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Antegrade pyelography for suspected ureteral obstruction in cats: 11 cases (1995–2001)

Christopher A. Adin DVM, DACVS1,2, Eric J. Herrgesell DVM, DACVR3, Thomas G. Nyland DVM, DACVR4, Joanne M. Hughes DVM5, Clare R. Gregory DVM, DACVS6, Andrew E. Kyles BVMS, PhD, DACVS7, Larry D. Cowgill DVM, PhD, DACVIM8, Gerald V. Ling DVM9, and 10
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  • 1 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 2 Present address is the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126.
  • | 3 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 4 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 5 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 6 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 7 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 8 Departments of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 9 Departments of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 10

Abstract

Objective—To determine sensitivity and specificity of radiography, ultrasonography, and antegrade pyelography for detection of ureteral obstructions in cats.

Design—Retrospective study.

Animals—11 cats.

Procedure—Medical records of cats that had radiography, ultrasonography, and antegrade pyelography performed for suspected ureteral obstructions were examined. Ultrasound-guided pyelocentesis and fluoroscopic- assisted antegrade pyelography were performed on 18 kidneys in 11 cats. Obstructive ureteral lesions were confirmed in all cats by surgical or necropsy examination. Sensitivity and specificity of survey radiography, ultrasonography, and antegrade pyelography for identification of ureteral obstructions were calculated. Surgical or necropsy findings were used as the standard for comparison.

Results—All cats were azotemic. Mean ± SD serum creatinine and BUN concentrations were 10.2 ± 6.1 and 149 ± 82 mg/dL, respectively. Fifteen of 18 ureters were found to be obstructed at surgery or necropsy. Sensitivity and specificity were 60 and 100% for radiography and 100 and 33% for ultrasonography, respectively, in identification of ureteral obstructions. Leakage of contrast material developed in 8 of 18 kidneys during antegrade pyelography and prevented diagnostic interpretation in 5 of 18 studies. For the 13 diagnostic studies, specificity and sensitivity were 100% by use of the antegrade pyelography technique. Correct identification of the anatomic location of the ureteral obstruction was obtained in 100% of diagnostic antegrade pyelography studies and in 60% of radiography or ultrasonography studies.

Conclusions and Clinical Relevance—Antegrade pyelography can be a useful alternative in the diagnosis and localization of ureteral obstructions in azotemic cats, although leakage of contrast material may prevent interpretation of the study. (J Am Vet Med Assoc 2003;222:1576–1581)

Abstract

Objective—To determine sensitivity and specificity of radiography, ultrasonography, and antegrade pyelography for detection of ureteral obstructions in cats.

Design—Retrospective study.

Animals—11 cats.

Procedure—Medical records of cats that had radiography, ultrasonography, and antegrade pyelography performed for suspected ureteral obstructions were examined. Ultrasound-guided pyelocentesis and fluoroscopic- assisted antegrade pyelography were performed on 18 kidneys in 11 cats. Obstructive ureteral lesions were confirmed in all cats by surgical or necropsy examination. Sensitivity and specificity of survey radiography, ultrasonography, and antegrade pyelography for identification of ureteral obstructions were calculated. Surgical or necropsy findings were used as the standard for comparison.

Results—All cats were azotemic. Mean ± SD serum creatinine and BUN concentrations were 10.2 ± 6.1 and 149 ± 82 mg/dL, respectively. Fifteen of 18 ureters were found to be obstructed at surgery or necropsy. Sensitivity and specificity were 60 and 100% for radiography and 100 and 33% for ultrasonography, respectively, in identification of ureteral obstructions. Leakage of contrast material developed in 8 of 18 kidneys during antegrade pyelography and prevented diagnostic interpretation in 5 of 18 studies. For the 13 diagnostic studies, specificity and sensitivity were 100% by use of the antegrade pyelography technique. Correct identification of the anatomic location of the ureteral obstruction was obtained in 100% of diagnostic antegrade pyelography studies and in 60% of radiography or ultrasonography studies.

Conclusions and Clinical Relevance—Antegrade pyelography can be a useful alternative in the diagnosis and localization of ureteral obstructions in azotemic cats, although leakage of contrast material may prevent interpretation of the study. (J Am Vet Med Assoc 2003;222:1576–1581)