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Cortez GL, Thomson CB, Scharf VF, Berent A, Buote NJ, Carson BA, Cassandra M, Mayhew PD, Singh A. Presentation, diagnosis, and outcomes of cats undergoing surgical treatment of ectopic ureters. Vet Surg 2024; 53:1019-1028. [PMID: 38863141 DOI: 10.1111/vsu.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/22/2024] [Accepted: 04/26/2024] [Indexed: 06/13/2024]
Abstract
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.
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Affiliation(s)
- Gabriela L Cortez
- Massachusetts Veterinary Referral Hospital, Ethos Discovery, Woburn, Massachusetts, USA
| | - Christopher B Thomson
- Veterinary Specialty Hospital, Ethos Discovery-North County, San Marcos, California, USA
| | - Valery F Scharf
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Allyson Berent
- Animal Medical Center, Interventional Endoscopy Service, New York, New York, USA
| | - Nicole J Buote
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Brittney A Carson
- The Ohio State University, College of Veterinary Medicine, Columbus, Ohio, USA
| | - Margaret Cassandra
- The Ohio State University, College of Veterinary Medicine, Columbus, Ohio, USA
| | - Philipp D Mayhew
- University of California-Davis, School of Veterinary Medicine, Davis, California, USA
| | - Ameet Singh
- Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Song MK, Fracka AB, Karn K, Roberts GD, Fransson BA. Receiver operating characteristics of computed tomography (CT) compared to cystoscopy in diagnosis of canine ectopic ureters: Thirty-five cases. Vet Surg 2024; 53:494-502. [PMID: 38287206 DOI: 10.1111/vsu.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE The aim of the study was to determine receiver operating characteristics (ROC) of computed tomographic excretory urography (CTEU) in predicting cystoscopic findings of ureteral anatomy. STUDY DESIGN Retrospective cohort study. ANIMALS Thirty-five client-owned dogs. METHODS The medical records of dogs referred for suspected ectopic ureters were reviewed. Inclusion criteria included CTEU findings reported by board-certified radiologists, followed by rigid cystoscopy with or without ureteral cystoscopic laser ablation (CLA). Data included signalment, urinary incontinence degree, body condition score, weight, degree of colon distension, CTEU and cystoscopy findings. ROC analysis was used to compare CT-predicted ureteral orthotopia/ectopia to cystoscopy findings. Additionally, ROC of CT predicted ureteral orifice locations was analyzed. Regression covariate analysis was performed to identify factors that may have influenced accuracy of diagnosis. RESULTS The ability of CT to identify a normal and intra-or extramural ectopic ureters conclusively and correctly was 13/26 (50%) and 32/41(78%), respectively. Sensitivity and specificity of identifying extramural versus intramural ureters was 2/7 versus 30/46 (29 vs. 65%) and 61/63 versus 17/24 (97 vs. 71%), respectively. Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively. Covariate analysis failed to identify interfering factors. CONCLUSIONS CT did not accurately predict anatomy of ureters; CT findings may need confirmation by cystoscopy and possibly intraoperative fluoroscopy prior to determining if CLA is indicated or not. CLINICAL SIGNIFICANCE Our results may be of importance for surgeons interpreting the CTEU findings. CTEU prediction of the location of the ureteral orifice shows low sensitivity especially in or close to the urethral sphincter area.
