URETERAL SURGERY - TO STENT OR TO CUT?

摘要

Ureteral obstruction secondary to urolithiasis is the most common indication for ureteral surgery in dogs and cats.The number of ureteroliths, the integrity of the ureteral wall, infection, and the presence or absence of concurrent nephrolithiasis, will often dictate the treatment that is performed.Prospective studies comparing traditional surgery to the novel technique of stenting with regards to complications and long term outcome are necessary in guiding treatment recommendations.Ureteral surgery in both dogs and cats can be challenging, even for the most experienced surgeon. Meticulous surgical technique in conjunction with appropriate magnification is essential in preventing both short and long term complications. The most common indication for ureteral surgery in our veterinary patients is ureteral obstruction secondary to urolithiasis. Although the majority of these cases are treated with traditional surgical techniques, with the recent introduction of ureteral stents for veterinary patients, many surgeons question the best approach for patients with ureteral obstructions. Presentation of a patient can vary with regards to the number of ureteroliths, the presence or absence of concurrent nephrolithiasis, infection, whetherthe disease is unilateral or bilateral, the degree of obstruction present, and any underlying kidney dysfunction. Limited information currently exists in the veterinary literature regarding complications and long term outcome in patients following ureteral stenting and there are currently no evidence based studies in the veterinary literature that compare traditional surgery to this novel technique. Cases of trauma, fibrosis, congenital stenosis, stricture, neoplasia and dried solidified blood calculi have also been associated with ureteral obstruction in our veterinary patients and generate similar discussion with regards to the best approach for treatment.