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Lackeyram-Owen S, Gibson E, Reetz J, Chan T, Assenmacher CA, Clarke DL. Urothelial carcinoma associated with a long-term indwelling cystostomy component of a subcutaneous ureteral bypass device in a domestic shorthair cat. J Vet Intern Med 2024. [PMID: 39198022 DOI: 10.1111/jvim.17183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
Urothelial carcinoma (UC) occurs uncommonly in cats and no association has previously been observed with long-term indwelling urinary implants. An 18-year-old male castrated domestic shorthair cat initially was presented for hematuria, leading to the diagnosis of a right-sided ureterolithiasis and severe pyelectasia on ultrasound examination, prompting right-sided subcutaneous ureteral bypass (SUB) device placement. The cat subsequently had intermittent hematuria and dysuria, without ultrasonographic abnormality of the bladder or positive urine culture. Thirteen months later the patient developed refractory lower urinary tract signs, azotemia, a proliferative mass in the region of the cystostomy tube component of the SUB device and evidence of left ureteral obstruction. Cystostomy tube revision and left-sided SUB device placement were performed, as well as a partial cystectomy for removal of the mass. Upon histopathology, the mass was diagnosed as a UC. To our knowledge, UC associated with a long-term indwelling cystostomy catheter component of a SUB device has not been reported in veterinary medicine.
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Affiliation(s)
| | - Erin Gibson
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Reetz
- Department of Radiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Taylor Chan
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles-Antoine Assenmacher
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dana L Clarke
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kurtz M, Pey PBM, Mortier J, Manassero M, Da Riz F, Canonne‐Guibert M, Maurey C, Benchekroun G. Usefulness of serum amyloid A for the diagnosis of pyelonephritis in cats: A prospective evaluation. J Vet Intern Med 2024; 38:1542-1552. [PMID: 38669563 PMCID: PMC11099735 DOI: 10.1111/jvim.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The diagnosis of pyelonephritis in cats is challenging and development of a noninvasive and accurate biomarker is needed. HYPOTHESES Serum amyloid A (SAA) is increased in cats with pyelonephritis, but not in cats with other urinary tract diseases. ANIMALS A cohort of 125 cats (149 observations). METHODS This was a prospective study. Group 1 included cats with a diagnosis of pyelonephritis either confirmed by bacterial culture of pelvic urine (Group 1a) or presumed (1b). Group 2 included cats for which pyelonephritis was ruled out (with certainty: Group 2a or judged unlikely: Group 2b). SAA concentration was compared between groups, and accuracy of SAA for the diagnosis of pyelonephritis was calculated using a Receiver Operating Characteristic (ROC) curve analysis. RESULTS Median SAA concentration was significantly higher in Group 1a (86.8 mg/L [73.3; 161.5]; n = 8) than in Group 2a (4 mg/L [1.8; 5.6], n = 19; P < .001) and in Group 2b (5.4 mg/L [3.1; 9.7], n = 113; P < .001). It was also significantly higher in Group 1b (98.8 mg/L [83.1; 147.3]; n = 9) than in Group 2b (P < .001) and Group 2a (P < .001). Optimal diagnostic cut-off for SAA concentration was 51.3 mg/L. yielding a sensitivity of 88% (95% confidence interval: [64%; 99%]) and a specificity of 94% (95% confidence interval: [88%; 97%]). CONCLUSIONS AND CLINICAL IMPORTANCE Measurement of SAA could be used to rule out pyelonephritis in the case of low suspicion of the disease. Increased SAA concentration is suggestive of pyelonephritis despite a lack of specificity.
