HOW TO AVOID COMPLICATIONS WITH URETERAL SURGERY

摘要

Various types of procedures may be performed on the ureters of dogs and cats. Ureteral surgery may be indicated in dogs and cats with intraluminal, mural, or extramural causes of ureteral obstruction or trauma. Ureteral calculi have been the most common cause of ureteral obstruction in cats since their first report in 1998. Calculi are implicated as the primary cause for ureteral obstruction in 72-87% of cats, with >98% of calculi composed of calcium oxalate. Struvite, urate, and solidified blood stones have been reported less commonly. Ureteral stricture is another cause of obstruction, occurring in up to 28% of cats, and may occur concurrent with ureterolithiasis or following ureteral surgery or intervention. Postoperative mortality following ureterotomy or neoureterocystostomy ranged from 18-21% in early reports, owing to uroabdomen, recurrence of ureteral obstruction, or persistence of clinically significant azotemia. However, a recent publication regarding ureteral surgery in cats reported a mortality rate of only 8% associated with underlying chronic renal failure in most cases. This decrease in mortality is likely due to increased experience with ureteral surgery and improved perioperative critical care. Ureteral damage in small animal patients is uncommon, accounting for 0.01% of diagnoses of hospitalized patients, but is often related to external trauma. A retrospective study evaluating ureteral trauma in a small number of dogs and cats and one ferret reported that all noted ureteral injuries were related to blunt abdominal trauma. However, laceration, rupture, transection, or crushing of ureters may occur with penetrating injury as from bite wounds or from iatrogenic injury at surgery.