal and intra-or extramural ectopic ureters conclusively and correctly was 13/26 (50%) and 32/41(78%), respectively. Sensitivity and specificity of identifying extramural versus intramural ureters was 2/7 versus 30/46 (29 vs. 65%) and 61/63 versus 17/24 (97 vs. 71%), respectively. Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively. Covariate analysis failed to identify interfering factors. Conclusions: CT did not accurately predict anatomy of ureters; CT findings may need confirmation by cystoscopy and possibly intraoperative fluoroscopy prior to determining if CLA is indicated or not. Clinical significance: Our results may be of importance for surgeons interpreting the CTEU findings. CTEU prediction of the location of the ureteral orifice shows low sensitivity especially in or close to the urethral sphincter area.
Kennedy JFMS 2022
Feline ureteral obstruction: a case-control study of risk factors (2016–2019)
Results In total, 168 cats (28 cases, 140 controls) were included. Age, sex, breed, housing and total calcium were not significantly associated with UO; however, diet was. 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 (95% confidence interval 2.9–295; P = 0.009). There was no difference in the association between diet and UO in cats fed a mixed diet vs cats fed a predominantly moist food diet (P = 0.25). The area under the ROC curve was 72%. Conclusions and relevance Changes in diet formulation could provide a simple and economical method to reduce the risk of UO.