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Affiliation(s)
- Maxime Kurtz
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Pascaline Bénédicte Marie Pey
- Antech Imaging ServicesIrvineCaliforniaUSA
- Veterinary Hospital “I Portoni Rossi,” Anicura, Zola Predosa (BO)BolognaItaly
| | - Jérémy Mortier
- Ecole Nationale Vétérinaire d'Alfort, CHUVAService D'Imagerie MédicaleMaisons‐AlfortFrance
| | - Mathieu Manassero
- École Nationale Vétérinaire d'Alfort, CHUVAService de ChirurgieMaisons‐AlfortFrance
| | - Fiona Da Riz
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Morgane Canonne‐Guibert
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'Alfort, CHUVAService D'Imagerie MédicaleMaisons‐AlfortFrance
| | - Christelle Maurey
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Ghita Benchekroun
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'AlfortUniv Paris Est Créteil, INSERM, IMRBMaisons‐AlfortFrance
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Djoneva L, Lawson J, Rutherford L, Geddes R. Analysis of lower urinary tract signs and bacteriuria in cats with subcutaneous ureteral bypass systems. Vet Rec Open 2023; 10:e69. [PMID: 37534374 PMCID: PMC10393289 DOI: 10.1002/vro2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives Distinguishing bacterial cystitis from subclinical bacteriuria is necessary for feline treatment protocols and antimicrobial stewardship. This can be challenging in cats with subcutaneous ureteral bypass (SUB) systems because they may present with lower urinary tract signs without bacteriuria. We investigated the relationship between positive urine culture and lower urinary tract signs in cats with SUBs, including factors associated with each. Methods Clinical records were retrospectively reviewed to identify cats presenting with ureteral obstruction that underwent placement of a SUB device(s). The relationship between a positive urine culture and lower urinary tract signs was determined by chi-squared analysis. Univariable and multivariable logistic regression models were performed to identify factors associated with positive urine cultures and lower urinary tract signs. Results Two hundred and thirty visits were recorded for 61 cats, with 36 of 230 (16%) positive cultures in 21 of 61 (34%) cats. Lower urinary tract signs were documented at 97 of 230 (42%) visits, with 37 of 61 (61%) cats demonstrating lower urinary tract signs at some point. No relationship was found between culture results and lower urinary tract signs. Risk factors for a positive culture were higher urine pH, higher urine white blood cells and the presence of bacteriuria on microscopy. Risk factors for lower urinary tract signs were younger age and being a purebred cat (vs. non-purebred). Conclusions A high proportion of cats with SUBs exhibited sterile lower urinary tract signs, making differentiation between bacterial cystitis and subclinical bacteriuria difficult. This highlights the need for clearer guidelines on when to treat bacteriuria in cats with SUBs.
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Affiliation(s)
- Luba Djoneva
- Royal Veterinary CollegeNorth MymmsHatfieldHertfordshireUK
| | - Jack Lawson
- Royal Veterinary CollegeNorth MymmsHatfieldHertfordshireUK
| | | | - Rebecca Geddes
- Royal Veterinary CollegeNorth MymmsHatfieldHertfordshireUK
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Oyamada K, Inoue M, Sato-Takada K, Minamoto T, Fujiki M. Extravesicular, two-layer, side-to-side ureteroneocystostomy combined with tension-relieving techniques for feline proximal ureteral obstruction: A retrospective study. Vet Surg 2023; 52:972-982. [PMID: 37345232 DOI: 10.1111/vsu.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/21/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To describe the surgical technique for extravesicular, two-layer, side-to-side ureteroneocystostomy combined with tension-relieving techniques (ETSUTT) for feline proximal ureteral obstruction and report clinical outcomes. STUDY DESIGN Retrospective case series. ANIMALS Ten privately-owned cats with ureteral obstruction near the ureteropelvic junction (UPJ). METHODS Medical records were retrospectively reviewed for cats with ureteral obstruction close to the UPJ that underwent ETSUTT (2018-2021). The ETSUTT procedure consisted of a modified extravesicular technique (two-layer, side-to-side ureteroneocystostomy) and tension-relieving techniques (renal descensus, ureterocystopexy, and nephrocystopexy). RESULTS All cats survived through discharge. In all cats, postoperative blood urea nitrogen and creatinine concentrations were decreased, compared with preoperative concentrations. Perioperative complications included ureteral catheter dislodgement (3), transient pollakiuria (2), and dysuria (1), but no specific treatments were required. Urinary tract infection was observed postoperatively in three of the 10 cats. The median follow-up was 648 days (min-max: 86-1229 days). Seven of the 10 cats were alive without recurrent ureteral obstruction at the end of this retrospective study. CONCLUSION The ETSUTT procedure was successfully performed without major complications in cats with ureteral obstruction occurring near the UPJ. Use of ETSUTT provided a fair-to-good, long-term prognosis in cats that were otherwise difficult to manage. CLINICAL SIGNIFICANCE This novel procedure, ETSUTT, was feasible, safe, and could be a viable treatment option for feline proximal ureteral obstruction, including the UPJ, especially for obstructions caused by stricture.
