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How a Subcutaneous Ureteral Bypass (SUB) Device is Placed

If your cat is suffering from a ureteral obstruction, a Subcutaneous Ureteral Bypass (SUB) device may be the solution to restore their health.

Ureteral obstructions, often caused by urinary stones, can prevent the kidneys from draining urine properly into the bladder.

Left untreated, this condition can lead to severe complications, including kidney failure.

An SUB device allows urine to bypass the blockage and flow freely from the kidney to the bladder.

But how exactly is this device placed, and what does the procedure involve?

Subcutaneous Ureteral Bypass in Cats

Understanding your cat's anatomy

To better grasp how an SUB device works, it’s helpful to understand a bit about your cat’s anatomy. Your cat has two kidneys, each responsible for filtering waste from the blood and producing urine. The urine travels from the kidneys to the bladder through thin tubes called ureters. When a blockage occurs, usually due to urinary stones, the ureter becomes obstructed, preventing urine from flowing normally. This can cause the kidney to swell and stop functioning properly.

In some cases, one or both ureters may be blocked, which is where the SUB device comes in. The SUB system acts as a bypass, allowing urine to flow around the obstruction so it can drain from the kidneys into the bladder.

Subcutaneous Ureteral Bypass (SUB) Device in Cats

How the SUB device is placed

The placement of an SUB device is a delicate, intricate procedure performed by a veterinary surgeon.

Here’s how it works:

Implants in the kidney: First, a small tube is inserted into the renal pelvis, the part of the kidney that collects urine. This tube allows urine to drain from the kidney, bypassing the blocked ureter. The renal pelvis is often swollen due to the obstruction, and this swelling helps the surgeon insert the tube securely. After placing the tube, the opening is sealed using a special glue to prevent any leakage.

Nephrostomy tube: The tube used in the kidney is called a nephrostomy tube, which has a curled, J-shaped tip designed to stay securely in place. The tube features small openings, or fenestrations, that allow urine to flow through it. A small string at the end of the tube forms a locking loop, securing the tube in the kidney and preventing it from slipping out. A cuff is also glued in place on the outside of the kidney to create a tight seal, limiting the risk of leaks.

Subcutaneous ports: Once the nephrostomy tube is in place, the next step involves connecting it to a subcutaneous port system. This port sits just under your cat’s skin, and it has several important functions. It connects the nephrostomy tube from the kidney to the cystostomy tube, which drains urine into the bladder. The port also has a silicone diaphragm, which allows vets to easily flush and drain the system using a special Huber needle. This is crucial for preventing blockages caused by mineral buildup in the tubes.

Second tube to the bladder: A second tube, similar to the one in the kidney, is inserted into the bladder. This tube ensures that urine can flow from the kidney through the SUB device and into the bladder, where it can be safely excreted.

Benefits of the SUB device

The SUB system offers many benefits for cats with ureteral obstructions:

Prevention of mineral buildup: One of the main advantages of the SUB device is that it can be regularly flushed to prevent the formation of mineral stones, which are common in cats with urinary issues. By keeping the system clear, the risk of future blockages is significantly reduced.

Ease of urine collection and monitoring: The subcutaneous port system also allows vets to easily collect urine samples for analysis. This is especially important for monitoring your cat’s kidney function and detecting any signs of infection or stone formation.

Confirming the placement: fluoroscopy and contrast injection

To ensure that the SUB device is positioned correctly, the vet uses fluoroscopy, a type of real-time X-ray, during the procedure. Fluoroscopy helps the surgeon visualise the kidneys, ureters, and bladder in detail, allowing them to accurately place the tubes and identify the location of any blockages.

Once the SUB device is in place, the surgeon injects a contrast dye into the system through the subcutaneous port. This dye helps confirm that the tubes are properly positioned and that urine is flowing as it should. If the dye moves smoothly through the system, it indicates that the bypass is working and the ureters are effectively bypassed.

The placement of a Subcutaneous Ureteral Bypass device is a highly effective solution for treating ureteral obstructions in cats. This procedure can significantly improve your cat’s quality of life by restoring normal urine flow and preventing dangerous complications. While it may sound complex, the SUB device offers a safe and reliable way to manage a common and serious condition in cats. If your cat has been diagnosed with a ureteral obstruction, talk to your vet about whether an SUB device could be the right option for them.

Are you worried about your cat’s health?

If you are concerned about your cat, please reach out to our friendly team. Call us on 1300 228 377 or fill out the contact form below. In an emergency, please contact your local vet.

For vets – to refer a patient or book a telehealth consultation, please call us on 1300 228 377, book through the portal or fill in the form.

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Contacting Us

Pet Owners
If you would like to talk about treatment for your cat, call us on 1300 228 377 or fill in the form.
In an emergency, please contact your local vet.

Vets and Nurses
To refer a patient or book a telehealth consultation please call us on 1300 228 377, book through the portal or fill in the form. For advice calls, please see the guidelines here.

1300 228 377
1-15 Lexington Rd,
Underwood, QLD, AU, 4119
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