Diagnosis and surgical management of ectopic ureters

Presentation, diagnosis, and outcomes of cats undergoing surgical treatment of ectopic ureters

OBJECTIVE

To describe the signalment, treatment, complications, and outcomes of cats treated surgically for ectopic ureters.

STUDY DESIGN

Retrospective, multi-institutional study.

ANIMALS

Twelve client-owned cats.

METHODS

Medical records of cats diagnosed with unilateral or bilateral ectopic ureters were reviewed and analyzed. Data reported included signalment, clinical signs, diagnostics, open celiotomy, or cystoscopic surgical interventions, and outcomes.

RESULTS

Seven of the 12 cats in the study population were female or female spayed and the median age at time of presentation was 4 years, with an interquartile range (IQR) of 6 months-14 years. Presurgical diagnostic imaging diagnosed ectopic ureters by abdominal ultrasound (8/10), contrast enhanced computed tomography (3/3), fluoroscopic urography (3/4), or cystoscopy (6/7). Eight of 12 cats had extramural ectopic ureters and six cats were affected bilaterally. Eight affected cats underwent ureteroneocystostomy, one cat underwent neoureterostomy, two cats underwent cystoscopic laser ablation, and one cat underwent nephroureterostomy. Immediate postoperative complications occurred in three cats; one cat required additional surgical intervention. Short-term complications occurred in three cats, and long-term complications in two cats. All cats that underwent surgical or cystoscopic intervention had improvement of their urinary incontinence scores, with complete resolution in 11 cats.

CONCLUSION

Surgical correction of ectopic ureters in cats is associated with good long-term outcomes. Ectopic ureters in cats are commonly extramural and bilateral. Postoperative outcomes were acceptable and there were few postoperative complications, with varying forms of surgical correction.

CLINICAL SIGNIFICANCE

Ectopic ureters in cats are rare but urinary incontinence can be corrected or improved successfully with surgery.

ACVIM consensus statement on diagnosis and management of urinary incontinence in dogs

Urinary incontinence (UI) is a disorder of micturition that can occur in dogs of any age, sex, and breed depending on the underlying cause and time of onset. Diagnosis and treatment for various causes of UI in dogs have been described by multiple comprehensive single author review articles, but large prospective clinical trials comparing treatment outcomes in veterinary medicine are lacking. The objectives of this consensus statement therefore are to provide guidelines on both recommended diagnostic testing and treatment for various causes of UI in dogs. Specifically, pathophysiology directly related to the canine urinary system will be reviewed and diagnostic and therapeutic challenges will be addressed. A panel of 12 experts in the field (8 small animal internists [L. Adams, J. Bartges, A. Berent, J. Byron, J. Foster, A. Kendall, S. Vaden, J. Westropp], 2 neurologists [J. Coates, N. Olby], 1 radiologist [G. Oetelaar], and 1 surgeon [C. Adin]) was formed to assess and summarize evidence in the peer-reviewed literature and to complement it with consensus recommendations using the Delphi method. Some statements were not voted on by all panelists. This consensus statement aims to provide guidance for management of both male and female dogs with underlying storage or voiding disorders resulting in UI.

An Unusual Presentation of a Rare Combination of Double Moiety and Vaginal Ureter Insertion

The association between a duplex renal collecting system and ectopic ureter insertion is well-established. Although congenital genitourinary abnormalities are usually detected during childhood, incidentally, or due to underlying symptoms or medical complications, a few cases might not be diagnosed/treated until adulthood. Herein, we present a case of a 43-year-old lady who came to the emergency department with acute left flank pain associated with a burning sensation during micturition for four days. Imaging showed a duplex collecting system, and findings suggestive of obstructive uropathy. The patient underwent an initial trial of left ureteroscopy that was unsuccessful. Therefore, the interventional radiology (IR) department was consulted to perform left percutaneous nephrostomy insertion with antegrade ureteric stenting, where the patient was noted to have ectopic ureter insertion into the anterior wall of the vagina by antegrade ureterogram. The patient underwent ureter re-implantation to save the kidney from further insult.

