One of my personal interests is urologic surgery, that's part of one of the focuses of my surgical training.

私の個人的な興味のひとつは泌尿器外科で、外科研修の焦点のひとつでもある。

So I'm here to talk to you about subcutaneous ureteral bypass, or sub-surgery in cats.

そこで今回は、皮下尿管バイパス術、つまり猫におけるサブサージェリーについてお話しします。

So the reason we do this, you may already know, is to help bypass an obstructed ureter.

なぜこのようなことをするかというと、もうご存知かもしれませんが、閉塞した尿管をバイパスするためです。

So when the kidney needs to empty urine into the bladder, if the ureter is blocked it cannot do that.

そのため、腎臓が尿を膀胱に排出する必要があるとき、尿管が詰まっているとそれができない。

So the sub is a way for us to bypass that blocked ureter and allow urine to empty from the kidney.

つまり、尿管を迂回させて腎臓から尿を排出させるのがサブの方法なのだ。

So we have a little diagram here of a cat's abdomen.

ここに猫の腹部の小さな図がある。

The kidneys, there are two.

腎臓は2つある。

Your cat may or may not have one or two of those ureters blocked, so the ureters are these white tubes running down through the abdomen into the bladder, which is this little circle here.

尿管とは、腹部を通って膀胱につながる白い管のことで、この小さな丸の部分です。

So if those are blocked, if there is something blocking the way, typically a stone in cats, those are able to be bypassed by the use of our subcutaneous ureteral bypass system.

そのため、何かが道をふさいでいる場合、典型的な猫では結石がある場合、私たちの皮下尿管バイパスシステムを使用することで、それらをバイパスすることができます。

We have some of the implants here to help outline exactly what's involved, but in a very simple sense, we insert a tube into the pelvis part of the kidney.

ここでは、インプラントの一部をお見せして、その概要を説明しますが、非常に単純な意味では、腎臓の骨盤の部分にチューブを挿入します。

So this down here is a transverse section of a kidney, so the brown outer parts here are what generate the urine as it is filtered from the blood, and it empties into this triangular section here, which is called the renal pelvis.

この下は腎臓の横断面で、茶色い外側の部分が血液から濾過されて尿を生成し、腎盂と呼ばれるこの三角形の部分に排出される。

So in most cases with ureteral bypass, the ureter and renal pelvis is more dilated than normal, which in terms of us placing these implants actually makes it more straightforward.

つまり、尿管バイパスのほとんどの症例では、尿管と腎盂が通常よりも拡張している。

So what we need to do when we're placing that is insert a tube into this renal pelvis, which is then sealed with some glue on the outside.

腎盂にチューブを挿入し、外側を接着剤で密閉する。

So here is one of the ureteral catheters.

これが尿管カテーテルのひとつだ。

This is the end of the nephrostomy catheter, so the nephrostomy tube is the bit that goes into the kidney.

これは腎瘻カテーテルの先端で、腎瘻チューブは腎臓に入る部分です。

So the important parts that we have at the end here, we have this curled J-shaped section with little fenestrations, little holes along the end, which allow urine to be passed through, and then the little string that you can see here at the end is also part of the locking loop.

このカールしたJ字型の部分の端には、尿を通すための小さな穴が開いている。

So you'll see if I pull on the string at the other end, that will hold that locked, which then allows this locked portion at the end to become less likely to then pull back out of the kidney.

だから、もう一方の端の紐を引っ張れば、その紐がロックされ、端のロックされた部分が腎臓から引き戻されにくくなるのがわかるだろう。

So the last bit is this little cuff here, which is then super glued in place on the outside of the kidney, which helps form a seal around the edge of the hole that's passing through the tissue of the kidney to limit leakage.

この小さなカフを腎臓の外側に超接着することで、腎臓の組織を通る穴の縁をシールし、漏れを抑えることができる。

Once we've placed this tube, it is then passed through the outside of the body wall, so this tube here ends up sitting at this end section here and curling around, and then it's passed outside the body wall, and that then allows us to connect one of these subcutaneous ports.

このチューブを体壁の外側に通すと、このチューブはこの端の部分に収まり、くるくると巻いて、体壁の外側に通され、皮下ポートの1つに接続できるようになる。

So the port has three main parts.

港には3つの主要部分がある。

So there is the nephrostomy connection tube and the cystostomy connection tube, so this is the end that goes to the kidney, comes from the kidney rather, and this is the end that then drains into the bladder.

