Beidseitiger Einsatz eines subkutanen Ureter-Bypass bei einer Katze mit bilateraler Harnleiterobstruktion

Zusammenfassung

Eine 6 Jahre alte, weiblich-kastrierte Kurzhaarkatze wurde mit akuter Lethargie, Dehydratation, hochgradiger Azotämie, metabolischer Azidose, linksseitiger Renomegalie und beidseitiger Hydronephrose vorgestellt. Die Diagnostik einschließlich Sonographie führte zur Verdachtsdiagnose einer bilateralen Harnleiterobstruktion durch Ureterolithiasis. Die medikamentöse Therapie blieb erfolglos. Nach Bestätigung der Verdachtsdiagnose mithilfe eines antegraden Pyelogramms unter fluoroskopischer Kontrolle wurde beidseits ein subkutanes Ureter- Bypass(SUB)-System eingesetzt. Durch intensive postoperative Überwachung und engmaschige Labordiagnostik wurde die Flüssigkeitstherapie optimiert und die kardiovaskuläre Stabilität des Patienten gewährleistet. Innerhalb von 5 Tagen verbesserten sich klinische Symptome sowie Blutwerte deutlich und die Katze konnte entlassen werden. Verordnet wurden ein Futter zur Harnsteinprophylaxe sowie ein Phosphatbinder. Die Kontrolluntersuchungen 1 bzw. 4 und 7 Monate postoperativ (Blut- und Harnanalyse, Prüfung von Position und Durchgängigkeit der implantierten SUB-Systeme) ergaben Befunde vereinbar mit IRIS CNI-Stadium II (NP-AP0). Beide SUB-Systeme sorgten für einen unbeeinträchtigten Harnabfluss. Der bilaterale Einsatz eines subkutanen Bypass zwischen Niere und Blase eignet sich somit als Therapie für die bilaterale Harnleiterobstruktion der Katze infolge Ureterolithiasis. Nach Einsatz eines SUB-Systems bedarf es einer intensiven Überwachung des Patienten und einer Anpassung des Behandlungsplans nach seinen Erfordernissen.

Summary

A 6-year-old female spayed Domestic Shorthair cat was presented with acute lethargy, dehydration, marked azotemia, metabolic acidosis, left-sided renomegaly, and bilateral hydronephrosis. Ureterolithiasis and ureteral obstruction were suspected based on further diagnostics including abdominal sonography. Medical treatment was not successful. Fluoroscopically guided antegrade pyelography confirmed the diagnosis of bilateral ureteral obstruction due to ureterolithiasis. Subcutaneous ureteral bypass (SUB) devices were placed bilaterally, followed by close patient monitoring. Frequent reassessment of patient parameters and blood work served to adjust the fluid needs of the patient and to ensure proper hydration, correction of azotemia at an appropriate rate, and cardiovascular stability. After significant improvement of all patient parameters within 5 days, the patient was discharged from the hospital. Treatment included a dietary change to reduce the risk of stone formation as well as a phosphorus binder. Clinical and clinicopathologic parameters were unchanged at the 1- and 4- and 7-month rechecks (consistent with IRIS CKD stage II-NPAP0), and both SUB devices continued to provide unobstructed urine flow. Bilateral placement of subcutaneous ureteral bypass devices may be a safe and potentially effective treatment option for acute bilateral ureteral obstruction in cats with ureterolithiasis. Strict patient monitoring and patient-centered postoperative treatment decisions are crucial to successful treatment outcomes.

Schlüsselwörter

Azotämie - Urolithiasis - antegrades Pyelogramm - Nephrostomie - Ureter - Hämodialyse-Disäquilibrium

Keywords

Azotemia - urolithiasis - antegrade pyelogram - nephrostomy - ureter - dialysis disequilibrium syndrome

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