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Estudo retrospectivo das complicações em bypass ureteral subcutâneo em 60 gatos
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Resumo(s)
A obstrução ureteral por cálculos ocorre com alguma frequência nos felinos, sendo um desafio
para os clínicos que, pelo crescente conhecimento da patologia, a diagnosticam e actuam de
forma mais rápida e eficaz. O seu diagnóstico é feito tendo em conta a sintomatologia e as
análises bioquímicas, assim como através de meios complementares de diagnóstico por
imagem, como ecografia, radiografia e tomografia computorizada.
Quando o tratamento médico, não é eficaz é necessária uma actuação cirúrgica rápida para
cessar ou minimizar as lesões renais secundárias. O Bypass Ureteral Subcutâneo revolucionou
o tratamento cirúrgico de obstrução ureteral em felinos, permitindo a permanência de um cateter
de nefrostomia a longo prazo, diminuindo a taxa de complicações associada e melhorando a
qualidade de vida dos animais.
Este trabalho visou reconhecer as variáveis que influenciam o tempo até à ocorrência de
complicações com o SUB, numa população de 60 gatos que procederam à colocação de bypass
no Hospital Veterinário do Restelo. As complicações encontradas nesta amostra, em 37
animais, foram: infeção urinária (32%), obstrução do SUB por cálculos (38%), outros
problemas no SUB (14%), morte no recobro (13%) e hemorragia extensa (3%). Elaborou-se
uma análise com recurso ao método de Kaplan Meier.
A colocação bilateral do bypass, o grau de azotémia e a hipercaliémia foram as variáveis que
mais contribuíram para a ocorrência de complicações numa fase mais precoce, embora sem
significado estatístico.
O Bypass é uma técnica associada a complicações a médio/longo prazo que devem ser
ponderadas, pelo clínico, que em conjunto com o proprietário deverá ponderar a melhor
atuação, tendo em conta a historia clinica do paciente, assim como, patologias adjacentes que
possam pôr em causa o futuro do animal.
ABSTRACT - Ureteral obstruction from ureteroliths occurs frequently in felines. It can be a challenge for clinicians to both diagnose and manage this disease effectively and rapidly. The diagnosis is made based on physical findings, blood work and diagnostic imaging such as ultrasonography, radiography and computed tomography. When medical treatment is not effective, rapid surgical intervention is necessary to cease or minimize secondary renal lesions. Subcutaneous Ureteral Bypass has revolutionized the surgical treatment of ureteral obstruction in felines, allowing a long-term nephrostomy catheter to remain, reducing the associated complication rate and improving the quality of life of the animals. This study aimed to recognize the variables that influence the time to onset of complications with the SUB, in a population of 60 cats that where submitted to placement of bypass in the Veterinary Hospital of Restelo. The complications found in this sample in 37 animals were: urinary infection (32%), SUB obstruction by ureteroliths (38%), problems in the SUB (14%), death in anesthesia recovery (13%) and extensive hemorrhage (3%). A statistical analysis was made using the Kaplan Meier estimator. The bilateral placement of the bypass, the degree of azotemia and hyperkalemia were the variables that contributed the most to the occurrence of complications at an earlier stage, although without statistical significance. Bypass is a technique associated with medium/long-term complications that must be weighed by the clinician, who together with the owner should consider the best performance, taking into account the clinical history of the patient, as well as adjacent pathologies that can cause concerned the future of the animal.
ABSTRACT - Ureteral obstruction from ureteroliths occurs frequently in felines. It can be a challenge for clinicians to both diagnose and manage this disease effectively and rapidly. The diagnosis is made based on physical findings, blood work and diagnostic imaging such as ultrasonography, radiography and computed tomography. When medical treatment is not effective, rapid surgical intervention is necessary to cease or minimize secondary renal lesions. Subcutaneous Ureteral Bypass has revolutionized the surgical treatment of ureteral obstruction in felines, allowing a long-term nephrostomy catheter to remain, reducing the associated complication rate and improving the quality of life of the animals. This study aimed to recognize the variables that influence the time to onset of complications with the SUB, in a population of 60 cats that where submitted to placement of bypass in the Veterinary Hospital of Restelo. The complications found in this sample in 37 animals were: urinary infection (32%), SUB obstruction by ureteroliths (38%), problems in the SUB (14%), death in anesthesia recovery (13%) and extensive hemorrhage (3%). A statistical analysis was made using the Kaplan Meier estimator. The bilateral placement of the bypass, the degree of azotemia and hyperkalemia were the variables that contributed the most to the occurrence of complications at an earlier stage, although without statistical significance. Bypass is a technique associated with medium/long-term complications that must be weighed by the clinician, who together with the owner should consider the best performance, taking into account the clinical history of the patient, as well as adjacent pathologies that can cause concerned the future of the animal.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Obstrução Ureteral Urólito Gato Bypass ureteral subcutâneo Ureteral obstruction Ureteroliths Cat Subcutaneous Ureteral Bypass
Contexto Educativo
Citação
Reis, S.C. (2019). Estudo retrospectivo das complicações em bypass ureteral subcutâneo em 60 gatos. Dissertação de mestrado. Universidade de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária