A aplicação de Bypass Ureteral Subcutâneo como opção de tratamento à ureterolitíase obstrutiva
Data
2021-04-07
Título da revista
ISSN da revista
Título do Volume
Editora
Resumo
As obstruções ureterais podem ser patologias bastante desafiantes de diagnosticar e tratar em medicina veterinária. Múltiplos estudos documentam que a ureterolitíase é a causa mais comum para a sua ocorrência, havendo relatos que mais de 98% dos ureterólitos detetados em gatos contêm oxalato de cálcio na sua constituição, o que inviabiliza a sua dissolução. O diagnóstico da ureterolitíase assim como o seu maneio médico devem ser realizados de forma precoce, uma vez que a obstrução gerada pode induzir um rápido declínio da funcionalidade renal tal como lesões irreversíveis no seu parênquima. Dado que a terapêutica médica é na maioria das vezes ineficaz, existe quase sempre a necessidade de se intervir cirurgicamente. A invasividade e morbilidade associada às técnicas cirúrgicas tradicionais reforçam a importância do aparecimento de opções cirúrgicas inovadoras e menos invasivas. Entre elas destaca-se o Subcutaneous Ureteral Bypass (SUB), um dispositivo cada vez mais procurado em Portugal como forma de resposta à ureterolitíase obstrutiva nos pequenos animais, principalmente em gatos. O SUB consiste num dispositivo desenvolvido a partir do bypass nefrovesical subcutâneo utilizado na medicina humana, estando associado a complicações peri e pós-cirúrgicas reduzidas e a uma melhoria na qualidade de vida dos animais intervencionados. Deste modo, o presente trabalho visa a descrição de aspetos relacionados com a ureterolitíase obstrutiva, incidindo particularmente na cirurgia de implantação de dispositivos SUB como forma de tratamento desta doença. Assim, os principais objetivos desta dissertação são a descrição detalhada desta técnica cirúrgica, de acordo com o procedimento realizado pelo Centro Hospitalar Veterinário do Porto (CHV) que recorre somente à orientação ecográfica para esta finalidade, para além da identificação dos possíveis riscos e complicações inerentes e das vantagens e desvantagens associadas. Desta forma, através dos casos clínicos expostos, este trabalho sugere que a implantação dos sistemas de bypass ureteral subcutâneo são uma opção de tratamento viável em episódios de ureterolitíase obstrutiva em gatos, tornando-se num contributo importante para a compreensão, expansão e divulgação desta temática, o que favorece o desenvolvimento de escolhas terapêuticas conscientes na presença desta patologia.
Ureteral obstructions can be challenging disorders to diagnose and treat in veterinary medicine. Several studies document that ureterolithiasis is the most common cause of ureteral obstructions, with reports that more than 98% of cat ureteroliths contain calcium oxalate in their constitution, which prevents its dissolution. Ureterolithiasis diagnosis and medical management should be early performed, as it induces a rapid decline in renal function as well as irreversible lesions on the renal parenchyma. As medical treatment is mostly ineffective, there is often a requirement for surgical intervention. The invasiveness and morbidity associated with traditional surgical techniques increase the appealing for new interventional alternatives and less invasive surgical options. Among them stands out the Subcutaneous Ureteral Bypass (SUB), a therapeutic option increasingly sought in Portugal, as a way to treat obstructive ureterolithiasis in small animals, mainly in cats. The SUB device was developed from the subcutaneous nephrovesical bypass used in human medicine, being associated with minimal peri and postoperative complications and with an improvement in life quality of animals that underwent surgery. So, the present study provides an update review about obstructive ureterolithiasis, focusing in the implantation of SUB devices as a way to treat this disorder. In general, the main objectives of the this dissertation are to describe the surgical technique according to the procedure performed in Centro Hospitalar Veterinário do Porto (CHV), only realized under ultrasound guidance, and to identify the possible risks and complications inherent and the associated advantages and disadvantages. Thus, through the exposed clinical cases, this work suggests that subcutaneous ureteral bypass implantation is a viable option in the treatment of obstructive ureterolithiasis in cats, allowing for a better knowledge in this area, which favors the development of a conscious therapeutic choice in the presence of this pathology.
Ureteral obstructions can be challenging disorders to diagnose and treat in veterinary medicine. Several studies document that ureterolithiasis is the most common cause of ureteral obstructions, with reports that more than 98% of cat ureteroliths contain calcium oxalate in their constitution, which prevents its dissolution. Ureterolithiasis diagnosis and medical management should be early performed, as it induces a rapid decline in renal function as well as irreversible lesions on the renal parenchyma. As medical treatment is mostly ineffective, there is often a requirement for surgical intervention. The invasiveness and morbidity associated with traditional surgical techniques increase the appealing for new interventional alternatives and less invasive surgical options. Among them stands out the Subcutaneous Ureteral Bypass (SUB), a therapeutic option increasingly sought in Portugal, as a way to treat obstructive ureterolithiasis in small animals, mainly in cats. The SUB device was developed from the subcutaneous nephrovesical bypass used in human medicine, being associated with minimal peri and postoperative complications and with an improvement in life quality of animals that underwent surgery. So, the present study provides an update review about obstructive ureterolithiasis, focusing in the implantation of SUB devices as a way to treat this disorder. In general, the main objectives of the this dissertation are to describe the surgical technique according to the procedure performed in Centro Hospitalar Veterinário do Porto (CHV), only realized under ultrasound guidance, and to identify the possible risks and complications inherent and the associated advantages and disadvantages. Thus, through the exposed clinical cases, this work suggests that subcutaneous ureteral bypass implantation is a viable option in the treatment of obstructive ureterolithiasis in cats, allowing for a better knowledge in this area, which favors the development of a conscious therapeutic choice in the presence of this pathology.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
obstrução ureteral , ureterolitíase