Objective—To describe the procedure and clinical usefulness of locking-loop pigtail nephrostomy catheter (PNC) placement in dogs and cats.
Design—Retrospective case series.
Animals—16 cats (18 kidneys) and 4 dogs (4 kidneys) that underwent PNC placement.
Procedures—Medical records of patients that underwent PNC placement were reviewed. The PNCs were placed percutaneously with ultrasonographic and fluoroscopic guidance or via a ventral midline laparotomy with fluoroscopic guidance. Either a modified Seldinger technique or a 1-stab trocar introduction technique was used for PNC placement. Preoperative renal pelvic size, postoperative renal pelvic decompression, catheter patency, serum biochemical changes, and results of microbial culture of urine samples were reviewed. Length of time the catheter was in place, reason and method for catheter removal, complications, and clinical outcomes were noted.
Results—Reasons for PNC placement were ureterolithiasis (15 kidneys), ureteral stricture (3), malignant obstruction (2), and percutaneous nephrolithotomy (2). Seven of 22 catheters were placed percutaneously, and 15 were placed via a ventral midline laparotomy. Catheters were either size 5F (n = 17) or 6F (5). The PNCs remained indwelling for a median of 7 days (range, 1 to 28 days). Catheter-associated complications included urine leakage (n = 1) and accidental dislodgement by the patient at home (1). All catheters performed successfully by providing temporary urine diversion and drainage for successful renal pelvis decompression.
Conclusions and Clinical Relevance—Placement of locking-loop PNCs was safe, effective, and well tolerated in dogs and cats for temporary urine diversion to achieve renal pelvis decompression.
CASE DESCRIPTION 4 cats were examined because of ureteral obstruction.
CLINICAL FINDINGS Clinical and clinicopathologic abnormalities were nonspecific and included anorexia, lethargy, weight loss, anemia, leukocytosis, neutrophilia, lymphopenia, and azotemia. A diagnosis of pyonephrosis was made in all cats. The presence of bacteriuria was confirmed by means of urinalysis in 2 cats, bacterial culture of a urine sample obtained by means of preoperative cystocentesis in 2 cats, and bacterial culture of samples obtained from the renal pelvis intraoperatively in 3 cats. Ureteral obstruction was caused by a urolith in 3 cats; ureteral stricture associated with a circumcaval ureter was identified in 1 cat.
TREATMENT AND OUTCOME All 4 cats underwent renal pelvis lavage and placement of a subcutaneous ureteral bypass (SUB) device for treatment of obstructive pyonephrosis. Postoperatively, the cystostomy tube became occluded with purulent material in 1 cat, requiring exchange. The procedure was successful in relieving the obstruction and pyonephrosis in all cats. Three of 4 cats had documented resolution of urinary tract infection. One cat had persistent bacteriuria without clinical signs 1 month after SUB device placement.
CLINICAL RELEVANCE Results of this small series suggested that renal pelvis lavage with placement of an SUB device may be a treatment option for cats with obstructive pyonephrosis.
OBJECTIVE To determine outcomes of subcutaneous ureteral bypass (SUB) device placement for treatment of benign ureteral obstruction in cats.
DESIGN Retrospective case series.
ANIMALS 134 cats with SUB devices placed in 174 obstructed ureters during 144 hospitalizations.
PROCEDURES Medical records of cats that underwent SUB device placement for treatment of benign ureteral obstruction between 2009 and 2015 were reviewed. The SUB device was placed by use of fluoroscopic and surgical methods. Signalment, history, diagnostic imaging results, postprocedural results, duration of hospitalization, complications, and short- and long-term outcomes were recorded.
RESULTS Ureteral obstructions were caused by ureterolithiasis (114/174 [65.5%]), stricture (28/174 [16.1%]), both ureterolithiasis and stricture (29/174 [16.7%]), or pyonephrosis (1/174 [0.6%]); in 2 (1.1%) cats, the cause was not recorded. Fifty-two of the 134 (39%) cats had bilateral ureteral obstruction. At admission, 127 (95%) cats were azotemic. Median serum creatinine concentrations at admission and 3 months after SUB device placement were 6.6 and 2.6 mg/dL, respectively. Median renal pelvis diameters before and after the procedure were 9.2 and 1.5 mm, respectively. Postsurgical complications included device occlusion with blood clots (14/172 [8.1%]), device leakage (6/172 [3.5%]), and kinking of the device tubing (8/174 [4.6%]). Cats survived to hospital discharge after 135 of the 144 (94%) hospital admissions. The most common long-term complication was catheter mineralization (40/165 [24.2%]), which was documented a median of 463 days after device placement. A high postoperative serum ionized calcium concentration was significantly associated with SUB device occlusion.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that SUB device placement may be a viable option for treatment of cats with benign ureteral obstruction.
