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The ºÚÁÏÉçs subcutaneous ureteral bypass (SUB) Clinic is a collaboration between Soft Tissue Surgery and Internal Medicine Services

Upper urinary tract stones in cats appear to on the rise in the UK and are often difficult to detect and diagnose. On average more than one cat per week presents to ºÚÁÏÉç Small Animal Referrals with ureteral obstruction and associated acute kidney injury.

Surgical management of ureteral obstruction was revolutionised by the development of the subcutaneous ureteral bypass device or SUB™ (Norfolk Veterinary Products), but placement of these devices requires specific training and cats continue to require close monitoring postoperatively.

The clinic is a unique collaboration between services and is headed up by Dr Lynda Rutherford from Soft Tissue Surgery and Dr Rebecca Geddes, from the Internal Medicine Service. Other members of both teams are also involved in helping run the clinic, which also has two dedicated surgery Registered Veterinary Nurses, Nadine Rogers and Gemma Taylor.

The majority of cats with ureteral obstruction do not respond favourably to medical management and, therefore, emergency placement of a SUB provides an alternative route for urine flow. SUB placement is performed to save a cat’s life, with the intention of leaving the device in place permanently. However, SUBs require regular check-ups to ensure they are patent and no infection is present.

Cats with a SUB also need ongoing monitoring of their kidney function, as this has been shown to have the biggest impact on subsequent survival time.

In most cases, ureteral obstruction is caused by an ureterolith, but other causes include strictures, blood clots and masses. The underlying cause of upper urinary tract stones and the optimal way to prevent them from occurring is currently not well understood.

ºÚÁÏÉç SUB Clinic goals

• To provide an efficient service with regular re-examinations for cats with SUBs in place
• To provide regular assessment by both a soft tissue surgery specialist and an internal medicine specialist to provide the very best care for cats
• To help support veterinary surgeons in primary care practice to provide long-term management for cats following SUB placement at the ºÚÁÏÉç
• To enable us to understand this devastating condition better and work towards developing new improved ways to diagnose and treat this condition

Additional Information

Further information for referring veterinary surgeons and owners regarding treatment and management for cats with SUB devices can be found using the following links:

• ºÚÁÏÉç Clinical Podcast on SUBs

If you are a referring veterinary surgeon with a patient with suspected ureteral obstruction, please contact Reception urgently (Tel: +44 (0)1707 666399).

If you are a vet or an owner of a cat with a SUB and have any queries, please contact us at QMHASUBclinic@rvc.ac.uk or via Reception if your query is urgent (Tel: +44 (0)1707 666399 or QMHreception@rvc.ac.uk).