Laparoscopic ureteroneocystostomy in the treatment of urinary incontinence due to ectopy of the ureters in female dogs: A pilot study

Ureteral ectopia is rare and requires surgical treatment after a thorough diagnostic workup. Open surgical techniques for repositioning ectopic ureters have been known for many years and are well described in the literature. However, to the best of our knowledge, no laparoscopic method of correcting this pathology has been described, which, in our opinion, would benefit the animal in terms of the healing process and overall clinical outcomes. This study aimed to evaluate the possibility of laparoscopic treatment of ureteral ectopia, which causes urinary incontinence in dogs. All of the operated ten dogs presented in this study were client-owned females with symptoms of urinary incontinence due to a unilateral intramural ectopic ureter. A three-trocar laparoscopic technique was used to perform the ureteroneocystostomy of the ectopic ureter. In this article, clinicopathological data, imaging features, procedural findings, complications, and short- and long-term outcomes are presented. The procedure was feasible in all cases. No major postoperative complications were observed. Among the minor complications, slight hematuria was observed in three dogs, which resolved spontaneously. In the period of at least one year after surgery, no negative impact of the procedure was observed. Seven of the ten operated dogs regained urinary continence. The remaining three dogs required additional surgery (urethral bulking) because of a lack of improvement after adjuvant pharmacological treatment. Overall, good-to-excellent long-term outcomes can be achieved; however, dogs that remain incontinent after laparoscopic ureteroneocystostomy may require additional treatment.

Prognostic factors for continence after surgical correction of ectopic ureters of 51 dogs with long-term follow-up

Background

An ectopic ureter is a congenital malformation characterized by caudal displacement of one or both ureteral orifices and is the most common cause of urinary incontinence in young dogs. Complete resolution of incontinence after surgery has been reported in 25–82% of dogs. The aim of this study was to identify preoperative prognostic factors for continence after surgical treatment of dogs with an ectopic ureter. Dogs were included if surgical correction of an ectopic ureter was performed and at least 1 year follow-up was available.

Results

Fifty-one dogs met the inclusion criteria. The ectopic ureters were either intramural (91%) or extramural (9%). The ectopic ureters were bilateral in 49% of cases. Overall median follow-up time after surgery was 6.5 years (range 1–13 years). Surgical correction alone resolved urinary incontinence in 47% of cases. Low grade pre-operative incontinence, male sex and pre-operative presence of ureteral or renal pyelum dilation were significantly associated with urinary continence after surgery.

Conclusions

Dogs with severe preoperative incontinence were less likely to become completely continent after surgery, whereas male sex and preoperative dilation of the ureter or renal pyelum were positive prognostic indicators for continence. These results may assist in predicting outcome after surgical correction of ectopic ureters and suggest assessment of pre-operative urethral pressure profiling in future studies.

Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation

OBJECTIVE

To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic-guided laser ablation (CLA) in female dogs.

STUDY DESIGN

Retrospective study from 2011 to 2018.

ANIMALS

Twenty-five female dogs.

METHODS

Data collected included signalment, clinicopathologic data, procedural data, complications, and short-term and long-term outcomes. Complications were graded as minor or major if a surgical revision was required. Continence status was scored subjectively (1 = completely incontinent to 10 = fully continent).

RESULTS

Fifteen dogs had bilateral EU and 24 had intramural EU (iEU). Open surgical correction included 13 neoureterostomies, 2 neocystoureterostomies, and a combination of these in 2 dogs. Eight dogs underwent CLA. Eighteen dogs experienced minor complications (72%), and 2 experienced major complications (8%). One-month postoperative continence was achieved in 20/25 (80%) dogs (median score of 10). Incontinence recurred at a median time of 24.9 months in 5 dogs but responded to medical treatment. Overall, dogs remained continent for 66 months (median) and 22/25 (88%) dogs achieved continence with adjunction of medical/surgical treatment in incontinent ones. Fewer minor complications and postoperative recurrences of incontinence were documented after CLA than neoureterostomy (P < .01 and P < .05).

