Endoscopic nephrolithotomy for the removal of complicated nephroliths in dogs and cats: 16 kidneys in 12 patients (2005-2017).

OBJECTIVE: To describe techniques and outcomes for dogs and cats undergoing endoscopic nephrolithotomy (ENL) for the removal of complicated nephroliths. ANIMALS: 11 dogs and 1 cat (n = 16 renal units) with complicated nephroliths that underwent ENL via a surgically assisted ENL approach (12 renal units) or a percutaneous nephrolithotomy approach (4 renal units) between December 2005 and June 2017. PROCEDURES: Data were obtained from the medical records regarding preoperative, operative, and postoperative findings. Follow-up information on complications and outcomes was also collected. RESULTS: Indications for nephrolith removal included massive calculi displacing parenchyma (n = 7), recurrent urinary tract infections (5), and ureteral outflow obstruction (4). Median nephrolith diameter was 2.5 cm (range, 0.5 to 5.7 cm). Nephrolith composition differed among patients; calcium oxalate was the most common type (n = 7 [including 2 mixed nephroliths containing ≥ 60% calcium oxalate]). Following ENL (median duration, 180 minutes), 15 of 16 renal units were completely nephrolith free. Procedure-related complications included renal puncture-associated hemorrhage requiring a blood transfusion (n = 1), renal capsule tear (1), and ureteral puncture (1); all were managed without adverse consequence. Five of 12 patients remained alive at the final follow-up (median, 557 days after ENL), and none died from the procedure. CONCLUSIONS AND CLINICAL RELEVANCE: ENL as performed was safe and effective in removing complicated nephroliths in a renal-sparing manner for the patients in this study. This procedure requires technical training and could be considered for the treatment of complicated nephrolithiasis in dogs and possibly cats.

Treatment of fungal pyelonephritis and ureterolithiasis with a subcutaneous ureteral bypass system and systemic antifungal medication in a cat.

PURPOSE: We describe a case of ureteral obstruction and fungal pyelonephritis in a cat. The case was managed successfully with a subcutaneous ureteral bypass (SUB) device and systemic antifungal medication. CASE SUMMARY: A 9-year-old, male, neutered, domestic shorthair cat was referred for severe azotemia, ureteral obstruction, and sonographically identified progressive pyelectasia of the left kidney. A SUB device was placed. Cytology of the left kidney subsequently identified fungal organisms, and the cat responded clinically to treatment with fluconazole and supportive care. The cat survived for 11 months with intermittent fluconazole treatment. CONCLUSION: Fungal pyelonephritis should be considered as a possible concurrent diagnosis in cats with ureteral obstruction. The successful clinical outcome in this case suggests that treatment with SUB placement, antifungal medication, and supportive care could be an effective treatment strategy.

Endoscopic-guided sclerotherapy for renal-sparing treatment of idiopathic renal hematuria in dogs: 6 cases (2010-2012).

OBJECTIVE: To describe the use of sclerotherapy for the renal-sparing treatment of idiopathic renal hematuria (IRH) in dogs and report clinical outcomes. DESIGN: Retrospective case series. ANIMALS: 6 dogs (8 renal pelvises) with IRH. PROCEDURES: Medical records of dogs that underwent sclerotherapy were reviewed. Each ureterovesicular junction was identified cystoscopically to determine the side of bleeding, and a retrograde ureteropyelogram was performed with endoscopic and fluoroscopic guidance. A ureteropelvic junction balloon was used for ureteral occlusion, and pelvis filling volumes were recorded. A povidone iodine mixture, followed by a sterile silver nitrate solution, was infused into the renal pelvis. A double-pigtail ureteral stent was placed after the procedure. Information on preprocedure and postprocedure biochemical changes, imaging parameters, and clinical outcomes was obtained. RESULTS: 6 dogs (5 males and 1 female) had sclerotherapy for unilateral (4) or bilateral (2) bleeding. Five were right-sided and 3 were left-sided. The median age and weight of dogs were 3 years and 42.4 kg (93.28 lb), respectively. Median procedure time was 150 minutes. One dog that did not have a ureteral stent placed following the procedure developed short-term signs of renal pain and pyelectasis. Cessation of macroscopic hematuria occurred in 4 of 6 dogs (median, 6 hours). Two additional dogs improved moderately. Median follow-up time was 8 months (range, 3.5 to 20.5 months). CONCLUSIONS AND CLINICAL RELEVANCE: Topical sclerotherapy for IRH was safe and effective. Local sclerotherapy for IRH in dogs could be considered a valuable and minimally invasive renal-sparing treatment over ureteronephrectomy.

Multiple recurrent pancreatic cysts with associated pancreatic inflammation and atrophy in a cat.

Previous reports of true pancreatic cysts in cats have suggested that pancreatic cysts in cats are benign incidental findings. This case report describes the progressive clinical course and diagnostic findings in a cat with multiple recurrent pancreatic cysts. The presenting clinical signs included diarrhea, intermittent vomiting, polyphagia, and marked weight loss. Pancreatic cysts were identified via abdominal ultrasound and computed tomography (CT). An exploratory celiotomy and lesion histopathology confirmed multiple true pancreatic cysts of unknown etiology. One month after surgery the cat presented for lethargy and decreased appetite. Clinical re-evaluation was diagnostic for diabetes mellitus and an abdominal ultrasound confirmed recurrence of the pancreatic cysts. The recurrent nature of the pancreatic cysts and the concurrent development of diabetes mellitus were suggestive of progressive loss of pancreatic function or insulin resistance. This is the first described case of multiple recurring pancreatic cysts in a cat associated with pancreatic inflammation, atrophy and endocrine dysfunction.