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Journal of Veterinary Internal Medicine 2023Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO).
BACKGROUND
Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO).
HYPOTHESIS
Describe clinical characteristics and outcome of MM of BUO.
ANIMALS
Seventy-two client-owned cats with 103 obstructed kidneys.
METHODS
Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed.
RESULTS
Seventy-two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30-21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3-115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P = .05 and P = .01, respectively). Median survival times were 1188 days (range, 60-1700 days), 518 days (range, 7-1812 days), and 234 days (range, 4-3494 days) for success, partial success, and failure, respectively.
CONCLUSIONS AND CLINICAL IMPORTANCE
We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1-2 mm) were more likely to pass.
Topics: Cats; Animals; Ureteral Obstruction; Pyonephrosis; Retrospective Studies; Constriction, Pathologic; Kidney; Creatinine; Urinary Calculi; Cat Diseases
PubMed: 37073892
DOI: 10.1111/jvim.16709 -
IDCases 2016
PubMed: 27882302
DOI: 10.1016/j.idcr.2016.10.005 -
Diagnostics (Basel, Switzerland) Feb 2021Urinary tract infections (UTIs) are the most frequent community-acquired and healthcare-associated bacterial infections. UTIs are heterogeneous and range from rather... (Review)
Review
Urinary tract infections (UTIs) are the most frequent community-acquired and healthcare-associated bacterial infections. UTIs are heterogeneous and range from rather benign, uncomplicated infections to complicated UTIs (cUTIs), pyelonephritis and severe urosepsis, depending mostly on the host response. Ultrasound and computed tomography represent the imaging processes of choice in the diagnosis and staging of the pathology in emergency settings. The aim of this study is to describe the common ultrasound (US) and computed tomography (CT) features of pyonephrosis. US can make the diagnosis, demonstrating echogenic debris, fluid/fluid levels, and air in the collecting system. Although the diagnosis appears to be easily made with US, CT is necessary in non-diagnostic US examinations to confirm the diagnosis, to demonstrate the cause and moreover to stage the pathology, defining extrarenal complications. In emergency settings, US and CT are differently used in the diagnosis and staging of pyonephrosis.
PubMed: 33671431
DOI: 10.3390/diagnostics11020331 -
Seminars in Interventional Radiology Mar 2020Pyonephrosis is gross accumulation of pus within an obstructed renal collecting system that, if left untreated, can lead to potentially fatal septic shock. Treatment... (Review)
Review
Pyonephrosis is gross accumulation of pus within an obstructed renal collecting system that, if left untreated, can lead to potentially fatal septic shock. Treatment requires urgent decompression coupled with systemic antibiotics. Percutaneous nephrostomy (PCN) placement, first described in 1976 for the treatment of pyonephrosis, is now widely utilized for emergent decompression in these patients. When performed by an experienced interventional radiologist, PCN is a safe procedure with technical success rates of over 96 to 99%. This article will address the clinical presentation of pyonephrosis, and will discuss the indications, technique, complications, and outcomes of emergent PCN placement. Additionally, the expanded indications for PCN placement in nonemergent scenarios will also be described.
PubMed: 32139973
DOI: 10.1055/s-0039-3401842 -
The Indian Journal of Surgery Jun 2015Nephroenteric fistulas can be secondary to different etiologies, the most common of which are pyelocolic fistulas. The absence of pathognomonic symptoms and the... (Review)
Review
Nephroenteric fistulas can be secondary to different etiologies, the most common of which are pyelocolic fistulas. The absence of pathognomonic symptoms and the heterogeneity of presentation can sometimes result in a delay in diagnosis. We report on three cases: a pyelo-duodenal fistula secondary to kidney stones and subsequent pyonephrosis, a pyelocolic fistula due to inveterate ureteral stones with hydropyonephrosis, and a rare case of posttraumatic pyelocolic fistula. All patients were treated with radical nephrectomy and resection of the involved intestinal tract. Fistulas of the kidney with the gastrointestinal tract are complex not only for the surgical treatment, which is mandatory in the majority of cases, but also for clinical and instrumental diagnosis. Severe infection is a major concern due to the admixture of the enteric bacterial flora with the urinary tract. Nephroenteric fistulas require skilled surgical procedures, close control of the septic risk, management of patient's overall medical condition, and balance between invasive and conservative approach.
PubMed: 26246706
DOI: 10.1007/s12262-014-1046-1 -
Tidsskrift For Den Norske Laegeforening... Mar 2012
Topics: Aged, 80 and over; Diagnosis, Differential; Female; Humans; Nephrostomy, Percutaneous; Pyonephrosis; Ultrasonography
PubMed: 22398770
DOI: 10.4045/tidsskr.11.1491 -
World Journal of Radiology Nov 2014Spectrum of acute renal infections includes acute pyelonephritis, renal and perirenal abscesses, pyonephrosis, emphysematous pyelonephritis and emphysematous cystitis.... (Review)
Review
Spectrum of acute renal infections includes acute pyelonephritis, renal and perirenal abscesses, pyonephrosis, emphysematous pyelonephritis and emphysematous cystitis. The chronic renal infections that we routinely encounter encompass chronic pyelonephritis, xanthogranulomatous pyelonephritis, and eosinophilic cystitis. Patients with diabetes, malignancy and leukaemia are frequently immunocompromised and more prone to fungal infections viz. angioinvasive aspergillus, candida and mucor. Tuberculosis and parasitic infestation of the kidney is common in tropical countries. Imaging is not routinely indicated in uncomplicated renal infections as clinical findings and laboratory data are generally sufficient for making a diagnosis. However, imaging plays a crucial role under specific situations like immunocompromised patients, treatment non-responders, equivocal clinical diagnosis, congenital anomaly evaluation, transplant imaging and for evaluating extent of disease. We aim to review in this article the varied imaging spectrum of renal inflammatory lesions.
PubMed: 25431641
DOI: 10.4329/wjr.v6.i11.865