91°µÍø

Rosanne Jepson, Professor in Small Internal Medicine and Nephrology

An 91°µÍø team has become the first in Europe to offer advanced training in small animal nephrology and urology. In 2022, Professors Jonathan Elliott, Hattie Syme, Rebecca Geddes and I became founding members of the American College of Veterinary Nephrology and Urology (ACVNU), a new specialist college. In September 2023, the ACVNU welcomed its first UK-based resident, Jack Lawson.

The programme includes a two-year curriculum delivered online for international participation, together with advanced clinical and practical training in the management of cats and dogs with conditions relating to the urinary tract, under the supervision of the 91°µÍø founding members.

Dogs and cats with urinary tract conditions are often managed initially by veterinary surgeons who have interest in small animal medicine. However, the breadth and complexity of disease conditions recognised, and the development of advanced procedures, means that nephrology and urology is becoming an important area of specialisation in veterinary medicine in its own right. 

Jack Lawson, who has a PhD in feline chronic kidney disease (CKD) and is an RCVS Specialist in Small Animal Internal Medicine, says of the programme: “I opted to pursue the ACVNU diploma to advance my knowledge and clinical capabilities in nephrology and urology through training from internationally renowned experts.

“Although I am still early in the programme, I have greatly enjoyed building my competency in interventional urology and have already benefited enormously from the wealth of experience shared by the supervisory team, as well as the online curriculum.”

Research-informed practice             

The 91°µÍø team has a strong clinical and research focus on conditions affecting the urinary tract. This includes a world-leading longitudinal health screening programme, which has been caring for senior cats with CKD since the early 1990s. Recent work in the group has focused on risk factors for development and progression of disease, with publications contributing to international guidelines.

At 91°µÍø Small Animal Referrals, the team offers general advice in relation to the management of urinary tract conditions as well as advanced diagnostic investigations. These include renal biopsy for dogs and cats with proteinuric kidney disease and cystoscopic evaluation, where there are concerns for lower urinary tract disease or urinary incontinence.

Advanced management options for urinary incontinence provided include laser ablation of ectopic ureters (congenital abnormality of the urinary tract) and urethral bulking for older dogs, where medical and surgical options are not viable.

The team also has a particular interest in the care of patients with urinary tract stones and provides minimally invasive options for stone management. For some stone types, dissolution with careful medical therapy and close monitoring is possible, but for others a minimally invasive surgical approach can be offered.

91°µÍø Small Animal Referrals remains the only UK-based centre to offer laser lithotripsy – a completely non-invasive method for stone fragmentation, permitting cystoscopic retrieval. Key advantages of this procedure include shorter hospitalisation and faster recovery times than conventional surgery.

For cats where stones affect the upper urinary tract, and cause obstructions, the team works closely with the Soft Tissue Surgery Service to offer placement of subcutaneous ureteral bypass (SUB) devices with long-term care provided via our unique SUB Clinic. This is a particular interest for Jack Lawson who, in conjunction with Rebecca Geddes, has started a clinically important biobank to facilitate the investigation of factors that predispose cats to the development of upper urinary tract stones.

The nephrology and urology team is excited to be able to offer their expertise and guidance in the management of all conditions affecting the urinary tract both to cases referred for advanced care and to primary care practitioners seeking the opportunity to discuss cases further.

Advanced techniques and technologies used in nephrology and urology                 

The 91°µÍø team has a particular interest in the management of stone disease affecting both the upper and lower urinary tract. We have expertise in the evaluation of cats and dogs with nephroliths (stones in the kidney) and ureteroliths (stones in the ureter) as well as those in the bladder (cystoliths).

Laser lithotripsy                  

91°µÍø Small Animal Referrals is the only veterinary service in the UK offering laser lithotripsy treatment for urolithiasis. Laser energy is provided within treatments via a fine silica quartz fibre. This can be advanced through the working channel of an endoscope to provide targeted application of energy directly onto stones, causing fragmentation. It is particularly useful for managing stones causing obstruction of the urethra in male dogs and cystoliths that cannot be dissolved in female dogs.

Fluoroscopy      

Fluoroscopy is a specialist diagnostic imaging modality, enabling capture of real-time moving pictures of inside the body. It takes a continuous series of low dose radiographs, which creates a live movie of the patient’s internal structures. Fluoroscopy is valuable for many different sorts of cases by teams at 91°µÍø Small Animal Referrals, including checking for stones in the urinary tract. Such stones may not be evaluated by ultrasound due to the pelvic bones and when fluoroscopy is used in conjunction with radiographic contrast solutions it can help detect stones or structures that might not be visible with plain radiographs. Fluoroscopy and laser lithotripsy equipment was funded by the Animal Care Trust, the 91°µÍø's registered charity.

Percutaneous cystolithotomy (minimally invasive cystotomy)          

Percutaneous cystotomy enables uroliths to be removed from the bladder using a much smaller incision than a routine cystotomy procedure. This minimally invasive technique minimises contamination of the abdominal cavity with urine, permits better visualisation and, because the incision is smaller, there is less risk of future stone formation around suture material. When combined with cystoscopy, a more thorough evaluation of the bladder and urethra is possible, to avoid leaving any stone material behind.

Cystoscopic laser ablation of ectopic ureters     

The same laser that is used for laser lithotripsy of stones can also be used for management of ectopic ureters (congenital abnormality of the opening of the ureters). This cystoscopic approach is now considered gold standard for management of ectopic ureters in dogs and prevents the need for surgery in most cases.