Subcutaneous ureteral bypass device placement in 81 cats with benign ureteral obstruction (2013‐2018)

Objectives The aim of this study was to describe a method of subcutaneous ureteral bypass (SUB) device placement with intraoperative ultrasound guidance, with or without microsurgical ureterotomy, for the treatment of benign ureteral obstruction(s) in cats. A secondary aim was to describe the complications and outcomes in our population, and compare the two groups with and without ureterotomy. Methods The medical records of cats with benign ureteral obstruction(s) treated with SUB device placement with intraoperative ultrasound guidance between April 2013 and June 2018 were reviewed. Results Twenty-four cats with 30 obstructed ureters had a SUB device placement with intraoperative ultrasound guidance in 26 surgeries. A microsurgical ureterotomy was performed in 14/26 surgeries. Median age was 10.07 years (range 4–16.6). Eleven of 24 cats (46%) had a previous history of chronic kidney disease (CKD). All cats, including two patients with minimal pelvic dilation (⩽4 mm), had a successful intrapelvic placement of the SUB device. Median survival time was 1555 days (4.25 years); this was not significantly different between the two groups ( P = 0.4494). Stone analysis and bacterial culture, where available for review, revealed calcium oxalate in 12/12 and a negative culture in 6/7. The ureterotomy significantly prolonged the procedure duration (180 vs 125 mins) without significantly decreasing the short- and long-term complications ( P = 0.1588 and P = 0.2921, respectively), or the survival time ( P = 0.8437). Conclusions and relevance SUB device placement with intraoperative ultrasound guidance is an effective alternative for the treatment of ureteral obstruction. Ultrasound guidance may be a more accessible option when a trained veterinarian does not have access to fluoroscopy. Microsurgical ureterotomy did not show any advantage and prolonged the anesthesia. Our median survival time emphasizes a good outcome of SUB device placement, even in cats with a previous history of CKD.

Download Full-text

Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014–2016)

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x16670572 ◽

2016 ◽

Vol 19 (10) ◽

pp. 1030-1039 ◽

Cited By ~ 10

Author(s):

Véronique Livet ◽

Paul Pillard ◽

Isabelle Goy-Thollot ◽

David Maleca ◽

Quentin Cabon ◽

...

Keyword(s):

Ureteral Obstruction ◽

Recovery Period ◽

Ureteral Stricture ◽

Fluoroscopic Guidance ◽

Intraoperative Complication ◽

Device Placement ◽

Ultrasonographic Guidance ◽

Ureteral Surgery

Objectives The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Methods Data were obtained retrospectively from the medical records (2014–2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Results Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats ( P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. Conclusions and relevance SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in all cases.

Download Full-text

Age at Full-Time Use Predicts Language Outcomes Better Than Age of Surgery in Children Who Use Cochlear Implants

American Journal of Audiology ◽

10.1044/2019_aja-19-0073 ◽

2019 ◽

Vol 28 (4) ◽

pp. 986-992 ◽

Cited By ~ 2

Author(s):

Lisa R. Park ◽

Erika B. Gagnon ◽

Erin Thompson ◽

Kevin D. Brown

Keyword(s):

Cochlear Implants ◽

Time Use ◽

Expressive Language ◽

Normal Hearing ◽

Full Time ◽

Language Outcomes ◽

Age At Surgery ◽

Device Placement ◽

Device Use ◽

Better Than

Purpose The aims of this study were to (a) determine a metric for describing full-time use (FTU), (b) establish whether age at FTU in children with cochlear implants (CIs) predicts language at 3 years of age better than age at surgery, and (c) describe the extent of FTU and length of time it took to establish FTU in this population. Method This retrospective analysis examined receptive and expressive language outcomes at 3 years of age for 40 children with CIs. Multiple linear regression analyses were run with age at surgery and age at FTU as predictor variables. FTU definitions included 8 hr of device use and 80% of average waking hours for a typically developing child. Descriptive statistics were used to describe the establishment and degree of FTU. Results Although 8 hr of daily wear is typically considered FTU in the literature, the 80% hearing hours percentage metric accounts for more variability in outcomes. For both receptive and expressive language, age at FTU was found to be a better predictor of outcomes than age at surgery. It took an average of 17 months for children in this cohort to establish FTU, and only 52.5% reached this milestone by the time they were 3 years old. Conclusions Children with normal hearing can access spoken language whenever they are awake, and the amount of time young children are awake increases with age. A metric that incorporates the percentage of time that children with CIs have access to sound as compared to their same-aged peers with normal hearing accounts for more variability in outcomes than using an arbitrary number of hours. Although early FTU is not possible without surgery occurring at a young age, device placement does not guarantee use and does not predict language outcomes as well as age at FTU.

Download Full-text

An Experimental Study on Renal Functional Disturbance in Rabbits After Acute Ureteral Obstruction With Dynamic Gd-DTPA Enhanced MR Imaging

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1994.30.5.893 ◽

1994 ◽

Vol 30 (5) ◽

pp. 893

Author(s):

Kyoung Ja Shin ◽

Eun Chul Chung ◽

Chung Sik Sik Rhee

Keyword(s):

Experimental Study ◽

Mr Imaging ◽

Ureteral Obstruction ◽

Functional Disturbance

Download Full-text

Chronic Mechanical Circulatory Support for Patients with End-stage Heart Failure as a Definitive Treatment Option

European Cardiology Review ◽

10.15420/ecr.2010.8.2.22 ◽

2010 ◽

Vol 6 (4) ◽

pp. 22

Author(s):

Patrycja Ganslmeier ◽

Christof Schmid ◽

◽

Keyword(s):

Heart Failure ◽

Mechanical Circulatory Support ◽

Definitive Treatment ◽

Circulatory Support ◽

Randomized Evaluation ◽

Fda Approval ◽

Cerebrovascular Events ◽

Device Placement ◽

End Stage Heart Failure ◽

End Stage

Mechanical circulatory support for end-stage heart failure has become routine and is now increasingly used as definitive treatment. Several small devices qualify for this purpose, but only a few have gained US Food and Drug Administration (FDA) approval as yet. Several studies, including the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) study, the Investigation of Non-transplant-Eligible Patients Who Are Inotrope Dependent (INTrEPID) and the HeartMate (HM) II trial have confirmed a significantly improved quality of life and functional capacity after device placement. However, cerebrovascular events, infection and device malfunction still pose a considerable risk to patients and hinder widespread use.

Download Full-text