CONCLUSION

Ectopic ureter correction by open surgery or CLA resulted in a subjectively good prognosis, most dogs reaching continence within a month of surgery, although incontinence occasionally recurred in the long term. CLA was associated with fewer complications and incontinence recurrences than neoureterostomy.

CLINICAL SIGNIFICANCE

Cystoscopic-guided laser ablation should be preferred to correct iEU to prevent short-term complications and the recurrence of incontinence. Further studies should investigate the cause of postoperative recurrence of urinary incontinence.

Cystoscopic-guided scissor transection of intramural ectopic ureters as a novel alternate minimally invasive treatment option to laser ablation in female dogs: 8 cases (2011-2020)

OBJECTIVE

To evaluate the safety and efficacy of cystoscopic-guided scissor transection of ectopic ureters (CST-EU) in female dogs.

ANIMALS

8 incontinent female dogs with intramural ectopic ureters.

PROCEDURES

For this retrospective case series, data were collected from medical records of dogs that underwent CST-EU to relocate the ectopic ureteral orifice to an anatomically normal trigonal location between June 2011 and December 2020. Outcome after hospital discharge was determined using owner telephone questionnaires.

RESULTS

Ectopic ureters were bilateral in 4 of the 8 dogs, and all dogs had other urogenital tract anomalies. Owner questionnaire follow-up was available for 7 dogs, and results indicated 6 dogs had improved urinary continence immediately following the procedure. At the last follow-up (44 to 3,384 days after CST-EU), 3 of the 7 dogs were completely continent with CST-EU alone, 3 others became continent or were markedly improved with the addition of medications for urethral sphincter mechanism incompetence, and 1 required ureteroneocystostomy, colposuspension, and an artificial urethral sphincter to become fully continent. Owners of 5 of the 7 dogs reported that they considered the outcome of CST-EU as good to excellent, and all owners reported that they would consider having CST-EU performed again should they have another incontinent dog. Complications were minor, and only 3 dogs showed transient lower urinary tract signs after CST-EU.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated CST-EU could provide a safe, effective, minimally invasive alternative in the absence of laser technology for the treatment of intramural ectopic ureters in female dogs.

Acquired partial lower urinary tract obstruction caused by intravesical ureterocele in an adult dog

Ureterocele is an uncommon condition in dogs characterised by a cystic dilation of the submucosal portion of the distal ureter. A 4‐year‐old intact male Siberian husky with a 4‐month previous diagnosis of ureterocele was presented for pollakiuria. Abdominal ultrasound showed increased dimensions of the ureterocele, and a retrograde positive contrast urethrocystography detected a filling defect of the bladder neck lumen. The position of ureterocele was considered responsible for the partial urinary obstruction. This hypothesis is supported by the resolution of pollakiuria after surgical ureterocele resection. Based on a literature search, this is the first case of an intravesical ureterocele causing partial urinary obstruction in dogs. Ureterocele should be considered as a differential diagnosis in patients with pollakiuria.

Ultrasonography as a sensitive and specific diagnostic modality for the detection of ectopic ureters in urinary incontinent dogs

Ultrasonography is a widely available diagnostic modality for the identification of dogs with suspected ureteral ectopia; however published studies detailing its sensitivity and specificity are currently lacking. The aim of this retrospective, descriptive, diagnostic accuracy study was to evaluate the sensitivity and specificity of ultrasonography for the diagnosis of ureteral ectopia in incontinent dogs presenting to a referral institution, using cystoscopy as the gold standard. Medical records of urinary incontinent dogs presenting to a single institution (n = 38) were retrospectively reviewed for the presence of ureteric insertion abnormalities and concurrent urinary tract abnormalities. Ultrasonographic findings were compared with those from cystoscopic examination to determine diagnostic accuracy. The relationship between the presence of concurrent urinary tract abnormalities and ureteral ectopia was assessed using an independent samples t‐test and Mann–Whitney test. Statistical significance was set at P ≤ 0.05. Ultrasonography had a sensitivity of 93.5%, specificity of 100%, and diagnostic accuracy of 95% when identifying dogs with ureteral ectopia. When classifying individual ureters as ectopic or non‐ectopic, sensitivity was 87.8% and specificity was 86.7%. Dogs with ureteral ectopia had significantly more concurrent urinary tract abnormalities on ultrasound than unaffected dogs (P = 0.004). Ectopic ureters were associated with significantly more concurrent ipsilateral upper urinary tract ultrasonographic abnormalities than unaffected ureters (P < 0.001). Ultrasonography performed by an experienced ultrasonographer is a sensitive and specific screening tool for canine ureteral ectopia, which eliminates the need for heavy sedation, general anesthesia, and advanced imaging, although it should not be relied upon as the sole diagnostic modality for the assessment of individual ureters.

