Tailored ureteroneocystostomy with tension-relieving techniques for benign ureteral obstruction in cats: a retrospective study of 189 cases (220 ureters)

Objective: To describe the surgical techniques for ureteroneocystostomy in cats with benign ureteral obstruction, evaluate and compare the clinical outcomes of various techniques, and conduct meta-analyses using previously reported modalities. Methods: Medical records of cats that underwent ureteroneocystostomy for benign ureteral obstruction between 2018 and 2024 were reviewed. Retrieved data (4 ureteroneocystostomy techniques, complications, and survivals) were analyzed. Random-effect meta-analyses with a logit transformation were conducted using previous studies on implant placement (subcutaneous ureteral bypass or ureteral stents) and traditional surgery (ureterotomy or ureteroneocystostomy). Results: Overall, 220 ureters in 189 cats were treated with ureteroneocystostomy. Overall outcomes for all techniques were a perioperative mortality rate of 0.5% (95% CI, 0.0% to 1.6%), uroabdomen rate of 1.1% (95% CI, 0.3% to 4.0%), reobstruction rate of 8.5% (95% CI, 4.5% to 12.4%), and urinary tract infection rate of 13.2% (95% CI, 8.3% to 18.1%). These rates were lower than or similar to those in previous implant and traditional surgery studies. The 12-month survival rate was 89.4% (95% CI, 85.0% to 93.8%). Cats classified as International Renal Interest Society chronic kidney disease stage ≥ III at 1 month postoperatively had significantly shorter survival times than lower stages. Extravesicular, 2-layer, side-to-side ureteroneocystostomy with tension-relieving techniques reduced reobstruction risk compared with the other types of ureteroneocystostomy. Conclusions: Tailored ureteroneocystostomy and tension-relieving techniques can result in favorable long-term outcomes and low complication rates, similar to or better than those in previous implant and traditional surgery studies. Clinical Relevance: Ureteroneocystostomy is a primary surgical treatment for feline benign ureteral obstruction, particularly when combined with tension-relieving techniques and temporary ureteral catheterization.