Beidseitiger Einsatz eines subkutanen Ureter-Bypass bei einer Katze mit bilateraler Harnleiterobstruktion

Abstract

A 6-year-old female spayed Domestic Shorthair cat was presented with acute lethargy, dehydration, marked azotemia, metabolic acidosis, left-sided renomegaly, and bilateral hydronephrosis. Ureterolithiasis and ureteral obstruction were suspected based on further diagnostics including abdominal sonography. Medical treatment was not successful. Fluoroscopically guided antegrade pyelography confirmed the diagnosis of bilateral ureteral obstruction due to ureterolithiasis. Subcutaneous ureteral bypass (SUB) devices were placed bilaterally, followed by close patient monitoring. Frequent reassessment of patient parameters and blood work served to adjust the fluid needs of the patient and to ensure proper hydration, correction of azotemia at an appropriate rate, and cardiovascular stability. After significant improvement of all patient parameters within 5 days, the patient was discharged from the hospital. Treatment included a dietary change to reduce the risk of stone formation as well as a phosphorus binder. Clinical and clinicopathologic parameters were unchanged at the 1- and 4- and 7-month rechecks (consistent with IRIS CKD stage II-NP-AP0), and both SUB devices continued to provide unobstructed urine flow. Bilateral placement of subcutaneous ureteral bypass devices may be a safe and potentially effective treatment option for acute bilateral ureteral obstruction in cats with ureterolithiasis. Strict patient monitoring and patient-centered postoperative treatment decisions are crucial to successful treatment outcomes.

Minimal-invasive interventionelle Verfahren am Urogenitaltrakt von Hund und Katze

“…Dieser wird über den Port des Systems mit einem Zystostomiekatheter verbunden, der im Bereich des Apex vesicae in die Harnblase eingebracht und über eine Manschette mit deren Wand vernäht und verklebt wird. Das SUB™-System wird von Hunden und Katzen gut vertragen (20,40,51,60,63). Kurzfristig kommt es bei etwa 5% der Patienten zu einem geringen Austritt von Urin an der Eintrittsstelle des Nephrostomiekatheters (60).…”