Retrospective evaluation of cystoscopic-guided laser ablation of intramural ectopic ureters in female dogs

Background

Cytoscopic‐guided laser ablation (CLA) is a technique that can be used to correct intramural ectopic ureters (EUs) in dogs.

Hypothesis/Objectives

To describe clinicopathologic, imaging, and cystoscopic findings in dogs undergoing CLA for intramural EU correction, and whether any of these findings are associated with continence outcomes.

Animals

Thirty‐one client‐owned dogs undergoing CLA between 2009 and 2019.

Methods

Retrospective cohort study. Data collected from medical records included signalment, clinical findings (including continence score at presentation), clinicopathologic findings (serum biochemistry profile, urinalysis, and urine culture results before CLA), ultrasonography, and cystoscopy findings. Follow‐up information was collected at 1 day to 1 week, 1 week to 1 month, and at >1 month time points after CLA. Final continence score was determined based on this follow‐up information. Multiple logistic regression was used to determine factors that were associated with final continence score.

Results

Median continence score of dogs at initial evaluation was 2 (range, 2‐4). Median continence score after CLA alone was 3 (range, 1‐5). Seventeen of 31 (54.8%) dogs received adjunctive medical management after CLA. Median continence score after CLA with or without adjunctive medical management was 5 (range, 1‐5). Overall, 67.7% of dogs were considered continent after CLA with or without adjunctive medical management. No preoperative or perioperative factors were found to be associated with final continence score.

Conclusions

Cystoscopic‐guided laser ablation for intramural EU in female dogs provides improvement in incontinence. Dogs remaining incontinent after CLA may improve with adjunctive medical management. Surgical management is required to manage incontinence in dogs with extramural EU.

Long-term outcome of female dogs treated for intramural ectopic ureters with cystoscopic-guided laser ablation

OBJECTIVE

To report the complications and long-term outcome of female dogs with intramural ectopic ureter(s) (iEU) undergoing cystoscopic-guided laser ablation (CLA) and determine the effect of post-CLA neutering on urinary continence.

STUDY DESIGN

Retrospective clinical study.

ANIMALS OR SAMPLE POPULATION

Thirty-four client-owned dogs.

METHODS

Medical records of female dogs that had iEU-CLA were reviewed. A 10-point continence score was assigned before, immediately after, and at a minimum of 12 months postprocedure via owner telephone contact. Neutering status prior to and postprocedure was recorded.

RESULTS

Continence scores increased in all dogs after CLA (p < .0001, mean duration of follow-up: 63.9 ± 5.7 months) with an increase of the median score from 2 (preprocedure) to 10 (postprocedure). A urethral tear occurred in 2/34 dogs immediately after the procedure, successfully managed conservatively. Mild hematuria was present in 2/34, lasting less than 48 h. Postoperative urinary tract infections were documented in 6/34 dogs. Two dogs died of urinary-related issues at 1 and 5 months after CLA. Complete and near-complete urinary continence (scores 9 and 10/10) was achieved in 26/32 dogs including 3 dogs requiring medical (2) or surgical interventions (1). Post-CLA neutering did not affect continence scores (p = .44).