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Khoo TX, Wang S, Chambers B, McMillan A, Yates G. Modified endoluminal ureteral stenting for the management of proximal ureteral obstruction in two cats. JFMS Open Rep 2023; 9:20551169231210449. [PMID: 38115862 PMCID: PMC10729628 DOI: 10.1177/20551169231210449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Case series summary Two cases of placement of modified endoluminal ureteral stents are described, for revision of a subcutaneous ureteral bypass (SUB) and for primary treatment of obstructive ureterolithiasis. Modified endoluminal stents were inserted through the ureterotomy, anchored in the renal pelvis with a single pigtail and shortened to a length sufficient to span the proximal ureter and ureterotomy site. Relevance and novel information The advantages of this approach as a surgical option for feline obstructive ureterolithiasis are demonstrated, including the avoidance of disruption, or bypass, of the ureterovesicular junction, minimisation of implanted foreign material and avoidance of intravesicular stent mass, maintenance of the physiological route of urine flow, including preservation of active distal ureteral function, and limitation of the potential complications of ureterotomy. The clinical efficacy of this adaptation of the previously published endoluminal stenting technique is demonstrated with its applicability de novo and in the revision of other stenting procedures.
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Affiliation(s)
- Teng-Xiang Khoo
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Shaojing Wang
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Brenton Chambers
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Angus McMillan
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Guy Yates
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
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Dekerle B, Fournet A, Maurice E, Viateau V, Maurey C, Manassero M. Feline ureteral rupture with para-ureteral urinomas following blunt trauma: clinical presentation and long-term outcome after treatment by urinary diversion for five cases from 2012 to 2019. N Z Vet J 2023; 71:92-99. [PMID: 36281557 DOI: 10.1080/00480169.2022.2138605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CASE HISTORY Medical records were reviewed for cats that underwent surgical treatment of traumatic ureteral rupture (TUR) using urinary diversion procedures between 2012 and 2019. CLINICAL FINDINGS AND TREATMENT Five cats had presented with injuries associated with road traffic accidents. These included three cats with abdominal hernias that required surgical management. At a median of 15 days after the accident, cats represented with lethargy, the presence of an abdominal mass or with lower urinary tract symptoms and in all cats contrast diagnostic imaging showed proximal unilateral TUR with associated para-ureteral urinoma. Four cats received subcutaneous ureteral bypass (SUB) device placement and one had ureteral anastomosis over a stent. Unilateral cyst-like retroperitoneal fluid consistent with para-ureteral urinoma was observed in all cats and a diffuse retroperitoneal haematoma was noticed in four cats. No immediate major complications occurred, and all cats had post-operative serum creatinine concentration within the reference interval. The cat that had received a ureteral stent subsequently required placement of a SUB following stent encrustation 15 months after surgery. Median follow-up time was 34 (min 28, max 58) months and renal function was normal in all cats at the last follow-up. CLINICAL RELEVANCE Urinary diversion procedures provided long-term stable renal function following proximal TUR in these five cats. Delayed, subtle non-specific clinical signs subsequent to high-energy blunt trauma causing abdominal hernia and associated diffuse retroperitoneal haematoma, should raise suspicion of TUR. ABBREVIATIONS AFAST: Abdominal focused assessment with sonography for trauma; SUB: Subcutaneous ureteral bypass; TUR: Traumatic ureteral rupture.
