title: Clinical presentation and outcome of cats with circumcaval ureters associated with a ureteral obstruction.
abstract: BACKGROUND
  Circumcaval ureters (CU) are a rare embryological malformation resulting in ventral displacement of the caudal vena cava, which crosses the ureter, potentially causing a ureteral stricture.
  
  
  OBJECTIVE
  To evaluate cats with obstructed CU(s) and report the presenting signs, diagnostics, treatment(s), and outcomes. Cats with obstructed CU(s) were compared to ureterally obstructed cats without CU(s).
  
  
  METHODS
  193 cats; 22 circumcaval obstructed (Group 1); 106 non-circumcaval obstructed (Group 2); 65 non-obstructed necropsy cases (Group 3).
  
  
  METHODS
  Retrospective study, review of medical records for cats treated for benign ureteral obstructions from AMC and University of Pennsylvania between 2009 and 2013.
  
  
  METHODS
  surgical treatment of benign ureteral obstruction, complete medical record including radiographic, ultrasonographic, biochemistry, and surgical findings.
  
  
  RESULTS
  Seventeen percent (22/128) of obstructed cats had a CU (80% right-sided) compared to 14% (9/65) non-obstructed necropsy cats (89% right-sided). Clinical presentation, radiographic findings, and creatinine were not statistically different between Groups 1 and 2. Strictures were a statistically more common (40%) cause of ureteral obstruction in Group 1 compared to Group 2 (17%) (P = .01). The MST for Groups 1 and 2 after ureteral decompression was 923 and 762 days, respectively (P = .62), with the MST for death secondary to kidney disease in both groups being >1,442 days. Re-obstruction was the most common complication in Group 1 (24%) occurring more commonly in ureters of cats treated with a ureteral stent(s) (44%) compared to the subcutaneous ureteral bypass (SUB) device (8%) (P = .01).
  
  
  CONCLUSIONS
  Ureteral obstructions in cats with a CU(s) have a similar outcome to those cats with a ureteral obstruction and normal ureteral anatomy. Long-term prognosis is good for benign ureteral obstructions treated with a double pigtail stent or a SUB device. The SUB device re-obstructed less commonly than the ureteral stent, especially when a ureteral stricture was present.
authors.affiliation: Department of Interventional Radiology and Endoscopy, The AMC, New York, NY.
authors.forename: J
authors.initials: J
authors.lastname: Steinhaus
authors.forename: A C
authors.initials: AC
authors.lastname: Berent
authors.forename: C
authors.initials: C
authors.lastname: Weisse
authors.forename: A
authors.initials: A
authors.lastname: Eatroff
authors.forename: T
authors.initials: T
authors.lastname: Donovan
authors.forename: J
authors.initials: J
authors.lastname: Haddad
authors.forename: D
authors.initials: D
authors.lastname: Bagley
mesh_terms: D000818:Animals; D002371:Cat Diseases / Q000151:congenital* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D002415:Cats; D005260:Female; D008297:Male; D064749:Retrocaval Ureter / Q000175:diagnosis / Q000662:veterinary*; D012189:Retrospective Studies; D015607:Stents / Q000662:veterinary; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery / Q000662:veterinary*
keywords: Double pigtail stent; Retrocaval; Subcutaneous urteral bypass; Venous malformation