CONCLUSION

A large proportion of dogs regained and maintained full continence after CLA alone. Subsequent medical or surgical therapy allowed further improvements when needed. Post-CLA neutering did not negatively impact urinary continence score.

CLINICAL SIGNIFICANCE

The beneficial effect of iEU-CLA in female dogs is long standing and not affected by postprocedural neutering.

Urinary incontinence in a dog with a duplex renal system and extramural ectopic ureter

A 1-year-old female spayed French Bulldog was referred to the Interventional Radiology and Endoscopy Service for evaluation of urinary incontinence with partial response to medical management (phenylpropanolamine). Cystourethroscopy and retrograde ureteropyelogram were performed and revealed multiple congenital abnormalities including; a duplex renal system of the left kidney with one normal ureter with an intravesicular ureteral orifice and one extramural ectopic ureter with an associated branching and ureteral diverticulum. A dual vagina was also noted. Left neoureterocystostomy of the extramural ectopic ureter was performed and a temporary ureteral stent was concurrently placed and removed cystoscopically one month later, leaving the patient with two patent left ureters. Thirty-four months later the patient is mildly incontinent with no other comorbidities.

[Cystoscopic-guided laser ablation for treatment of ectopic ureteroceles in 2 female dogs]

Two female intact Labrador Retriever dogs (6 and 3 months of age, respectively) presented with a history of urinary incontinence. In both dogs, abdominal ultrasound revealed evidence of a unilateral ectopic ureterocele. Diagnosis of ureteral ectopia was established urethrocystoscopically by visualization of the ureteral orifice in the urethra, and an intramural course was confirmed via retrograde contrast fluoroscopy. Ectopic ureteral orifices were stenotic in both dogs. Cystoscopic- and fluoroscopic-guided laser ablation of the ectopic ureter were performed with a Hol:YAG laser. Following the procedure, both dogs were fully continent without any medical treatment. Cystoscopic- guided laser ablation of ureteroceles was effective and safe in these 2 dogs. Thus, this minimally invasive technique for the treatment of ectopic ureteroceles provides an alternative to surgical intervention.

Surgical treatment of retroiliac ectopic ureters with secondary hydronephrosis and hydroureter in a dog

CASE DESCRIPTION

An 8-month-old 41.2-kg (90.6-lb) sexually intact male Dogue de Bordeaux with urinary incontinence and signs of nausea was referred for further evaluation and treatment of bilateral hydronephrosis, hydroureter, and ectopic ureters.

CLINICAL FINDINGS

Clinicopathologic analyses revealed urine specific gravity and serum concentrations of urea nitrogen and creatinine within reference limits. Abdominal ultrasonography and CT revealed unilateral abdominal cryptorchidism, ureters that bilaterally passed dorsal to and appeared compressed by the external iliac arteries (retroiliac ureters), and bilateral hydronephrosis, hydroureter, and ectopic ureters. On CT, minimal uptake of contrast medium by the right kidney indicated either a lack of renal function or ureteral obstruction.

TREATMENT AND OUTCOME

The dog underwent exploratory laparotomy, right ureteronephrectomy, left neoureterocystostomy, bilateral castration, and incisional gastropexy without complication and was discharged 2 days postoperatively. Eleven days after surgery, the dog had improved but continued urinary incontinence, improved left hydronephrosis and hydroureter, and serum concentrations of urea nitrogen and creatinine within reference limits. At 24 months after surgery, the dog was reportedly clinically normal, other than having persistent urinary incontinence.

CLINICAL RELEVANCE

To our knowledge, this was the first report of a dog with retroiliac ureters and compression-induced ureteral obstruction with secondary hydroureter and hydronephrosis. Retroiliac ureters should be considered as a differential diagnosis in young dogs with ureteral obstruction. Our findings indicated that a good outcome was possible for a dog with retroiliac ureters treated surgically; however, the presence of additional congenital anomalies should be considered and may alter the prognosis in dogs with retroiliac ureters.

