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Subcutaneous ureteral bypass device for treatment of iatrogenic ureteral ligation in a kitten

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  • 1 Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 2 Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 3 Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 4 Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Abstract

Case Description—A 17-week-old spayed female Sphinx was evaluated after a 3-day history of inappetence, lethargy, and vomiting. Three weeks prior, the kitten had undergone routine elective ovariohysterectomy.

Clinical Findings—Abdominal ultrasonography revealed moderate hydronephrosis of the left kidney, and the left ureter was tortuous and dilated from the kidney to the level of the midureter, where it abruptly tapered. No discrete cause of obstruction could be identified. Clinicopathologic analyses revealed that the kitten was nonazotemic.

Treatment and Outcome—Exploratory laparotomy revealed that the distal portion of the left ureter was irregular with ill-defined margins and abundant scar tissue, likely secondary to iatrogenic ureteral ligation during the ovariohysterectomy (suture was not observed). Intraoperative antegrade pyelography confirmed complete left ureteral obstruction extending distally from the level of the midureter. A subcutaneous ureteral bypass device was placed to allow for renal decompression. No complications were encountered in the perioperative period, and the kitten recovered well after anesthesia. The kitten was discharged from the hospital 7 days after initial evaluation and continued to do well after surgery. At long-term follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation.

Clinical Relevance—A subcutaneous ureteral bypass device successfully allowed renal decompression in a kitten with iatrogenic ureteral ligation. A subcutaneous ureteral bypass device may be an alternative to historical surgical options in cases of unilateral ureteral obstruction and may result in a good long-term outcome.

Abstract

Case Description—A 17-week-old spayed female Sphinx was evaluated after a 3-day history of inappetence, lethargy, and vomiting. Three weeks prior, the kitten had undergone routine elective ovariohysterectomy.

Clinical Findings—Abdominal ultrasonography revealed moderate hydronephrosis of the left kidney, and the left ureter was tortuous and dilated from the kidney to the level of the midureter, where it abruptly tapered. No discrete cause of obstruction could be identified. Clinicopathologic analyses revealed that the kitten was nonazotemic.

Treatment and Outcome—Exploratory laparotomy revealed that the distal portion of the left ureter was irregular with ill-defined margins and abundant scar tissue, likely secondary to iatrogenic ureteral ligation during the ovariohysterectomy (suture was not observed). Intraoperative antegrade pyelography confirmed complete left ureteral obstruction extending distally from the level of the midureter. A subcutaneous ureteral bypass device was placed to allow for renal decompression. No complications were encountered in the perioperative period, and the kitten recovered well after anesthesia. The kitten was discharged from the hospital 7 days after initial evaluation and continued to do well after surgery. At long-term follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation.

Clinical Relevance—A subcutaneous ureteral bypass device successfully allowed renal decompression in a kitten with iatrogenic ureteral ligation. A subcutaneous ureteral bypass device may be an alternative to historical surgical options in cases of unilateral ureteral obstruction and may result in a good long-term outcome.

Contributor Notes

Dr. Johnson's present address is Animal Specialty & Emergency Center, 1535 S Sepulveda Blvd, Los Angeles, CA, 90025.

Address correspondence to Dr. Culp (wculp@ucdavis.edu).