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Upper urinary tract urolithiasis
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Renal and ureteral surgery in small animals can be challenging, even for the most experienced surgeon; Lilly Aronson gives an overview of the best options currently available for treating upper urinary tract obstructions.
Lillian R. Aronson
VMD, Dip. ACVS - School of Veterinary Medicine, University of Pennsylvania, USA.
After completing veterinary school and an internship at the University of Pennsylvania, Dr. Aronson undertook a small animal surgical residency at the University of California, Davis (UCD). From 1994-1996 she was the coordinator of the renal transplantation program for animals at UCD. Following her residency, she joined the faculty at the University of Pennsylvania – where she is currently Professor of Surgery – and started their renal transplantation program. Her clinical interests include all areas of soft tissue surgery, but in particular microvascular surgery and complex urinary tract surgery (including renal transplantation), and treatment of urolithiasis. As well as frequently lecturing in her specialist fields, she is the author of a textbook on small animal surgical emergencies.
Key Points
- Calcium oxalate (CaOx) uroliths are commonly identified in the upper urinary tract of both cats and dogs.
- Owners should be made aware that the majority of cats presenting with CaOx urolithiasis have pre-existing chronic kidney disease.
- Traditional surgical techniques may be successfully performed with appropriate surgical training and can avoid complications associated with the use of long-term implants.
- In some situations a combination of traditional and interventional techniques are necessary to relieve an obstruction; at other times interventional techniques alone may be indicated.
Surgical intervention of the upper urinary tract is most commonly indicated when urolithiasis develops, resulting in partial or complete obstruction of urinary outflow. In cats, > 90% of upper urinary tract uroliths are composed of calcium oxalate (CaOx) although other urolith types, including struvite and dried solidified blood calculi, also occur (1) (2). In dogs, CaOx and struvite uroliths are seen with a more equal frequency, with a reported incidence of struvite uroliths in the upper urinary tract between 20-60% (3). When an obstruction is not present, less invasive treatment using medical dissolution is recommended for certain urolith types (struvite and possibly cysteine and purine), but CaOx uroliths will not dissolve with medical management and surgical intervention is often necessary to relieve the obstruction and prevent further renal injury.
Renal and ureteral surgery in cats and dogs can be challenging for even the most experienced surgeon, mainly due to the sheer size of the ureter, particularly in cats. Meticulous surgical technique and appropriate magnification are essential in preventing both short and long-term complications.
Introduction
The choice of surgical treatment often depends on patient presentation, which can vary with regard to the number and location of ureteroliths and whether the disease is unilateral or bilateral, the presence or absence of concurrent nephrolithiasis, and any underlying kidney infection or dysfunction. Additionally, the duration of obstruction likely impacts the recovery of renal function; unfortunately in many cases, and particularly in patients with unilateral disease, this information is unknown. Depending on the type of urolith and location within the urinary tract, treatment may involve a combination of medical, interventional and/or surgical management. [...]
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