A 5-year-old 11.5-kg (25.3-lb) castrated male Boston Terrier (dog 1), an 8-year-old 27.8-kg (61.2-lb) castrated male Boxer (dog 2), and a 10.5-year-old 15.9-kg (35.0-lb) spayed female Pembroke Welsh Corgi (dog 3) were evaluated because of severe, gross hematuria and suspected idiopathic renal hematuria.
All 3 dogs had hematuria, anemia, blood clots in their urinary bladders, and unremarkable findings on coagulation and mucosal bleeding time assessments. With cystourethroscopy, lower urinary tract hemorrhage originating from a small lesion in the urinary bladder (n = 2) or urethra (1) and normal-appearing yellow urine jetting from both ureterovesicular junctions were visualized in each dog.
TREATMENT AND OUTCOME
Cystoscopically guided surgical resection of a hemorrhagic lesion of the urinary bladder was performed on dog 1, and histologic evaluation of the resected tissue confirmed urinary bladder telangiectasia. Dogs 2 and 3 each underwent cystourethroscopically guided laser ablation of a hemorrhagic lesion (presumptively diagnosed as hemangioma, angioma, or telangiectasia) in the urinary bladder (dog 2) or urethra (dog 3). The longest follow-up duration was 7 years, and none of the 3 dogs had subsequent recurrence of gross hematuria.
Findings suggested that cystourethroscopy should be considered part of the diagnostic plan for hematuria in dogs before pursuing major surgical treatment or when results of conventional diagnostic procedures do not indicate the underlying cause. In addition, histologic results for dog 1 indicated urinary bladder telangiectasia, previously an unreported cause of severe, chronic lower urinary tract hematuria in dogs.
Objective—To describe the technical aspects and clinical outcome of endoscopic- and fluoroscopic-guided ureteropelvic lavage and ureteral stent placement for treatment of obstructive pyonephrosis in dogs.
Procedures—All patients with obstructive pyonephrosis were treated with a ureteral stent. Medical records were reviewed for history, clinical signs, pre- and postprocedural clinical and imaging data, and short- and long-term outcomes.
Results—13 dogs (14 ureters) had unilateral or bilateral ureteral obstructions and pyonephrosis due to ureterolithiasis (n = 13) or a suspected ureteral stricture (1). Eleven dogs had positive results of bacteriologic culture of urine obtained from the bladder, renal pelvis, or both. Ten were thrombocytopenic, and 8 were azotemic. Stents were placed fluoroscopically with endoscopic (n = 11) or surgical (3) assistance. Median hospitalization time was 48 hours (range, 6 to 260 hours). Median follow-up time was 480 days (range, 2 to 1,460 days). Intraoperative complications occurred in 2 patients (stent occlusion from shearing of a guide wire, and wire penetration of the ureter at the location of a stone). Short-term complications included a bladder hematoma (n = 1) and transient dysuria (1). Long-term complications included stent encrustation (n = 1), stent migration (1), and tissue proliferation at the ureterovesicular junction (5), which had no clinical implications. Recurrent urinary tract infections were documented in 7 dogs.
Conclusions and Clinical Relevance—Ureteral stenting was a successful renal-sparing treatment for obstructive pyonephrosis in dogs and could often be performed in a minimally invasive manner. There were few major complications. This technique may be considered as an effective treatment option for this condition in dogs.
Objective—To evaluate the technical, short-term, and long-term outcomes in cats with benign ureteral obstructions treated by means of double-pigtail ureteral stent placement.
Design—Retrospective case series.
Animals—69 cats (79 ureters).
Procedures—The diagnosis of benign ureteral obstruction was made via abdominal ultrasonography, radiography, and ureteropyelography. Ureteral stent placement was attempted endoscopically, surgically, or both, with fluoroscopic guidance. The medical records were reviewed for pre-, intra-, and postoperative data; complications; and outcome.
