Treatment and outcomes of ureter injuries due to ovariohysterectomy complications in cats and dogs

Urinary Tract Trauma in Cats: Stabilisation, Diagnosis and Management

PRACTICAL RELEVANCE

Traumatic injury of the urinary tract may be caused by external accidental trauma or due to iatrogenic injury (typically as a result of catheterisation procedures). Thorough patient assessment and careful attention to patient stabilisation are essential, with diagnosis and surgical repair delayed until the patient is stable, if necessary. Treatment depends on the location and severity of the trauma. If diagnosed and treated promptly, the chance of survival of a patient without other concurrent injuries is good.

CLINICAL CHALLENGES

Following accidental trauma, at the initial presentation urinary tract injury can be overshadowed by other injuries, but if left undiagnosed or untreated it can lead to serious morbidity and potentially mortality. Many of the surgical techniques described for management of urinary tract trauma can be associated with complications, and so comprehensive communication with the owners is necessary.

PATIENT GROUP

The main population affected by urinary tract trauma is young, adult male cats, owing to their roaming behaviour, as well as their anatomy and the resulting increased risk of urethral obstruction and its associated management.

AIMS

This article aims to serve as a guide to all veterinarians who treat cats for the diagnosis and management of urinary tract trauma in cats.

EVIDENCE BASE

This review summarises the current knowledge available from a number of original articles and textbook chapters in the literature that cover all aspects of feline urinary tract trauma, and is supported by the authors' own clinical experience.

Case Report: Successful Management and Long-Term Follow-Up of Bilateral Ureteral Ligation in a Dog Secondary to Cryptorchid Castration Utilizing Bilateral Ureteral Stents and a Neoureterocystostomy Procedure

Objective

To report the successful management of the bilateral ureteral obstruction secondary to ureteral ligation during unilateral cryptorchid surgery in a dog with the utilization of bilateral ureteral stent placement and a neoureterocystostomy procedure.

Summary

A 7-month-old male-castrated Weimaraner weighing 30 kg was presented to a university teaching hospital for evaluation of a 4-day history of lethargy, vomiting, and stranguria following exploratory laparotomy for a left-sided unilateral cryptorchid castration. Based on the concurrent presence of severe azotemia and ultrasonographic findings of bilateral hydronephrosis and hydroureter, the dog was diagnosed with the suspected bilateral ureteral obstruction. The dog underwent a laparotomy which revealed bilateral ureteral ligation which was corrected with a left-sided neoureterocystostomy and right-sided retrograde ureteral stent placement. Subsequent placement of a left-sided ureteral stent due to complications with the neoureterocystostomy site was performed later. Ultimately, both ureteral stents were able to be removed a few months later. The dog was clinically doing well with a baseline creatinine of 1.5 mg/dl (132.6 μmol/L) 532 days following initial bilateral ureteral ligation.

New or Unique Information Provided

This case report describes the successful long-term management of iatrogenic bilateral ureteral obstructions in a male dog using a combination of bilateral ureteral stents and neoureterocystostomy.

Novel surgical approach to neoplastic lesions in the distal part of the urethra: A pilot cadaver study comparing open and hybrid techniques

Tumours of the distal urethra in female dogs are often difficult to treat, and the surgical methods described thus far have technical limitations. This study aimed to present a novel approach to the surgical treatment of distal urethral tumours. This study used dog cadavers to evaluate the technical feasibility of surgically removing neoplastic lesions in the distal urethra and compared surgical outcomes of open surgery with those of hybrid surgery (combination of laparoscopy and open surgery). Open intact, open spayed, hybrid intact, and hybrid spayed dog cadaver groups underwent surgery (n = 6 per group). The novel surgical method was based on vulvovaginectomy (ovariohysterectomy in intact dogs), resection of the distal part of the urethra, and pre-pubic urethrostomy. Outcomes of interest included technical feasibility of each procedure, using both surgical techniques, wound length, time required to complete the procedure, and the incidence of intraoperative ureter and rectum injuries. Surgical technique and reproductive status affected operating time. Technique choice affected wound length; the surgical wound was longer in the open group than in the hybrid group. Macroscopic evaluation of the rectum did not reveal any damage to the wall. There was no evidence of ureter leakage or obstruction in any case. The present findings suggest that both open and hybrid surgery can be used to treat distal urethral tumours.

Bilateral renal descensus and intravesicular ureteroneocystostomy for treatment of bilateral ureteral ligation and transection that occurred during ovariohysterectomy in two cats

CASE DESCRIPTION

6-month-old and 7-month-old spayed female domestic shorthair cats were referred because of complications associated with inadvertent bilateral ureteral ligation and transection during ovariohysterectomy.

CLINICAL FINDINGS

Both cats had a 1- to 2-day history of lethargy, inappetence, and vomiting. Initial exam findings included lethargy, signs of abdominal pain, anuria, and dehydration. Clinicopathologic testing revealed azotemia and hyperkalemia. Abdominal ultrasonography revealed peritoneal effusion and bilateral pyelectasia in both cats and retroperitoneal effusion in one. Fluid analysis in both cats supported a diagnosis of uroabdomen.

TREATMENT AND OUTCOME

Exploratory celiotomy was performed in both cats, and bilateral ureteral ligation and transection was confirmed. Bilateral renal descensus and ureteroneocystostomy with an intravesicular mucosal apposition technique was successfully performed in both cats. Clinicopathologic evaluation performed 1 day after surgery in one cat and 5 days after surgery in the other revealed complete resolution of azotemia. Ultrasonographic examination of the urogenital tract performed approximately 4 months after surgery in the first cat and 1 month after surgery in the second cat revealed complete resolution of renal pelvic dilation bilaterally.

CLINICAL RELEVANCE

Bilateral intravesicular ureteroneocystostomy in conjunction with bilateral renal descensus was used successfully to treat bilateral ureteral transection that occurred in 2 cats during routine ovariohysterectomy. Limited treatment options currently exist for this serious complication, and euthanasia is often considered. This technique, which relies on the use of the natural surrounding tissues for successful treatment, can offer a potential treatment option to correct this uncommon but devastating complication.