Search Results
You are looking at 1 - 7 of 7 items for
- Author or Editor: Kimberly Todd x
- Refine by Access: All Content x
Abstract
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 [4], ureteritis [2], dysuria [2], pyelonephritis [1], or reflux [1]). 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.
Abstract
Objective—To evaluate short- and long-term outcome following endovascular treatment of intrahepatic portosystemic shunts in dogs.
Design—Retrospective case series.
Animals—100 dogs.
Procedures—All patients had angiographic evaluation with or without endovascular shunt attenuation. The medical records were reviewed for pertinent data, complications, outcome, and survival time.
Results—95 dogs with congenital intrahepatic portosystemic shunts received 111 procedures (83% [79/95] had 1 treatment, and 17% [16/95] had > 1 treatment; 5 dogs had no treatment because of excessive portal venous pressure–central venous pressure gradients). Angiography identified 38 right, 33 left, and 19 central divisional single shunts (n = 90) and 10 complex or multiple shunts. Partial shunt attenuation was performed in 92 dogs by means of caval stent placement and insertion of thrombogenic coils within the shunt, and 3 had complete acute shunt occlusion. Major intraoperative complications (3/111 [3%]) included temporary severe portal hypertension in 2 dogs and gastrointestinal hemorrhage in 1 dog. Major postoperative (< 1 week after surgery) complications (14/111 [13%]) included seizures or hepatoencephalopathy (7/111 [6%]), cardiac arrest (2/111 [2%]), jugular site bleeding (2/111 [2%]), pneumonia (1/111 [1%]), suspected portal hypertension (1/111 [1%]), and acute death (1/111 [1%]). Median follow-up time was 958 days (range, 0 to 3,411 days). Median survival time for treated dogs was 2,204 days (range, 0 to 3,411 days). Outcome was considered excellent (57/86 [66%]) or fair (13/86 [15%]) in 70 of 86 (81%) treated dogs.
Conclusions and Clinical Relevance—Results suggested that endovascular treatment of intrahepatic shunts in dogs may result in lower morbidity and mortality rates, with similar success rates, compared with previously reported outcomes for open surgical procedures. Gastrointestinal ulceration was a common finding among this population of dogs, and lifelong gastroprotectant medications are now recommended.
Abstract
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.
Abstract
Objective—To determine outcome associated with use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats.
Design—Retrospective case series.
Animals—3 dogs and 3 cats.
Procedures—All 6 animals had severe inspiratory stertor at initial examination. Two animals had no orifice present at the stenosis. Nasopharyngeal stenosis was diagnosed and stent size determined by use of computed tomography. A percutaneous transluminal angioplasty balloon premounted with a balloon-expandable metallic stent was placed over a guidewire, advanced through the stenotic lesion under fluoroscopic and rhinoscopic guidance, and dilated to restore patency.
Results—All animals had immediate resolution of clinical signs after stent placement. The procedure took a median of 38 minutes (range, 22 to 70 minutes). One animal with a stenosis located far caudally needed the tip of the stent resected because of hairball entrapment and exaggerated swallowing. Both animals without an orifice in the stenosis had tissue in-growth requiring a covered stent. All animals were reexamined 6 to 12 weeks after treatment via rhinoscopy, radiography, computed tomography, or a combination of techniques. All animals lacked signs of discomfort; 5 of 6 were breathing normally 12 to 28 months after the procedure.
Conclusions and Clinical Relevance—Transnasal balloon-expandable metallic stent placement may represent a rapid, safe, noninvasive, and effective treatment in animals with nasopharyngeal stenosis. If the stenosis is extremely caudal in the nasopharynx, serial balloon dilatation might be considered prior to stent placement. A covered stent should be considered initially if the stenosis is completely closed.
Abstract
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.
Abstract
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 [3]) 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.
