Long-Term Outcomes After Prophylactic Infusion of 2% Tetrasodium Ethylenediaminetetraacetic Acid in 95 Subcutaneous Ureteral Bypass Devices in 66 Cats With Benign Ureteral Obstructions

Background

The use of subcutaneous ureteral bypass device(s) (SUB) for the treatment of benign ureteral obstructions (BUO) in cats has become more routine in veterinary practices. Device mineralization and chronic urinary tract infections (UTI) are the most reported long-term complications.

Hypothesis/Objective

To evaluate the occurrence of mineralization, bacteriuria, and chronic infections in cats after SUB placement, where 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) was infused during standard SUB flushing when compared to a historical control group where sterile saline was used for flushing. The hypothesis is that tEDTA will decrease the rate of mineralization occlusions and infections of SUB devices without increasing other complications.

Animals

Ninety-five SUBs (39 unilateral; 28 bilateral) in 66 cats.

Methods

Retrospective study; Medical records from all cats that had > 180-day follow-up after undergoing SUB device placement were evaluated. Group 1 consisted of cats flushed routinely with saline only, Group 2 with saline and then switched to 2% tEDTA during their follow-up period, and Group 3 with 2% tEDTA only.

Results

Device mineralization was documented in 9/28 (32%), 8/16 (50%), and 10/51 (19%) SUB devices in Groups 1, 2, and 3, respectively (p = 0.025). Exchange was needed from re-obstruction in 4/28 (14%), 5/16 (31%) and 3/51 (6%), respectively (p = 0.016). Chronic UTI occurred in 7/21 (33%), 4/12 (33%), and 1/33 (3%) of cats, respectively (p = 0.004). UTI at the time of surgery was associated with the development of a chronic UTI (p = 0.01).

Conclusions/Clinical Importance

Prophylactic use of 2% tEDTA might be helpful in reducing frequency of long-term SUB device complications and could be considered as part of the long term management plan.