Pogo falls under a lucky Star
Pogo is a 6 year old Siamese male neutered that belongs to a regular AVS client. Pogo has multiple vets, 2 practitioners in Florida and Missouri and 2 specialists also. Pogo’s owners are very proactive about monitoring and maintaining the health of their cats. The stars aligned properly for Pogo through a serious of unrelated but critical events. First, Dr. Hause, even being an old guy, likes to stay up on what’s new in veterinary internal medicine. He spent a week at The Animal Medical Center in New York in the Interventional Radiology/Endourology Department with Drs. Berent and Weisse in December 2011 observing and learning about new minimally invasive techniques. He then attended the ureteral stenting course presented by AMC in February 2012. A substantial investment in equipment and inventory is necessary to perform these new techniques. Fluoroscopy is critical and AVS owns a C arm fluoroscope. Cystoscopy requires a large investment in equipment. AVS owns all 3 sizes of rigid cystoscopes and a flexible ureteroscope. In order to do ureteral stenting, a substantial inventory of veterinary stents must be purchased and be on hand. There are multiple lengths and sizes of these stents and the appropriate size will not be determined until during the procedure. AVS has all of the available ureteral stents that were acquired in March 2012. Pogo had routine blood work done by his Florida practitioner in March 2012. He was mildly azotemic and was in IRIS stage 2. The owners were advised to recheck his renal function in 3 months. They returned to Missouri and presented Pogo to their practitioner and requested a recheck of his blood a month later. The azotemia had worsened and he was in IRIS stage 3 of CKD. Pogo was presented to Dr. Hause for evaluation. Repeat bloodwork confirmed that Pogo was in IRIS stage 3. An abdominal ultrasound was performed by Dr. Christine Cocayne and the left kidney had changes compatible with CKD but the right kidney had marked hydronephrosis and hydroureter with a small calculus in the proximal ureter. Radiographs confirmed the presence of a single calculus in the proximal ureter. A culture was taken of Pogo’s urine. Pogo’s owners were advised about various options for him but the best treatment plan was placement of a ureteral stent. Dr. Andrea DeLuke was consulted and surgery was scheduled for the next day. Pogo was admitted and fluids were started. He was given Zeniquin pending culture results. His blood pressure was 170 mmHg. Dr. DeLuke performed the surgery with Dr. Hause assisting and providing the expertise for placement of the ureteral stent. An over the needle catheter was passed into the kidney until a urine flash was obtained. A weasel wire was then placed thru the catheter into the renal pelvis under fluoroscopic guidance and on down into the ureter. The catheter could not be placed past the calculus and associated scarring of the proximal ureter. Dr. DeLuke made an ureterotomy incision and removed the calculus (Ca oxalate). The weasel wire was passed out of the upper end of the ureter then hand directed back into the distal portion. Subsequently the wire went readily into the bladder and via a nick incision out thru the bladder wall.. A ureteral dilator was passed from the kidney over the wire into the bladder and out. A 2.5 Fr by 14 cm stiff stent was then placed over the wire with the upper pigtail of the stent in the renal pelvis and the lower pigtail in the bladder lumen. All incisions were closed and Pogo recovered well. His renal values post op were stable but increased on the day of release so he was sent home with subcutaneous fluids to be given by the owner. On follow up examination, his renal values dropped him back to IRIS stage 2 CKD. His blood pressure returned to 140 mmHg without therapy and a brief ultrasound showed the stent in proper position with a normal renal pelvic diameter. Pogo had clinically returned to normal and his incision was healing well. Although Pogo’s CKD will likely progress, he now has 2 marginal kidneys instead of only one with the other obstructed. AVS and their DVMs were very happy to be able to provide this therapy for Pogo. This type of outcome makes the time and investment in this technology very worthwhile. A year ago this would not have been possible for Pogo in Missouri. The stars aligned properly for him and other cats and dogs in the future that need this type of treatment.