Avoiding ligating ureters in cat spays

RE: Avoiding ligating ureters in cat spays

Julie Innes — Tue, 14 Jan 2020 17:11:36 GMT

I hate midline cat spays! maybe because I was taught to do flank and have done so many that way, I struggle to do them midline! I think it's a bit like the old saying that the safest way is the way you are most comfortable and experienced with.

But then, I also love my catgut, and hate ligating with anything else!

RE: Avoiding ligating ureters in cat spays

Alistair Graham-Evans — Sat, 11 Jan 2020 05:25:44 GMT

The latter as I don't think there is any evidence that discount neutering in dogs has any effect on the stray population.

RE: Avoiding ligating ureters in cat spays

Lindsey Edwards — Sat, 11 Jan 2020 01:28:51 GMT

Are you implying flank spay is inferior or negligent technique? Please provide evidence as I have not encountered any evidence to support this and have repaired as many if not more midline than flank complications.

RE: Avoiding ligating ureters in cat spays

Mike Dale — Thu, 09 Jan 2020 16:23:49 GMT

I recall two former colleagues of mine writing a letter or short communication to the Record describing cases of bowel entrapment seen with long pieces of retained uterine horn becoming adhered to local bowel. Always made me try harder to get close to the cervix for fear of incurring the wrath of these noble gents.

RE: Avoiding ligating ureters in cat spays

Chris Vogt — Thu, 09 Jan 2020 13:30:37 GMT

I wholeheartedly agree

RE: Avoiding ligating ureters in cat spays

Lucy Fleming — Thu, 09 Jan 2020 12:48:53 GMT

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/28756/avoiding-ligating-ureters-in-cat-spays/218651"]is it really philantropy? or just poor management and a race to the bottom in loss leaders? [/quote]

Probably a little of both - certainly one of the stated reasons for keeping neutering prices low is to encourage uptake, but whether that is actually the end result is probably questionable! As an easily comparable price pressure is certainly on to keep it low.

I'm not sure the evidence that flank approach is more painful in and of itself is really there - seems to be easily confounded by other factors including surgeon skill/ preference for either technique...so whichever you find better is almost certainly the best! Healing time in cats is probably theoretically relevant given how little they rest after surgery, but I can't think of any cases where it's actually been clinically relevant....

RE: Avoiding ligating ureters in cat spays

gdbvet — Thu, 09 Jan 2020 03:14:16 GMT

Did flank speys for 30 odd yrs.Splitting /cutting muscle to get into abd cavity a lot more painful post op than splitting the linea alba.Much happier with post op recovery now.Use single pack of pds in both flank and mid line speys so no difference in costs.Takes a little more time only.

RE: Avoiding ligating ureters in cat spays

Bob Russell — Wed, 08 Jan 2020 11:54:05 GMT

Absolutely a loss leader!

A bit like the pet shop nearby doing vaccination clinics one afternoon a week. According to the website the vets are experienced and offer a range of services.

Sadly cannot tell a dog from a bitch puppy and apparently they don't need worming! Some of this might be a misunderstanding because the vet could not speak English.

As the client commented 'cheap does not always mean good value'!

Now puppy has changed name and been properly wormed!!

RE: Avoiding ligating ureters in cat spays

Dinu Catilina — Wed, 08 Jan 2020 10:54:45 GMT

is it really philantropy? or just poor management and a race to the bottom in loss leaders?

RE: Avoiding ligating ureters in cat spays

Sarah Keir — Wed, 08 Jan 2020 09:34:20 GMT

gdbvet - your post suggests that the vets who do flank spays are not 'doing the job properly'. There are many ways to skin a cat.

'charge accordingly' - unfortunately, in the philanthropic culture of the vet profession, neutering has always be done at a discount. It would be interesting to see how a practice got on if they charged fully for neutering rather than discounting it to a nominal figure. Would the clients be accepting that they need to pay the full rate for the procedure and get that practice to do it, or they would shop around and find everywhere else charged a quarter of that and think the vets were just money squeezing? Also in the perception of clients, all practices do it 'properly'; they don't know what goes on behind the scenes and how some places cut corners to cut costs.

RE: Avoiding ligating ureters in cat spays

Rob Loxley — Wed, 08 Jan 2020 09:30:01 GMT

[quote userid="12430" url="~/001/nonclinical/f/life-in-practice-discussions/28756/avoiding-ligating-ureters-in-cat-spays/218642"]do simple interrupted sutures to secure the linea alba[/quote]

Any evidence that this is more secure/safer than simple continuous, or just more dogma? The last review I read (https://www.veterinaryevidence.org/index.php/ve/article/download/99/192?inline=1) couldn't conclude one was better?

RE: Avoiding ligating ureters in cat spays

gdbvet — Wed, 08 Jan 2020 06:13:13 GMT

Return to midline speys.Better visualisation of all structures,and since the introduction of pds,vicryl etc safe as well.Throw your cassette of catgut into the dustbin and also do simple interrupted sutures to secure the linea alba .Do the job properly and charge accordingly.Also learn proper intradermal skin suturing techniques.Cat's are a doddle.

RE: Avoiding ligating ureters in cat spays

Michael Woodhouse — Mon, 23 Dec 2019 22:36:18 GMT

on a flank spay I pull to the bifurcation to get the 2nd horn. Ligate both sides of uterine body together. Never knowingly seen a ureter

RE: Avoiding ligating ureters in cat spays

Rob Loxley — Mon, 23 Dec 2019 21:56:46 GMT

[quote userid="9515" url="~/001/nonclinical/f/life-in-practice-discussions/28756/avoiding-ligating-ureters-in-cat-spays/218386"]how to you get so far down on a flank spay?[/quote]

on a flank spay, very rarely down to the uterine bifurcation, so ligate each side just below the ovary. Much easier as you can make your incision more cranial so easier ovarian access. another complication I've see with too much pulling on the cervical end was someone tearing one of the arteries down that end, had to open it up midline to find and fix

RE: Avoiding ligating ureters in cat spays

Dinu Catilina — Mon, 23 Dec 2019 17:08:02 GMT

I guess it can stretch quite a bit but I would rather not cause even more pain.

RE: Avoiding ligating ureters in cat spays

Sarah Keir — Mon, 23 Dec 2019 16:24:25 GMT

In cats I have started doing ovariectomies as standard. I have never managed to knowingly remove a cats cervix; how to you get so far down on a flank spay?

RE: Avoiding ligating ureters in cat spays

Dinu Catilina — Fri, 20 Dec 2019 13:43:47 GMT

My suggestion is to perform ovariectomies in healthy animals which I suspect will reduce the risk of ligating a ureter.

RE: Avoiding ligating ureters in cat spays

James Dunne — Fri, 20 Dec 2019 12:36:26 GMT

Hi Neil

When I worked in the UK I witnessed a very experienced small animal vet take out a ureter during a flank cat spay. They realised what they had done and were quite shocked. I remember them sending it for histology to confirm their fears. They did inform the owner immediately and the cat was okay in the end (on one kidney obviously). So I guess the moral here is that it can happen, but how the error is handled afterwards is important both clinically and professionally.

Kind regards

James