Management of bilateral ureteral trauma using ureteral stents and subsequent subcutaneous ureteral bypass devices in a cat

This report describes a cat that presented with abdominal pain and worsening azotaemia following unknown trauma. Further diagnostic investigations and surgery confirmed bilateral ureteral trauma. The cat was initially managed surgically by bilateral ureteroureterostomy over ureteral stents. The clinical signs and biochemical parameters rapidly resolved, but 2 months later the cat developed signs consistent with sterile cystitis that was unresponsive to medical management. Removal of the ureteral stents resulted in severe azotaemia as a result of stricture formation at the previous ureteral anastomosis site. The ureteral stents were initially replaced with soft stents, but subsequently cut short owing to the persistence of clinical signs of cystitis. Following shortening of the ureteral stents severe azotaemia was again observed. The resulting pelvic dilatation allowed for placement of bilateral subcutaneous ureteral bypass (SUB) systems, which resulted in alleviation of all clinical signs 12 months after SUB placement.