Feline ureteral obstructions Part 2: surgical management

Feline obstructive ureteral disease will likely remain a common and frustrating cause of critical illness in cats for the foreseeable future. Since many cats are uraemic and cardiovascularly unstable secondary to obstructive nephropathy, prompt recognition using clinical intuition, blood work and diagnostic imaging is essential to make a timely diagnosis and decision about timing for intervention, if indicated. Multiple surgical and interventional procedures exist for the management of feline ureteral obstructions but there is no ideal technique and all currently available procedures carry risk of infection, re-obstruction, urine leakage and the need for additional procedures in the future. Therefore, until clear, evidence-based guideline exist, the decision about which ureteral procedure to perform in cats should be guided by nature of the obstruction, location, concurrent urolithiasis, infection and surgeon preference. In all likelihood, ureteral surgery, stents and ureteral bypass devices will continue to remain viable options and the decision about which procedure to use will be made on a case-by-case basis.