Results—69 cats (79 ureters) had stent placement attempted for various causes: ureterolithiasis (56/79 [71%]), stricture (10/79 [13%]), both ureterolithiasis and stricture (12/79 [15%]), or a purulent plug (1/79 [1%]). Stent placement was successful in 75 of 79 ureters (95%). Median number of stones per ureter was 4 (range, 0 to > 50), and 67 of 79 (85%) had concurrent nephrolithiasis. Preoperative azotemia was present in 95% (66/69) of cats (median creatinine concentration, 5.3 mg/dL [range, 1.1 to 25.8 mg/dL]), and 71% (49/69) remained azotemic (median, 2.1 mg/dL [range, 1.0 to 11.8 mg/dL]) after successful surgery. Procedure-related, postoperative (< 7 days), short-term (7 to 30 days), and long-term (> 30 days) complications occurred in 8.7% (6/69; 7/79 ureters), 9.1% (6/66), 9.8% (6/61), and 33% (20/60) of cats, respectively; most of these complications were minor and associated with intermittent dysuria or the need for ureteral stent exchange. The perioperative mortality rate was 7.5% (5/69), and no deaths were procedure related. The median survival time was 498 days (range, 2 to > 1,278 days). For patients with a renal cause of death, median survival time was > 1,262 days, with only 14 of 66 cats (21%) dying of chronic kidney disease. Nineteen (27%) cats needed a stent exchange (stricture in-growth [n = 10], migration , ureteritis , dysuria , pyelonephritis , or reflux ). No patient died of the procedure or recurrent ureteral obstruction.
Conclusions and Clinical Relevance—Results of the present study indicated that ureteral stenting is an effective treatment for benign ureteral obstructions in cats regardless of obstructive location, cause, or stone number. The perioperative morbidity and mortality rates were lower than those reported with traditional ureteral surgery. The short- and long-term complications were typically minor but may necessitate stent exchange or use of an alternative device, particularly with ureteral strictures. The prognosis for feline ureteral obstructions after ureteral stenting could be considered good when the procedure is performed by trained specialists.
Objective—To determine the outcome of minimally invasive ureteral stent placement for dogs with malignant ureteral obstructions.
Design—Retrospective case series.
Animals—12 dogs (15 ureters) with ureteral obstruction secondary to a trigonal urothelial carcinoma.
Procedures—In all patients, indwelling, double-pigtail ureteral stents were placed by means of percutaneous antegrade needle and guide wire access under ultrasound and fluoroscopic guidance.
Results—Stents were successfully placed in all patients. In 11 of 12 patients, percutaneous antegrade access was accomplished. One patient required access via laparotomy because percutaneous access could not be achieved. The median survival time from the date of diagnosis was 285 days (range, 10 to 1,571 days), with a median survival time of 57 days (range, 7 to 337 days) from the date of stent placement. Three complications occurred in 1 patient. Seven patients required concurrent urethral stent placement for relief of urethral obstruction. All animals were discharged from the hospital (median hospitalization time after stent placement, 18 hours [range, 4 hours to 7 days]) with an indwelling, double-pigtail ureteral stent (3 bilateral and 9 unilateral) in place. All stents evaluated 0.25 to 11 months after placement were considered patent.
Conclusions and Clinical Relevance—Findings suggested that ureteral stent placement was safe, effective, and well tolerated in patients with malignant ureteral obstructions. Stents could be reliably placed in a minimally invasive manner and remain patent long-term. Ureteral stent placement should be considered as early as possible in patients with neoplasia, prior to the development of permanent renal damage.
Objective—To describe and evaluate the short- and long-term outcomes in female dogs after cystoscopic-guided laser ablation of ectopic ureters (CLA-EU).
Design—Prospective case series.
Animals—32 incontinent female dogs with intramural ectopic ureters.
Procedures—A diagnosis of intramural ectopic ureters was made via cystoscopy and fluoroscopy in all patients. Transurethral CLA-EU (via diode laser [n = 27] or Holmium:yttrium aluminum garnet laser ) was performed to relocate the ectopic ureteral orifice cranially into the urinary bladder. All vaginal anomalies were treated with the laser concurrently. Follow-up evaluation was standardized and included urinary continence scoring, serial bacteriologic culture of urine samples, and a follow-up cystoscopy 6 to 8 weeks after CLA-EU.
