Ureteroneocystostomy as a treatment for benign ureteral obstruction and ectopic ureter in cats: 37 cases

Objective: To report complications and outcomes following ureteroneocystostomy performed in cats presenting for benign ureteral obstruction or ectopic ureters. Methods: This was a retrospective, single-institution study of 37 cats. Medical records were reviewed for pre-, intra-, and postoperative variables including preexisting disease, pre- and postoperative bloodwork, location and source of obstruction, surgical technique, ureteral stent placement, postoperative clinical signs, and survival time. Follow-up was ≥ 14 days or until death. The Kaplan-Meier method was used to calculate median survival, and univariable and multivariable logistic regression was used to examine correlation of variables with postoperative complications and mortality. Results: Overall median survival was 1,980 days, with 92% of cats surviving to discharge. There was no intraoperative mortality and a relatively low incidence of short- (19%) and long-term (24%) complications. Highest mortality rate was within the first 30 days. Factors associated with increased mortality were increased preoperative BUN, creatinine, and phosphorous. Surgical ureteral stent removal occurred in 86% (6 of 7) of cases when placed, secondary to long-term recurrent urinary tract infections and stent migration. Conclusions: Ureteroneocystostomy was a viable treatment option for benign obstructions and extramural ectopic ureters in cats, with overall longer median survival and lower long-term complication incidence compared to historical subcutaneous ureteral bypass device and ureteral stent literature. Preoperative azotemia was associated with poorer outcomes. Ureteral stents were associated with long-term complications, prompting removal. Clinical Relevance: Ureteroneocystostomy should be highly considered as a treatment option for cats presenting with benign ureteral obstructions and ectopic ureters.