Four-dimensional CT excretory urography is an accurate technique for diagnosis of canine ureteral ectopia

Computed tomographic (CT) excretory urography is commonly used to investigate canine ureteral ectopia (UE). Modern technology allows time-resolved CT imaging (four-dimensional CT excretory urography [4D-CTEU]) over a distance exceeding the detector collimation. Objectives of this prospective, observational, diagnostic accuracy study were to evaluate the diagnostic accuracy of CT excretory urography (CTEU) and 4D-CTEU for UE in dogs with lower urinary tract signs, assess the influence of pelvis positioning, and to determine the significance of the ureterovesical junction (UVJ) angle for UE diagnosis. Thirty-six dogs, with a total of 42 normotopic ureters, 27 intramural ectopic ureters, and three extramural ectopic ureters, underwent CTEU and 4D-CTEU with randomized pelvis positioning. Randomized CTEU and 4D-CTEU studies were scored by two observers for ureteral papilla location and murality on a grading scheme. Interobserver agreement, sensitivity, and specificity for ureter topia status and diagnosis were calculated. Computed tomographic excretory urography showed moderate interobserver agreement for the left ureter and perfect for the right ureter, whereas 4D-CTEU showed bilateral nearly perfect agreement between both observers. When comparing CTEU versus confirmed diagnosis, there was a sensitivity and specificity of 73% and 90.2%, respectively, whereas 4D-CTEU showed a sensitivity and specificity of 97% and 94.6%, respectively. An obtuse UVJ angle is significantly more commonly observed in ectopic intramural than normotopic ureters and is significantly associated with increased diagnostic confidence of UE. The use of a wedge to angle the pelvis did not increase the diagnostic confidence in determining ureteral opening position. Four-dimensional CT excretory urography is an accurate and reliable diagnostic technique to investigate UE as cause of urinary incontinence in dogs that is slightly superior to CTEU.

Spaying and urinary incontinence in bitches under UK primary veterinary care: a case-control study

Objectives

To evaluate associations between spaying and urinary incontinence in bitches under primary veterinary care in the UK.

Materials and Methods

A case–control study was nested within the study population of 333,910 bitches, which included all bitches within the VetCompass database with an electronic patient record in 2016 or in both 2015 and 2017. The electronic records were searched automatically for urinary incontinence cases, which were manually reviewed for inclusion. All non‐cases were included as controls. Additional demographic and clinical information was extracted on cases and controls.

Results

The study included 427 incident cases and 1708 controls that were presented between November 1, 2014 and October 31, 2017. Prior spaying was associated with increased odds of urinary incontinence (odds ratio: 3.01; 95% CIs: 2.23 to 4.05). Increased odds of urinary incontinence were additionally associated with increasing age and increasing bodyweight. Age at spay was not associated with urinary incontinence.

Clinical Significance

The findings support spaying as a major risk factor associated with urinary incontinence, but age at spay appears to be of less clinical importance. These results will help assist clinicians in making evidence‐based recommendations on spaying while taking other considerations for urinary incontinence into account.

Canine Incontinence

Incontinence is a frustrating condition for both pet owners and their veterinarians. Fortunately, most causes are easily diagnosed and most dogs respond to appropriate therapy. This article reviews normal urine storage and voiding, causes of incontinence, typical clinical presentation, diagnostics, and treatment.

Ureter ectópico extramural em um cão Labrador Retriever: relato de caso

RESUMO A ectopia ureteral é uma enfermidade congênita que se caracteriza quando um ou ambos os ureteres apresentam-se inseridos fora do seu local anatômico, com a inserção ocorrendo no útero, no colo da bexiga, na uretra ou na vagina, devido a uma diferenciação anormal dos ductos mesonéfricos e metanéfricos. Nos machos, a inserção pode ocorrer também nos ductos deferentes e na próstata. A incontinência urinária é o sinal clínico mais comumente associado ao ureter ectópico. O presente relato descreve um caso de ureter ectópico extramural unilateral, em um cão da raça Labrador Retriever de sete anos de idade, corrigido cirurgicamente, e mostra a importância dos exames radiográfico contrastado e ultrassonografia.

