Hidronefrose por obstrução ureteral em felino doméstico
Carregando...
Data
2023-12
Tipo de documento
Artigo Científico
Título da Revista
ISSN da Revista
Título de Volume
Área do conhecimento
Modalidade de acesso
Acesso aberto
Editora
Autores
WAGNER, Ariane Gambeiro
FALQUETE, Gabriel Altea
SOARES, Luana da Silva
SILVA, Priscilla Oliveira
Orientador
SILVA, Mariana Aguiar
Coorientador
Resumo
O objetivo do presente estudo de caso é descrever um caso clínico de hidronefrose por obstrução ureteral, em felino doméstico resgatado já com sintomas, apresentando o tratamento realizado, sinais clínicos, exames, procedimentos cirúrgicos e prognóstico final da paciente. Trata-se de paciente felino, fêmea, (SRD), castrada, resgatada a cerca de 1 mês, sem histórico conhecido, adulta, pesando cerca de 4,0kg. A coleta de dados foi feita através do acompanhamento junto da equipe médica que prestou o atendimento durante todo o tratamento da paciente. A paciente presente neste estudo, foi acompanhada clinicamente do período de fevereiro de 2019 a abril de 2020, submetida a exames onde foi constatado obstrução ureteral por cálculo levando a hidronefrose renal. A conduta inicial tomada para realizar uma tentativa do urólito ser movido para a vesícula urinária, foi o tratamento clínico medicamentoso com uso de Cloridrato de prazosina, Amitriptilina e fluidoterapia subcutânea. Embora o tratamento medicamentoso tenha apresentado uma discreta melhora no quadro, sua função renal se mostrou instável na repetição dos exames após cerca de um mês, sendo indicado a realização de ureterotomia para a retirada do cálculo. Seis dias após a remoção, um novo ultrassom foi feito, indicando atrofia do rim esquerdo e obstrução de ureter direito, com rim direito com perda de arquitetura e dilatação de pelve. Após nova tentativa de tratamento medicamentoso, seguida de novo procedimento cirúrgico, a paciente apresentou distensão abdominal, sendo diagnosticada após exames com presença de gás livre e líquidos na cavidade, com função renal intensamente elevada, constatado após punção e avaliação a presença de uroperitôneo. Embora não tenha sido realizada necropsia após o óbito da paciente, avaliando todos os sinais clínicos e exames laboratoriais, conclui-se que houve extravasamento de urina do local da cirurgia para a cavidade abdominal. Estudos recentes mostram que existem novas possibilidades de tratamento para o distúrbio, como colocação de stents duplos ureterais felinos ou dispositivo de bypass ureteral subcutâneo, as novas formas de tratamento podem ser mais eficazes, porém possuem um custo muito elevado e de difícil acesso, sendo a ureterotomia ainda a cirurgia mais realizada na tentativa de remoção de urólitos ureterais
The objective of this case study is to describe a clinical case of hydronephrosis due to ureteral obstruction, in a rescued domestic feline already with symptoms, presenting the treatment carried out, clinical signs, exams, surgical procedures and the patient's final prognosis. This is a female feline patient (SRD), spayed, rescued approximately 1 month ago, with no known history, adult, weighing approximately 4.0kg. Data collection was carried out through monitoring with the medical team that provided care throughout the patient's treatment. The patient present in this study was clinically monitored from February 2019 to April 2020, undergoing tests that revealed ureteral obstruction due to stones leading to renal hydronephrosis. The initial approach taken to attempt to move the urolith to the urinary bladder was clinical drug treatment using Prazosin hydrochloride, Amitriptyline and subcutaneous fluid therapy. Although the drug treatment showed a slight improvement in the condition, his renal function proved to be unstable on repeat tests after about a month, and a ureterotomy was indicated to remove the stone. Six days after removal, a new ultrasound was performed, indicating atrophy of the left kidney and obstruction of the right ureter, with the right kidney showing loss of architecture and dilation of the pelvis. After another attempt at drug treatment, followed by a new surgical procedure, the patient presented with abdominal distension, being diagnosed after examinations with the presence of free gas and liquids in the cavity, with intensely elevated renal function, confirmed after puncture and evaluation the presence of uroperitoneum. Although no necropsy was performed after the patient's death, evaluating all clinical signs and laboratory tests, it was concluded that there was leakage of urine from the surgery site into the abdominal cavity. Recent studies show that there are new treatment possibilities for the disorder, such as placement of feline double ureteral stents or subcutaneous ureteral bypass device. New forms of treatment may be more effective, but they are very expensive and difficult to access, and the ureterotomy still the most commonly performed surgery in an attempt to remove ureteral uroliths
The objective of this case study is to describe a clinical case of hydronephrosis due to ureteral obstruction, in a rescued domestic feline already with symptoms, presenting the treatment carried out, clinical signs, exams, surgical procedures and the patient's final prognosis. This is a female feline patient (SRD), spayed, rescued approximately 1 month ago, with no known history, adult, weighing approximately 4.0kg. Data collection was carried out through monitoring with the medical team that provided care throughout the patient's treatment. The patient present in this study was clinically monitored from February 2019 to April 2020, undergoing tests that revealed ureteral obstruction due to stones leading to renal hydronephrosis. The initial approach taken to attempt to move the urolith to the urinary bladder was clinical drug treatment using Prazosin hydrochloride, Amitriptyline and subcutaneous fluid therapy. Although the drug treatment showed a slight improvement in the condition, his renal function proved to be unstable on repeat tests after about a month, and a ureterotomy was indicated to remove the stone. Six days after removal, a new ultrasound was performed, indicating atrophy of the left kidney and obstruction of the right ureter, with the right kidney showing loss of architecture and dilation of the pelvis. After another attempt at drug treatment, followed by a new surgical procedure, the patient presented with abdominal distension, being diagnosed after examinations with the presence of free gas and liquids in the cavity, with intensely elevated renal function, confirmed after puncture and evaluation the presence of uroperitoneum. Although no necropsy was performed after the patient's death, evaluating all clinical signs and laboratory tests, it was concluded that there was leakage of urine from the surgery site into the abdominal cavity. Recent studies show that there are new treatment possibilities for the disorder, such as placement of feline double ureteral stents or subcutaneous ureteral bypass device. New forms of treatment may be more effective, but they are very expensive and difficult to access, and the ureterotomy still the most commonly performed surgery in an attempt to remove ureteral uroliths
Palavras-chave
Gato, Urólito, Dilatação, Uroperitôneo