Ureteral Surgery

Question 1

Berent, JAVMA, 2014:
Ureteral stenting in cats

1. What % of cats had concurrent ipsilateral nephroliths and ureteroliths?
2. What % of cats had previously had ureteral surgery for ureteroliths, and what % of these cats had evidence of nephroliths at the time of initial surgery?
3. What % of cats developed post-op uroabdomen?
4. What % of cats required stent exchange and for what reasons?
5. What was the most common minor complication?
6. What % of cats had positive urine cultures in the long-term?
7. Overall MST?
8. What was associated with re-obstruction and why?

Answer 1

Berent, JAVMA, 2014:

1. 85% had concurrent ipsilateral nephroliths and ureteroliths
2. 23% had previous ureteral surgery, and 86% of these cats had evidence of nephroliths at the time of initial surgery
3. 7% developed post-op uroabdomen
4. 28% required stent exchange due to re-obstruction (19%), stent migration (6%) or stent irritation (3%)
5. Dysuria (pollakiuria, stranguria) was the most common minor complication
6. 13% had positive urine cultures in the long-term
7. Overall MST: 498 days; 21% died of chronic kidney disease
8. Cats with a ureteral stricture were more likely to re-obstruct than cats without a ureteral stricture (37% vs 10%) - the fibrous tissue of a stricture does not allow for passive dilation of the ureter following stent placement, therefore if the stent becomes occluded with debris, which is ultimately expected in most stents in the long-term, re-obstruction would occur in the area of the stricture where passive dilation does not occur

Question 2

Kuntz, JAVMA, 2015:
Double pigtail ureteral stenting for renal-sparing treatment of obstructive pyonephrosis

1. Intra-op complication rate?
2. Long-term complications?
3. What % of cases developed recurrent UTIs?

Answer 2

Kuntz, JAVMA, 2015:

1. Intra-op complication rate: 14%
2. Long-term complications: stent encrustation, stent migration, tissue proliferation at the ureterovesicular junction
3. 50% developed recurrent UTIs

Question 3

Culp, JAVMA, 2016:
Ureteral stenting vs ureterotomy in cats

1. What % of cats developed post-obstructive diuresis following DPU stenting vs ureterotomy?
2. What % of cats developed anemia following DPU stenting vs ureterotomy?
3. What % of cats developed abdominal effusion following DPU stenting vs ureterotomy?
4. Azotemia resolved in what % of cats following DPU stenting vs ureterotomy?
5. Mortality rates following DPU stenting vs ureterotomy?
6. What decreased the likelihood of survival to discharge?
7. What increased the likelihood of developing post-op abdominal effusion?

Answer 3

Culp, JAVMA, 2016:

1. Post-obstructive diuresis: 100% of DPU stenting vs 50% of ureterotomy cases
2. Anemia: 100% of DPU stenting vs 97% of ureterotomy cases
3. Post-op abdominal effusion: 23% of DPU stenting vs 33% of ureterotomy cases
4. Azotemia resolved in 62% of DPE stenting cases vs 31% of ureterotomy cases
5. Mortality rates: 8% for DPU stenting vs 22% for ureterotomy
6. Post-op abdominal effusion decreased the likelihood of survival to discharge
7. Ureterotomy in conjunction with DPU stenting increased the likelihood of developing post-op abdominal effusion

Question 4

Wormser, JAVMA, 2016:
Ureterotomy or ureteroneocystostomy vs ureteral stenting in cats

1. Peri-op complication rate for DPU stenting?
2. Peri-op complication rate for ureterotomy and ureteroneocystostomy?
3. Peri-op mortality rate was similar between cats that had DPU stenting and those that did not - true or false?
4. Were signs of chronic lower urinary tract disease and chronic UTI more common among cats that had DPU stent placement or cats that did not?
5. What % of cats had recurrent ureteral obstruction?

Answer 4

Wormser, JAVMA, 2016:

1. Peri-op complication rate for DPU stenting: 14%
2. Peri-op complication rate for ureterotomy and ureteroneocystostomy: 3%
3. True
4. Signs of chronic lower urinary tract disease and chronic UTI were more common among cats that had DPU stent placement than cats that did not
5. 22% had recurrent ureteral obstruction

Question 5

Deroy, JAVMA, 2017:
DPU stents vs SUB devices in cats

1. What were SUB devices associated with?
2. Most common peri-op complication of DPU stenting?
3. Which procedure was more likely to be associated with signs of cystitis?
4. Peri-op mortality rate for DPU stent vs SUB device placement?
5. Which procedure was more likely to develop device obstruction due to encrustation in the long-term?

Answer 5

Deroy, JAVMA, 2017:

1. SUB devices were associated with a shorter duration of surgery, fewer complications, fewer additional procedures after device placement, and longer survival time
2. Most common peri-op complication of DPU stenting was uroabdomen (18%)
3. Cats in the DPU stent group developed signs of cystitis more commonly than cats in the SUB device group (52% vs 22%)
4. Peri-op mortality rates: 18% for DPU stenting vs 13% for SUB device placement
5. DPU stents were more likely to develop device obstruction due to encrustation in the long-term compared to SUB devices (26% vs 4%)

Question 6

Pavia, JAVMA, 2018:
Ureteral stenting in dogs

1. Major and minor intra-op complication rates?
2. Short-term and long-term complication rates?
3. What % of dogs developed post-op hematuria?
4. What % of dogs required stent exchange and what % required stent replacement with a SUB device?
5. What was associated with requiring stent exchange or replacement?
6. Pre-op UTI was not associated with the outcome or development of long-term complications - true or false?

