Department of Clinical Sciences, Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA.
J Feline Med Surg. 2021 Dec;23(12):1183-1191. doi: 10.1177/1098612X211002014. Epub 2021 Mar 23.
The aim of this study was to describe a method of subcutaneous ureteral bypass (SUB) device placement with intraoperative ultrasound guidance, with or without microsurgical ureterotomy, for the treatment of benign ureteral obstruction(s) in cats. A secondary aim was to describe the complications and outcomes in our population, and compare the two groups with and without ureterotomy.
The medical records of cats with benign ureteral obstruction(s) treated with SUB device placement with intraoperative ultrasound guidance between April 2013 and June 2018 were reviewed.
Twenty-four cats with 30 obstructed ureters had a SUB device placement with intraoperative ultrasound guidance in 26 surgeries. A microsurgical ureterotomy was performed in 14/26 surgeries. Median age was 10.07 years (range 4-16.6). Eleven of 24 cats (46%) had a previous history of chronic kidney disease (CKD). All cats, including two patients with minimal pelvic dilation (⩽4 mm), had a successful intrapelvic placement of the SUB device. Median survival time was 1555 days (4.25 years); this was not significantly different between the two groups ( = 0.4494). Stone analysis and bacterial culture, where available for review, revealed calcium oxalate in 12/12 and a negative culture in 6/7. The ureterotomy significantly prolonged the procedure duration (180 vs 125 mins) without significantly decreasing the short- and long-term complications ( = 0.1588 and = 0.2921, respectively), or the survival time ( = 0.8437).
SUB device placement with intraoperative ultrasound guidance is an effective alternative for the treatment of ureteral obstruction. Ultrasound guidance may be a more accessible option when a trained veterinarian does not have access to fluoroscopy. Microsurgical ureterotomy did not show any advantage and prolonged the anesthesia. Our median survival time emphasizes a good outcome of SUB device placement, even in cats with a previous history of CKD.
本研究旨在描述一种在术中超声引导下进行皮下输尿管旁路（SUB）装置放置的方法，包括或不包括显微输尿管切开术，用于治疗猫的良性输尿管梗阻。次要目的是描述我们人群中的并发症和结果，并比较有和没有输尿管切开术的两组。
回顾了 2013 年 4 月至 2018 年 6 月期间接受术中超声引导下 SUB 装置放置治疗良性输尿管梗阻的猫的病历。
26 例手术中有 24 只猫的 30 条梗阻输尿管进行了 SUB 装置放置，其中 14 例进行了显微输尿管切开术。中位年龄为 10.07 岁（范围 4-16.6）。24 只猫中有 11 只（46%）有慢性肾病（CKD）的既往病史。所有猫，包括 2 只骨盆扩张最小（⩽4 mm）的猫，均成功地将 SUB 装置置于盆腔内。中位生存时间为 1555 天（4.25 年）；两组之间无显著差异（ = 0.4494）。结石分析和细菌培养的结果显示，12/12 例为草酸钙，7/6 例为阴性培养。输尿管切开术显著延长了手术时间（180 分钟对 125 分钟），但并没有显著降低短期和长期并发症（ = 0.1588 和 = 0.2921）或生存时间（ = 0.8437）。
在术中超声引导下进行 SUB 装置放置是治疗输尿管梗阻的一种有效替代方法。当有训练的兽医无法获得透视时，超声引导可能是一种更易获得的选择。显微输尿管切开术没有显示出任何优势，反而延长了麻醉时间。我们的中位生存时间强调了 SUB 装置放置的良好结果，即使在有 CKD 既往病史的猫中也是如此。