腎瘻接続チューブと膀胱瘻接続チューブがあり、こちらは腎臓に行く方で、どちらかというと腎臓から来る方、そしてこちらは膀胱に排出される方です。

This central portion here is a little silicon diaphragm, which allows us to pass a special needle called a Huber needle, which is designed not to cut any little cores out of the silicon diaphragm itself, so you can see it has a slightly bent end so that the tip of the needle doesn't cut a core through and leave a hole so it can leak, and that allows us to flush and drain the system and help avoid any further mineral collection, which can sometimes result in obstruction of the tubing.

この中央部分が小さなシリコン・ダイアフラムで、フーバー針と呼ばれる特殊な針を通すことができます。この針は、シリコン・ダイアフラムから小さな芯を切り取らないように設計されており、針の先端が芯を切り取って穴が開いて漏れることがないように、先端が少し曲がっているのがわかります。

So that then gets sutured to the outside of the body wall after the tube from the kidney is connected to one end, and then a corresponding tube, so a second tube that is placed similarly to how it's placed into the kidney, doing the same thing, placed into the bladder to help then complete the circuit.

腎臓からのチューブが一端に接続された後、そのチューブが体壁の外側に縫合され、対応するチューブ、つまり腎臓に入れるのと同じように入れられる2本目のチューブが膀胱に入れられ、同じことをして回路を完成させる。

So it then gets connected to the other end of our subcutaneous port, and then connected through into the bladder.

そして、皮下ポートのもう一方の端に接続され、膀胱につながる。

So instead of having this blocked ureter, the urine is able to flow through the tube that's inserted into the kidney, through this injection port which sits subcutaneously, and then that then follows through and drains into the bladder, thus bypassing the obstructed ureter.

つまり、尿管が閉塞する代わりに、尿は腎臓に挿入されたチューブを通り、皮下にあるこの注入ポートを通って、膀胱に流れ込み、閉塞した尿管をバイパスして膀胱に排出される。

So now the other benefit of having this subcutaneous port rather than just directly connecting the two, is that this injection port allows us to both easily collect urine samples and and also to flush the system, because the main reason for these problems happening is that these cats are prone to forming mineral stones, so those mineral stones can also form within the tubes themselves, so by regularly flushing them, it allows us to help control the, helps us control the likelihood of those blocking further down the track.

なぜなら、このような問題が起こる主な理由は、猫がミネラル結石を形成しやすいからで、ミネラル結石はチューブ内にも形成されます。

When we're inserting these catheters, because the abdomen is open, we can visualise that they go into the kidney itself, but we still can't see the inside part of this, the end of this tube once it's been inserted, so, and although most of the cases have urine flowing back through the tube to confirm that it's in the right place, we also use fluoroscopy, which is video x-ray, to help identify the position by, after insertion of the tube, by injecting a contrast liquid into the tube itself, which then helps fill up the section of that renal pelvis, and helps both confirm the location, and the other thing it can do is help outline the size and diameter of the ureter further down, and typically also help locate the obstruction that's occurring as well.

カテーテルを挿入する際、腹部が開いているため、腎臓の中に入っていることは確認できますが、チューブが挿入されると、チューブの先端の内側はまだ見えません、チューブを挿入した後、チューブ自体に造影剤を注入し、腎盂の断面を埋めることで、位置を確認し、さらに尿管のサイズと直径の輪郭を描くことができます。

So that typically allows us to be more confident that the nephrostomy portion of the catheter is exactly where we need it to be.

そのため、通常、カテーテルの腎瘻部分が必要な場所に正確に留置されていることをより確信することができる。

And then once that's in place, we typically go about placing the rest of the bits which don't necessarily need fluoroscopy, but the other thing we do at the end of surgery, once everything is in place, is we'll inject some contrast into the subcutaneous port, which helps confirm the patency of all of the tubing, to make sure that both liquid can flow back and forth into the kidney, but also back and forth into the bladder as well, to help us ensure that the system is doing what it needs to do.

そして、それが所定の位置に設置されたら、通常、透視を必ずしも必要としない残りの部分を設置していきますが、手術の最後に行うもう一つのことは、すべてが所定の位置に設置されたら、皮下ポートに造影剤を注入します。

So thanks very much for listening to our video about placement and the use of subcutaneous ureteral bypass, so if you do have any questions, please feel free to get in contact with us at veterinary specialist services, and cat specialist services, and we'll be very happy to try and answer any questions you have.

皮下尿管バイパスの留置と使用についてのビデオをお聞きいただき、ありがとうございました。何かご質問がありましたら、獣医専門サービス、猫専門サービスまでお気軽にご連絡ください。

Thank you.

ありがとう。