vET'S CASE STUDY: SUBs
Little Bear holds a big place in the hearts of owners Susan and Trevor Jones in Norfolk, who have had him since a kitten. Now 17 years old, he has been incredibly lucky not to have any major health concerns until now, when his health took a turn for the worse very suddenly..
Susan and Trevor were quick to act when they first noticed Little Bear was not well and he was referred to the Internal Medicine and Soft Tissue Surgery teams in our Small Animal Clinic. He was hypercalcaemic , resulting in a build-up uroliths , which eventually blocked his right ureter. He needed emergency surgery. Using a new surgical technique Senior Clinician and soft tissue surgeon Daniela Murgia, implanted a device called SUB (Subcutaneous Ureteral Bypass), which creates a bypass of the blocked ureter and saves the kidney itself from further damage.
Left: CT urography scan during the excretory phase showing right ureteral obstruction secondary to the presence of 5 ureteroliths in the right ureter
Placement of a SUB device is currently the best surgical technique to use in order to decompress or preserve affected kidneys. The use of the SUB system is primarily indicated for ureteral obstruction, ureteral stricture, ureteral rupture and stent failure. It is considered the most optimal solution to address ureteral strictures
This device consists of a locking loop pigtail nephrostomy tube placed into the renal pelvis, which usually is ectatic owing to the ureteral obstruction, a fenestrated and cuffed cystostomy catheter and a titanium subcutaneous shunting port.
The urine flows from the kidney through the nephrostomy tube into the titanium port and through the cystostomy tube into the urinary bladder.
Right top: Intraoperative view of the nephrostomy and cystostomy catheter in place.
Right bottom: Intraoperative view of the titanium port connected to the nephrostomy and cystostomy catheter and sutured to the left abdominal wall subcutaneously
The subcutaneous shunting port is easily accessible to sample urine, perform contrast ureteropyelography and cystography and to drain/flush the renal pelvis, ureter and bladder.
Once in place the SUB’s patency has to be monitored and flushing of the system is required every 3 to 6 months under ultrasonography control. Flushing is performed via the subcutaneous titanium port using a non-coring needle (Huber needle) only. The use of the normal hypodermic needle can damage the port and the system.
Left: Fluoroscopic ventro-dorsal and latero-lateral view showing the SUB device in place. The locking loop nephrostomy catheter and the cystostomy catheter connect to the subcutaneous titanium port in absence of evident tubes kinking.
Little Bear was sent home on strict rest for 8 weeks whilst he healed from the surgery.Now a couple of months later, he’s been back to the Clinic for his check up and Daniela and the team are extremely pleased with his progress, and happy to report he has made a full recovery.
To find out more about this technique for your clients contact Daniela Murgia for more details.