Benoît Cuq: Dr. Vét., IPSAV, Dipl. ACVIM-SAIM, MRCVS

Benoît Cuq: Dr. Vét., IPSAV, Dipl. ACVIM-SAIM, MRCVS

Dr. Benoît Cuq is a graduate of the National Veterinary School of Toulouse (France). After a one-year Clinical Pathology Specialty Internship in Toulouse, he moved to Canada, initially as a Rotating Intern at the Université de Montréal, then as a Rotating Intern at the Ontario Veterinary College. He subsequently completed a Small Animal Internal Medicine Residency and a PhD at the Ontario Veterinary College.

Benoit decided on an academic career as soon as he qualified from the University of Toulouse Veterinary College, France. He enrolled in internships at Toulouse, Montréal and Guelph. This led to a small animal internal medicine residency at Guelph from 2014-2017, diploma status of the ACVIM in 2018 and a PhD in pathophysiology, also at Guelph in 2016.  

He is now an Assistant Professor at the UCD School of Veterinary Medicine in Dublin, where in addition to the qualifications outlined above, he is a recognised specialist in small animal internal medicine from the Veterinary Council of Ireland.

Benoit speaks very clearly in English and like many of our European colleagues in more than one language, in his case French, English and Spanish. I looked forward to this webinar as it deals with a subject of which I was completely ignorant.  I was not disappointed.  

Benoit begins his presentation with a nod to Shakespeare by ‘To SUB or not to SUB –that is the question.’ If that doesn’t make sense you may not be alone. Later in the presentation, he lets us know that it stands for Subcutaneous Ureteral Bypass, a new technique he describes as the ‘gold standard’ treatment. This gives me the opportunity of letting you know that the follow-up link to this webinar is below:

Returning to part 1, there are 10 possible causes of UO listed. Ureterolithiasis is the most common at 65.5%, followed by strictures (16.1%), a combination of these (16.7%) and then the less common ones.  

There has been a 30 fold in identifying UO secondary to Ureterolithiasis over a recent 12-year period.  Calcium oxalate stones cause 87% of the cases, and a further 11% contain calcium. 75% occur in the proximal ureter, 20% in the mid-portion and 5% in the distal third of the ureter.  Medical management for stone dissolution is not effective, nor recommended.  

Obstructive nephropathy occurs with loss of renal function (40% at 24 hours) after the initial insult. If this is unresolved fibrosis and remodelling of the kidneys will result (big kidney, little kidney presentation).  

Clinically these cases have a median age of 9 years and are mostly DSH. Signs are vague and non-specific: – 

  • Poor appetite-77% 
  • Weight loss-64% 
  • Vomiting-56% 
  • PU/PD-31% 
  • Haematuria-25% 
  • Dysuria-23% 
  • Oliguria or anuria-14% 

There is usually more than one sign-on presentation with a median duration of 2 weeks.  

Physical examination reveals, in 82% of the cases, renal asymmetry (big kidney/small kidney). There may be heart murmurs in 66%, varying degrees of hydration, nausea, hypersalivation, uraemic ulceration and a normal or empty bladder. 

Significant biochemical abnormalities include azotaemia in 95% of patients and hyperkalemia is an additional common finding. In 25% of cats, there is ionised hypercalcaemia. Haematological abnormalities include anaemia in 68% of the cats, accounting for haemic murmurs. There are also varying urine sediment abnormalities-haematuria, pyuria, epithelial cells, crystalluria, bacteria and casts. 

Calcium oxalate stones and calcium-containing stones are radio-opaque when exceeding 5mm in size. Radiographs are diagnostically very useful and are indicated to assess the entire urinary tract for nephroliths, ureteroliths and cystoliths.  

Benoit advises using both radiography and ultrasound to increase diagnostic sensitivity. He continues with very high quality radiographs and ultrasound images of typical cases.  There is ample explanation of, in particular, the technical aspects of ultrasound measurements. Ultrasound must surely be the most diverse and useful diagnostic technique available in veterinary medicine in all species? There are some examples of its use in several cases in quiz form before collating all the diagnostic information so far by demonstrating a ragdoll cat called Yukiko, which presented with UO.  

Benoit summaries his presentation: – 

  • UO is a challenging diagnosis. 
  • US sensitivity 77% 
  • US + radiography 90% sensitivity 
  • Clinical findings on presentation, clinicopathological data and imaging findings are required for the diagnosis 
  • Time is of the essence -40% loss of nephrons after 24 hours and medical management is extremely limited, with only 10% success. 

As mentioned in the beginning, subcutaneous ureteral bypass (SUB) is a new emergency surgery for these cases and he ends by describing a success story – a cat that was treated in this way at UCD. 

This is a very good webinar. It will be of use to anyone that treats cats, and I am looking forward to the follow up on August 12th. 2021. In that webinar, he will explain in detail the use of the SUB technique, and presumably from his quotation of the Bard, whether to use it or not.