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Affiliation(s)
- B Dekerle
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (ChuvA), Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - A Fournet
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (ChuvA), Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - E Maurice
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (ChuvA), Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - V Viateau
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (ChuvA), Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - C Maurey
- Department of Small Animal Internal Medicine, Centre Hospitalier Universitaire Vétérinaire d'Alfort (ChuvA), Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - M Manassero
- Department of Small Animal Surgery, Centre Hospitalier Universitaire Vétérinaire d'Alfort (ChuvA), Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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Robakiewicz P, Halfacree Z. Urinary Tract Trauma in Cats: Stabilisation, Diagnosis and Management. J Feline Med Surg 2023; 25:1098612X231159073. [PMID: 36867077 PMCID: PMC10812010 DOI: 10.1177/1098612x231159073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
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.
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Affiliation(s)
- Paula Robakiewicz
- Davies Veterinary Specialists, Part of Linnaeus Group, Manor Farm Business Park, Higham Gobion, UK
| | - Zoë Halfacree
- Davies Veterinary Specialists, Part of Linnaeus Group, Manor Farm Business Park, Higham Gobion, UK
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Geddes RF, Davison LJ, Elliott J, Syme HM, O'Neill DG. Risk factors for upper urinary tract uroliths and ureteral obstruction in cats under referral veterinary care in the United Kingdom. J Vet Intern Med 2023; 37:567-577. [PMID: 36860138 PMCID: PMC10061198 DOI: 10.1111/jvim.16659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Cats presenting with upper urinary tract uroliths (UUTUs) and ureteral obstruction ("obstructive UUTU") are typically younger than cats with idiopathic CKD that often have incidental nephroliths. HYPOTHESIS Cats with upper urinary tract urolith have 2 clinical phenotypes; a more aggressive phenotype at risk of obstructive UUTU at a young age and a more benign phenotype in older cats, with reduced risk of obstructive UUTU. OBJECTIVES Identify risk factors for UUTU and for obstructive UUTU. ANIMALS Eleven thousand four hundred thirty-one cats were referred for care over 10 years; 521 (4.6%) with UUTU. METHODS Retrospective VetCompass observational cross-sectional study. Multivariable logistic regression models were performed to identify risk factors for a diagnosis of UUTU vs no UUTU and additionally, obstructive UUTU vs nonobstructive UUTU. RESULTS Risk factors for UUTU included female sex (odds ratio [OR] 1.6, confidence interval [CI] 1.3-1.9; P < .001), British shorthair, Burmese, Persian, Ragdoll or Tonkinese (vs non-purebred ORs 1.92-3.31; P < .001) breed and being ≥4 years (ORs 2.1-3.9; P < .001). Risk factors for obstructive UUTU were female sex (OR 1.8, CI 1.2-2.6; P = .002), having bilateral uroliths (OR 2.0, CI 1.4-2.9; P = .002) and age, with the odds of obstructive UUTU increasing as age at diagnosis of UUTU decreased (≥12 years, reference category; 8-11.9 years, OR 2.7, CI 1.6-4.5; 4-7.9 years, OR 4.1, CI 2.5-7.0; 0-3.9 years, OR 4.3, CI 2.2-8.6; P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE Cats diagnosed with UUTU at a younger age have a more aggressive phenotype with higher risk of obstructive UUTU compared to cats over 12 years of age diagnosed with UUTU.
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Affiliation(s)
- Rebecca F Geddes
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, United Kingdom
| | - Lucy J Davison
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, United Kingdom
| | - Jonathan Elliott
- Comparative Biological Sciences, Royal Veterinary College, Royal College Street, Camden, London NW1 0TU, United Kingdom
| | - Harriet M Syme
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, United Kingdom
| | - Dan G O'Neill
- Pathobiology and Population Science, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, United Kingdom
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Bernhard C, Linsart A, Mentré V. Circumcaval ureter in two ferrets (Mustela putorius furo). J Exot Pet Med 2022. [DOI: 10.1053/j.jepm.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Current Concepts in Urinary Surgery. Vet Clin North Am Small Anim Pract 2022; 52:387-417. [DOI: 10.1016/j.cvsm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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