Results—Ectopic ureteral orifices of all dogs were initially located in the urethra. Eighteen of 30 dogs had bilateral ectopic ureters, and 12 had unilateral ectopic ureters. All dogs had other concurrent urinary anomalies. At the time of last follow-up (median, 2.7 years after CLA-EU, [range, 12 to 62 months]), 14 of 30 (47%) dogs did not require any additional treatments following CLA-EU to maintain urinary continence. For the 16 residually incontinent dogs, the addition of medical management, transurethral bulking-agent injection, or placement of a hydraulic occluder was effective in 3, 2, and 4 dogs, respectively, improving the overall urinary continence rate to 77% (23/30 dogs). One dog had evidence of polypoid cystitis at the neoureteral orifice 6 weeks after CLA-EU that was resolved at 3 months.
Conclusions and Clinical Relevance—CLA-EU provided an effective, safe, and minimally invasive alternative to surgery for intramural ectopic ureters in female dogs.
OBJECTIVE To describe the technique and short- and long-term outcomes for dogs undergoing double-pigtail ureteral stent placement for treatment of benign ureteral obstruction.
DESIGN Retrospective case series.
ANIMALS 44 dogs (57 ureters).
PROCEDURES Medical records of dogs that underwent ureteral stenting for treatment of benign ureteral obstruction between 2010 and 2013 were reviewed. Signal-ment, history, pertinent diagnostic imaging results, endourologic and post-procedural details, duration of hospitalization, complications, and outcome (short term, 7 to 30 days; long term, > 30 days) were recorded. Ureteral stent placement was performed endoscopically, surgically, or both, with fluoroscopic guidance.
RESULTS 57 ureters (44 dogs) underwent stenting because of obstructive ureterolithiasis (n = 48 [84%]), stricture (5 [9%]), or both (4 [7%]). Endoscopic or surgical techniques were successful for stent placement in 45 of 55 and 12 of 12 ureters (34/42 and 10/10 dogs), respectively. Median hospitalization time was 1 day. Median creatinine concentration was 2 mg/dL prior to stenting and 1.3 mg/dL 3 months after the procedure. Urinary tract infections were present in 26 of 44 (59%) dogs prior to stenting and in 11 of 43 dogs (26%) after stenting. One of the 44 (2%) dogs died after undergoing stenting, but the cause of death was not related to the procedure. Median follow-up time was 1,158 days (range, 3 to > 1,555 days), with 30 of 44 dogs alive at the time of last follow-up.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that ureteral stenting may be a viable option for first-line treatment of dogs with benign ureteral obstruction. However, patients should be monitored for urinary tract infection following stenting.
To describe techniques and outcomes for dogs and cats undergoing endoscopic nephrolithotomy (ENL) for the removal of complicated nephroliths.
11 dogs and 1 cat (n = 16 renal units) with complicated nephroliths that underwent ENL via a surgically assisted ENL approach (12 renal units) or a percutaneous nephrolithotomy approach (4 renal units) between December 2005 and June 2017.
Data were obtained from the medical records regarding preoperative, operative, and postoperative findings. Follow-up information on complications and outcomes was also collected.
Indications for nephrolith removal included massive calculi displacing parenchyma (n = 7), recurrent urinary tract infections (5), and ureteral outflow obstruction (4). Median nephrolith diameter was 2.5 cm (range, 0.5 to 5.7 cm). Nephrolith composition differed among patients; calcium oxalate was the most common type (n = 7 [including 2 mixed nephroliths containing ≥ 60% calcium oxalate]). Following ENL (median duration, 180 minutes), 15 of 16 renal units were completely nephrolith free. Procedure-related complications included renal puncture-associated hemorrhage requiring a blood transfusion (n = 1), renal capsule tear (1), and ureteral puncture (1); all were managed without adverse consequence. Five of 12 patients remained alive at the final follow-up (median, 557 days after ENL), and none died from the procedure.
CONCLUSIONS AND CLINICAL RELEVANCE
ENL as performed was safe and effective in removing complicated nephroliths in a renal-sparing manner for the patients in this study. This procedure requires technical training and could be considered for the treatment of complicated nephrolithiasis in dogs and possibly cats.