Combined Use of Intravesicular Ureteroneocystostomy Techniques to Correct Ureteral Ectopia in a Male Cat

A 2 yr old castrated male Himalayan presented for evaluation and treatment of persistent urinary incontinence that had been present since birth. Ultrasonographic evaluation of the urinary tract revealed suspected bilateral, extramural, ureteral ectopia that was confirmed at the time of surgical exploration. Marked left hydroureter and a normal right ureter were found entering the urethra ∼ 2 cm caudal to the bladder neck. An intravesicular mucosal apposition (modified Leadbetter-Politano) and “drop-in” ureteroneocystostomy techniques were used for reimplantation of the left and right ureter, respectively. Postoperatively, the cat gained urinary continence and remained continent and clinically normal 6 mo following surgery.

Bilateral extraluminal ectopic ureters in a Maine Coon cat

Ectopic ureters are rarely observed in cats. Therefore, for a better chance of success in the corrective surgical procedure and survival of the patient, diagnosis should be confirmed early. This report illustrates the occurrence of bilateral ectopic ureters in a seven month old Maine Coon cat and describes the medical and surgical management adopted for correction of the abnormality.

Ectopia ureteral unilateral congênita em uma cadela Teckel Dachshund com pelagem arlequim: relato de caso

O presente relato apresenta a primeira descrição de ectopia ureteral congênita na raça Teckel Dachshund, diagnosticada em uma cadela com pelagem arlequim. O animal, aos dois meses de idade, apresentava sinais de incontinência urinária e cistite bacteriana, sendo submetido a um plano diagnóstico para confirmação de ureter ectópico. A urografia excretora revelou hidroureter direito com desembocadura caudal ao trígono da bexiga. O exame físico do animal evidenciou ainda hérnia inguinal bilateral, o que reforçou a caracterização da origem congênita das alterações. Aspectos de bem-estar animal são também discutidos.

Ectopic ureters in male dogs: review of 16 clinical cases (1999-2007)

Ureteral ectopia is a well-described cause of urinary incontinence in female dogs, but this condition has not been completely characterized in male dogs. Sixteen male dogs with ectopic ureters were evaluated between Jan 1999 and Mar 2007. Male dogs were similar to female dogs with ectopic ureters in terms of breed, presenting complaint, age of onset, and bilateral nature of the ectopia. Diagnosis was made by expert interpretation of imaging techniques such as excretory urography and contrast-enhanced computed tomography (CT). Overall, 11 of 13 dogs that had surgical correction of ectopic ureters were incontinent preoperatively. Urinary continence was restored in 82% of those dogs.

Clinical Outcomes of Surgically Managed Ectopic Ureters in 33 DogsS

Factors that predict postoperative continence and incontinence were evaluated in 33 female dogs with surgically corrected ectopic ureters. The current study found that intramural or extramural, left- or right-sided, and unilateral or bilateral ectopic ureters were not significant factors influencing postoperative incontinence in affected dogs. The presence of either hydroureter or urinary tract infection was also not significantly associated with postoperative incontinence. Dogs with ectopic ureters that were incontinent postsurgically tended to remain unresolved.

Bilateral ureteral ectopia with renal dysplasia and urolithiasis in a dog

A 7-month-old, 4.3-kg, spayed female bichon frise was referred for evaluation of chronic urinary incontinence. Abdominal radiographs revealed calculi within the right kidney and ureter. An ultrasound revealed a small right kidney. An abdominal computed tomography scan with contrast revealed that the left ureter was extramurally ectopic, inserting into the proximal urethra. A right intramural ectopic ureter was identified during cystotomy. Ureteronephrectomy was performed on the right, and ureteroneocystostomy was performed on the left. A telephone conversation with the owner 4 months after surgery revealed that the dog exhibited no evidence of urine dribbling, and urinary continence was maintained well on phenyl-propanolamine (1.75 mg/kg orally q 12 hours). This is the first report of successful surgical management of bilateral ureteral ectopia with concurrent, unilateral, renal dysplasia and urolithiasis.

