Becks, an adorable middle aged cat presented to North Coast Veterinary Specialist & Referral Centre (NCVS) with lethargy and inappetence. Following a consultation with Dr Richard Mitchell, one of our Specialists in Small Animal Surgery, Becks was hospitalised and diagnostics performed. Completed inhouse blood tests revealed azotemia. Ultrasound examination by Dr Chris Small (internal medicine) revealed a small right kidney; dilated left ureter; dilated left kidney and bilateral ureteroliths. These changes were consistent with severe bilateral renal dysfunction with probable irreparable right kidney function.
At surgery, ultrasound findings were confirmed and the left ureter was identified. As expected in most cats, the left ureter was too small to be able to remove the ureterolith and place a stent. The right kidney was small and walnut-sized consistent with a dysfunctional right kidney. A decision was made to try to restore left kidney function and normal urine flow by bypassing the obstructed ureter. This was performed with a specifically designed device called a subcutaneous ureteral bypass system (SUBS). This involved placement of a silicon pigtail catheter into the renal pelvis with a second catheter placed and secured into the bladder. The catheters were then connected via a subcutaneously placed injection port, that allows for regular flushing of the system and monitoring of the urine for complications such as infection. The SUBS was placed under fluoroscopic guidance to ensure correct placement of all implants.
An oesophagostomy tube was placed at the time of surgery as early positive nutritional balance has been demonstrated to improve outcomes. Post operatively Becks has recovered extremely well with returned to normal appetite and demeanour. Repeat and regular monitoring of Becks’s kidney enzymes have revealed a return to normal levels, implying adequate kidney function. Becks’s was recently been seen for three-month follow-up examination and he would appear to be a normal happy cat.
The SUBS device is an extremely effective method of maintaining renal function when no other options exist. In some cases stenting is possible but is often ineffective in cats, with nephrectomy not an option in this case. Larger studies overseas reveal these devices, when implanted and functioning correctly, provide long-term quality of life in these patients with a very low complication rate. We have performed a few of these procedures in selected cases and are pleased to be able to offer the surgery at NCVS.