Answer 6

Pavia, JAVMA, 2018:

1. Intra-op complication rates: 5% major, 4% minor
2. Short-term complication rate: 13%
   Long-term complication rate: 47%
3. 20% developed post-op hematuria
4. 12% required stent exchange and 4% required stent replacement with a SUB device
5. Calcium apatite or phosphate stones had an increased risk of requiring stent exchange or replacement
6. True

Question 7

Nesser, Vet Surg, 2018:
Ureteral stones in cats

Association between stone size and stone location?

Answer 7

Nesser, Vet Surg, 2018:

Larger stone size was associated with a more proximal stone location

Question 8

Cray, JAVMA, 2018:
Treatment of pyonephrosis with a SUB device

1. What % of the cats developed post-op occlusion of the cystostomy catheter with purulent material?
2. What % of cats had resolution of the UTI?

Answer 8

Cray, JAVMA, 2018:

1. 25% developed post-op occlusion of the cystostomy catheter with purulent material
2. 75% had resolution of the UTI

Question 9

Berent, JAVMA, 2018:
SUB device in cats

1. What % of cats had bilateral ureteral obstruction?
2. What % of cats were azotemic?
3. List 3 post-op complications.
4. Mortality rate?
5. Most common long-term complication?
6. What was associated with SUB device occlusion?

Answer 9

Berent, JAVMA, 2018:

1. 39% had bilateral ureteral obstruction
2. 95% were azotemic
3. Post-op complications: device occlusion with blood clots (8%), device tubing kinking (5%), device leakage (4%)
4. Mortality rate: 6%
5. Most common long-term complication was catheter mineralization (24% of cases)
6. High post-op serum ionised calcium concentration was associated with SUB device occlusion

Question 10

Balsa, JAVMA, 2019:
Post-obstructive diuresis following ureteral stent or SUB device placement in cats

1. Did cats with anuria before surgery have shorter or longer post-obstructive diuresis?
2. Mortality rate?
3. What % of cats had resolution of azotemia?

Answer 10

Balsa, JAVMA, 2019:

1. Cats with anuria before surgery had longer post-obstructive diuresis
2. Mortality rate: 8%
3. Azotemia resolved in 50% of the cats

Question 11

Kopecny, JVIM, 2019:
Urine cultures following SUB device and ureteral stent placement

What % of cats had positive post-op urine cultures?

Answer 11

Kopecny, JVIM, 2019:

25% had positive post-op urine cultures

Question 12

Noel, Vet Surg, 2017:
Ectopic ureters in dogs

1. What was the most common type of ectopic ureters and was it more common in female or male dogs?
2. Minor post-op complication rate?
3. Major post-op complication rate?
4. What % of dogs had recurrence of urinary incontinence and at a mean of how many months post-op?
5. Unilateral vs bilateral ectopic ureters, intramural vs extramural ectopic ureters, and presence or absence of other congenital urogenital abnormalities were not prognostic factors for post-op continence - true or false?
6. Short-term and long-term outcomes?

Answer 12

Noel, Vet Surg, 2017:

1. Intramural ectopic ureters in female dogs were overrepresented
2. Minor post-op complication rate: 32%
3. Major post-op complication rate: 11%
4. Incontinence recurred in 35% at a mean of 5 months post-op
5. True
6. 92% good to excellent short-term outcomes and 81% good to excellent long-term outcomes

Question 13

Steinhaus, JVIM, 2015:
Circumcaval ureters in cats

1. What % of cats with ureteral obstruction had a circumcaval ureter, and which side was it more common in?
2. What % of cats without ureteral obstruction had a circumcaval ureter, and which side was it most common in?
3. In cats with ureteral obstruction and a circumcaval ureter, was ureteral obstruction more common in ureters that were treated with ureteral stents or SUB devices?

Answer 13

Steinhaus, JVIM, 2015:

1. 17% of cats with ureteral obstruction had a circumcaval ureter, and it was more commonly right-sided (80%)
2. 14% of cats without ureteral obstruction had a circumcaval ureter, and it was more commonly right-sided (89%)
3. In cats with ureteral obstruction and a circumcaval ureter, ureteral obstruction was more common in ureters that were treated with ureteral stents compared to SUB devices

Question 14

Rogatko, JVIM, 2019:
Endoscopic laser ablation for ureteroceles in dogs

1. Conversion rate to surgery?
2. What % of the ureteral orifices associated with the ureteroceles were ectopic?
3. What % of the ureteroceles had stenotic or imperforate ureteral orifices?

Answer 14

Rogatko, JVIM, 2019:

1. 15% conversion rate to surgery
2. 71% of the ureteral orifices associated with the ureteroceles were ectopic
3. 93% of the ureteroceles had stenotic or imperforate ureteral orifices

Question 15

Wavreille, Vet Surg, 2015:
Suture-free technique for canine ureteral resection-anastomosis using a microvascular anastomotic system

1. What was necessary to allow complete mechanical interlock of the anastomotic rings?
2. The microvascular anastomotic system technique was faster and had higher burst strength compared to hand sutured anastomosis - true or false?

Answer 15

Wavreille, Vet Surg, 2015:

1. Selective impaling of the mucosa and submucosa without the muscular and adventitia was necessary to allow complete mechanical interlock of the anastomotic rings
2. True