Subcutaneous Ureteral Bypass

Introduction
Ureteral obstructions and associated upper urinary tract problems have often plagued veterinary surgeons. These conditions have often been monitored with benign neglect due to the associated morbidity and mortality rates associated with surgical intervention – often performed late in the disease when the patient is debilitated. Unfortunately, these conditions appear to be increasing in our feline population and there is a considerable amount of research documenting the progressive damage that occurs to the nephrons when ureteral obstructions are present. Interventional radiologic (IR) and interventional endoscopic (IE) techniques, like ureteropyelography, percutaneous nephrostomy tube placement, ureteral stenting and the use of a subcutaneous ureteral bypass (SUB) device, have aided tremendously in the ability to simultaneously diagnosis and treat ureteral obstructions in a minimally invasive manner with long-term ureteral protection from future obstruction, while concurrently lowering the morbidity and mortality when compared to traditional surgical techniques (ureterotomy, neoureterocystostomy, ureteronephrectomy or renal transplantation). Endourologic procedures are considered standard of care in human adult and pediatric surgery and are currently being applied in veterinary patients regularly. This talk will focus on the authors’ management and treatment of cats with ureteral obstructions from various causes and will review data from what has been reported in the past, the more recent interventional modalities, and the future options on the horizon. Data from over 250 consecutive cases treated interventionally will be reported and discussed.  [...]