Subcutaneous ureteral bypass for treatment of proximal ureteral obstruction secondary to retroperitoneal fibrosis after renal transplantation in a cat

Peter J Laminette ¹, Robert J Hardie ¹

⁰University of Wisconsin-Madison, School of Veterinary Medicine, Department of Surgical Sciences, Madison, WI, USA.

Jfms Open Reports +

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August 26, 2024

View abstract on PubMed

Summary

This case study details a cat with chronic kidney disease that underwent renal transplantation. A subcutaneous ureteral bypass (SUB) device was used to manage ureteral obstruction in the transplanted kidney, marking a novel approach in feline veterinary medicine.

Area Of Science

Veterinary Medicine
Nephrology
Surgical Innovation

Background

A domestic shorthair cat with a 2-year history of chronic kidney disease underwent orthotopic renal transplantation.
Post-transplantation complications included hydronephrosis and hydroureter, necessitating a neoureterocystostomy for ureteral stricture.

Observation

Recurrent obstruction, hydronephrosis, and azotemia occurred 12 months post-transplantation, attributed to retroperitoneal fibrosis and adhesions.
A subcutaneous ureteral bypass (SUB) device was surgically placed to manage the ureteral obstruction in the transplanted kidney.

Findings

The SUB device provided temporary relief, but occlusion due to catheter kinking required replacement at 15 months.
Despite interventions, renal function ultimately deteriorated, leading to euthanasia 28 months after SUB placement.

Implications

This report highlights the first documented use of a SUB device for ureteral obstruction in a feline renal transplant recipient.
While offering a potential solution, the case underscores challenges in long-term management and device patency in this complex clinical scenario.

Keywords:

Renal transplantation retroperitoneal fibrosis subcutaneous ureteral bypass ureteral obstruction vascular coupling