Delayed-onset urinary incontinence in five female dogs with ectopic ureters

This case series describes five female dogs with congenital ectopic ureter presenting with delayed-onset urinary incontinence out of 22 female dogs diagnosed with ectopic ureter over a 102-month period at a veterinary teaching hospital. All five dogs improved following surgical treatment of ectopic ureter, but only three remained continent long-term without further intervention. Delayed-onset urinary incontinence in female dogs with ectopic ureters may be more common than the current literature suggests. Congenital ectopic ureter should be considered and investigated as a possible contributing factor in female dogs presenting with delayed-onset urinary incontinence.

Urinary incontinence: selected current concepts

UI is highly prevalent in older adults and associated with excess comorbidity and increased mortality. Intensive screening and comprehensive clinical examination of all elders enables prompt detection, accurate classification, and appropriate treatment. OAB is the most common cause of persistent incontinence in the older adult. As with other types of UI, behavior modification is first-line treatment of OAB. Although antimuscarinic agents have been shown to be highly effective in the treatment of OAB, limited data are available regarding the safety and tolerability of these agents in older adults. Patients who fail to respond to noninvasive treatment or those in whom surgery may be appropriate should be referred to the urologist for evaluation and further management.

Comparison of two surgical techniques for management of intramural ureteral ectopia in dogs: 36 cases (1994–2004)

OBJECTIVE

To determine outcome associated with intramural ureteral ectopia treated with 1 of 2 surgical techniques (neoureterostomy with ligation of the distal ureteral segment vs neoureterostomy with resection of the distal ureteral segment) and compare results of these 2 techniques in dogs.

DESIGN

Multicenter retrospective case series.

ANIMALS

36 dogs (15 treated with the ligation technique and 21 treated with the resection technique).

PROCEDURES

Information was obtained from medical records. Long-term follow-up information was obtained by owner questionnaire.

RESULTS

15 of 21 (71%) dogs in the resection group and 7 of 14 (50%) dogs in the ligation group still had urinary incontinence after surgery. Three of 20 (15%) dogs in the resection group and 4 of 14 (29%) dogs in the ligation group reportedly had multiple episodes of urinary tract infection following surgery. The outcome of surgery was judged to be excellent by the owners of 10 of 18 (56%) dogs in the resection group and 9 of 14 (64%) dogs in the ligation group. No significant differences were found between surgery treatment groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of the present study suggest that although most owners of dogs that undergo surgery for treatment of intramural ureteral ectopia consider the outcome of surgery to be excellent, substantial proportions of dogs will continue to have urinary incontinence and recurrent urinary tract infections after surgery. Findings do not provide any support to the hypothesis that the resection technique is superior to the ligation technique for management of dogs with intramural ureteral ectopia.

Surgical management of urinary incontinence

Urethral sphincter mechanism incompetence and ureteral ectopia are the two most common causes of urinary incontinence in dogs and cats. Surgical treatments for both disorders have been described. Once a diagnosis is made, surgical intervention may lead to improved outcomes with resolution of incontinence in many patients. Proper case selection and surgical technique are critical in achieving clinical success when managing these difficult cases.

Bilateral ectopic ureters in a male dog with unilateral renal agenesis

A 1-year-old neutered male mixed-breed dog was evaluated because of signs of urinary incontinence. Retrograde positive contrast urethrocystography and excretory urography with pneumocystography revealed bilateral intramural ectopic ureters and absence of the right kidney. During abdominal exploratory surgery, only the left kidney was located. The left intramural ectopic ureter was repaired by neoureterostomy (creation of a new opening for the ureter to enable urine to empty into the bladder). The right ectopic ureter was ligated at its entrance into the urinary bladder serosa. Results of excretory urography (performed immediately after surgery and repeated 8 weeks later) revealed successful correction of the left intramural ectopic ureter. Twelve weeks after surgery, the dog remained continent. To the authors' knowledge, there are few reports of ectopic ureters in male dogs; furthermore, the urinary tract abnormalities detected concurrently in this dog are also unusual.