References
Treatment of ureterolithiasis in feline patients
Abstract
Ureterolithiasis is becoming more frequently diagnosed in feline patients as diagnostic imaging has become more available and the understanding of the clinical signs suggestive of this disease process has grown. The presence of ureteral stones can be diagnosed by radiography and ultrasonography. As 98% of ureteral stones in cats are calcium oxalate, medical management may not be an option for the majority of cases. Subcutaneous ureteral bypass, nephroureterectomy, ureteral stenting and lithotripsy are all techniques that can be used for the treatment of ureteral obstruction caused by ureteral stones; this article focuses on the subcutaneous ureteral bypass device (SUB). This paper outlines how ureterolithiasis is diagnosed, briefly outlines treatment options then focuses on how the SUB device is placed. Postoperative care following a SUB placement is discussed as these patients need careful medical management in the immediate postoperative period to resolve azotaemia without causing fluid overload as well as lifelong follow-up care to ensure the SUB device stays patent and to support renal function.
Ureteral obstructions can be difficult to diagnose and treat in veterinary medicine. This article outlines the diagnostic process and discusses some recent advances in treatment options. Ureters are thick-walled fibromuscular ducts that sit in the retroperitoneal space and connect the renal pelvises with the urinary bladder (Lamb, 1998) (Figure 1). The ureter is lined with transitional cell epithelium surrounded by a connective tissue layer called the lamina propria. Together, these two layers make up the mucosa. The lumen is normally collapsed, opening only when urine passes through (Hardie, 2014). The internal diameter of the feline ureter is approximately 0.4 mm.
Ureterolithiasis is the most common cause of ureteral obstruction in both dogs and cats although ureteral strictures and neoplasia are also reported. More than 98% of feline and 50% of canine uretoliths are reported to be calcium oxalate. These types of stones do not dissolve medically and need to be passed spontaneously, removed surgically via a urethrotomy or medically managed to permit urine passage (Berent, 2011).
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