Abstract
The aims of this study were to report the postoperative incidence of subcutaneous ureteral bypass (SUB)-associated bacteriuria and risk factors in a large population of UK cats, to identify the commonly implicated isolates in these cases and to report associations of positive postoperative urine cultures with device occlusion or a need for further surgery. Electronic clinical records were reviewed to identify cats with ureteral obstruction that underwent unilateral or bilateral SUB implantation between September 2011 and September 2019. In total, 118 client-owned cats were included in the study population. Information recorded included signalment, history, surgical and biochemical factors, urinalysis and culture results. Multivariable logistic regression was performed to identify variables associated with a positive postoperative culture. In total, 10 cats (8.5%) had a positive postoperative culture within 1 month postsurgery and 28 cats (23.7%) within 1 year postsurgery. Cats with a positive preoperative culture were significantly more likely to have a positive culture within 6 months postoperatively (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.18-14.18; P = 0.026). Of the 14 cats with a positive preoperative culture, six (42.9%) returned a positive culture within 1 year postoperatively, and in four cases (66.7%) the same isolate was identified. Cats with a higher end-anaesthetic rectal temperature were significantly less likely to return a positive culture within 3 months (OR 0.398, 95% CI 0.205-0.772; P = 0.006) postsurgery. Cats culturing positive for Escherichia coli at any time point (OR 4.542, 95% CI 1.485-13.89; P = 0.008) were significantly more likely to have their implant removed or replaced. Perioperative hypothermia and preoperative positive culture were independent predictors of a postoperative positive culture and this should be taken into consideration when managing these cases. Positive postoperative culture rates were higher than have previously been reported.
Highlights
Peri-operative hypothermia and pre-operative positive culture were independent predictors of a post-operative positive culture and this should be taken into consideration when managing these cases
Intraluminal ureteral obstruction is an occurrence of increasing incidence in feline medicine; with ureterolithiasis implicated in the majority of cases [1]
This study presents the results from a large number of urine cultures collected from cats with SUB systems placed in a UK referral centre over an eight year period
Summary
Intraluminal ureteral obstruction is an occurrence of increasing incidence in feline medicine; with ureterolithiasis implicated in the majority of cases [1]. Successful management of ureteral obstruction depends on prompt renal decompression to prevent permanent loss of glomerular filtration capacity [3]. Where medical treatment failed, nephrectomy was indicated; in recent years many institutions have adopted ureteral bypass using the SUB system [4]. The SUB system consists of two catheters, placed in the renal pelvis and bladder lumen, connected to a shunting port sited in the subcutaneous tissue [4], allowing urine to bypass the affected ureter. SUB placement mortality rates compare favourably to more traditional surgical techniques, with 0% - 13% perioperative mortality reported [5, 6] compared to 18% perioperative mortality for both traditional interventions [1] and ureteral stent placement [6]. Intraoperative complications are reported to occur in 7% of cases [5] and perioperative complications necessitating surgical intervention reported in 7% and 9% of cases respectively [5, 6]; with device occlusion, device leakage and urethral obstruction most commonly observed
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