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Affiliation(s)
| | | | - Krystina Karn
- Washington State University, Pullman, Washington, USA
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Kim M, Aerin J, Traslavina RP, Yoon H. Orthotopic ureterocele with concurrent ureteral urothelial carcinoma in a dog. Vet Med Sci 2022; 8:1881-1886. [PMID: 35820027 PMCID: PMC9514461 DOI: 10.1002/vms3.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mu‐Young Kim
- Department of Veterinary Surgery College of Veterinary Medicine Konkuk University Seoul Republic of Korea
| | - Jeong Aerin
- Department of Veterinary Surgery College of Veterinary Medicine Konkuk University Seoul Republic of Korea
| | | | - Hun‐Young Yoon
- Department of Veterinary Surgery College of Veterinary Medicine Konkuk University Seoul Republic of Korea
- KU Center for Animal Blood Medical Science Konkuk University Seoul Republic of Korea
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Dekerle B, Maurice E, Decambron A, Viateau V, Maurey C, Manassero M. Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation. Vet Surg 2022; 51:568-575. [PMID: 35348227 DOI: 10.1111/vsu.13807] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/16/2022] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Bastien Dekerle
- Department of Surgery, ChuvA, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Emeline Maurice
- Department of Surgery, ChuvA, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Adeline Decambron
- Department of Surgery, ChuvA, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Véronique Viateau
- Department of Surgery, ChuvA, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Christelle Maurey
- Department of Internal Medicine, ChuvA, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Mathieu Manassero
- Department of Surgery, ChuvA, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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Uva A, Gernone F, Cavalera MA, D'Ippolito P, Ricciardi M, Carelli G, Zatelli A. Acquired partial lower urinary tract obstruction caused by intravesical ureterocele in an adult dog. J Small Anim Pract 2022; 63:707-712. [PMID: 35211999 PMCID: PMC9543016 DOI: 10.1111/jsap.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- A Uva
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Strada Provinciale per Casamassima km. 3, 70010, Valenzano, Italy
| | - F Gernone
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Strada Provinciale per Casamassima km. 3, 70010, Valenzano, Italy
| | - M A Cavalera
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Strada Provinciale per Casamassima km. 3, 70010, Valenzano, Italy
| | - P D'Ippolito
- Laboratorio ACV Triggiano, Via C. Battisti 255/257, 70019, Triggiano, Italy
| | - M Ricciardi
- Private Practitioner CT-MRI Support Service, Via dei Glicini 11, 70016, Noicattaro, Italy.,Centro Veterinario Polidiagnostico, Via A. Stradella 49, 76123, Andria, Italy.,Ospedale Veterinario S. Fara, Via Generale Nicola Bellomo 91 bis, 70124, Bari, Italy
| | - G Carelli
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Strada Provinciale per Casamassima km. 3, 70010, Valenzano, Italy
| | - A Zatelli
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Strada Provinciale per Casamassima km. 3, 70010, Valenzano, Italy
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Lew LJ, Berent AC, Kirsch MS, Weisse CW. Bladder wall adhesion causing a vesicular septum in a dog following surgical cystotomy. J Am Vet Med Assoc 2022; 260:1-8. [PMID: 35175927 DOI: 10.2460/javma.21.01.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 8-year-old spayed female Yorkshire Terrier-Poodle dog was evaluated for persistent pollakiuria and stranguria following routine cystotomy for calcium oxalate cystoliths. CLINICAL FINDINGS The dog presented for a cystotomy with intermittent hematuria. Postoperative radiographs revealed no remaining cystoliths. Urine, cystolith, and bladder mucosal aerobic cultures were negative. Pollakiuria, stranguria, and hematuria developed immediately after surgery and persisted despite antibiotics. Ultrasound revealed suspected fibrous adhesions within the urinary bladder lumen connecting the dorsal and ventral bladder wall creating a septum. This was confirmed cystoscopically 4 weeks after surgery. TREATMENT AND OUTCOME Cystoscopic-guided laser ablation was performed to incise abnormal tissue connecting the ventral and dorsal bladder wall using a holmium:yttrium-aluminum-garnet laser. Three weeks later, ultrasound revealed adhesion resolution though mild pollakiuria and stranguria persisted. Oxybutynin was prescribed and clinical signs resolved. At 27 months after ablation, hematuria occurred with recurrent cystoliths. These cystoliths were removed by percutaneous cystolithotomy, documenting a cystoscopically normal bladder wall. The patient had normal urination for 55.5 months after ablation, with normal bladder wall thickness on ultrasound repeated at 27 and 36 months after ablation. CLINICAL RELEVANCE To the authors' knowledge, an adhesion creating a septum between the dorsal and ventral bladder wall has not been previously reported as a complication after cystotomy in any species and should be considered as a cause of persistent lower urinary signs after surgery. Ultrasound identified the lesion in this dog. Because bladder abnormalities can develop quickly after surgery, ultrasound might be considered if urine testing is not supportive of infection. Cystoscopic-guided laser ablation was a successful minimally invasive treatment in this case.
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Werner M, Meyer-Lindenberg A, Felten S, Hartmann K, Dorsch R. [Cystoscopic-guided laser ablation for treatment of ectopic ureteroceles in 2 female dogs]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2021; 49:310-316. [PMID: 33890272 DOI: 10.1055/a-1428-7266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Melanie Werner
- Medizinische Kleintierklinik, Zentrum für klinische Tiermedizin, Ludwig-Maximilians-Universität München
| | - Andrea Meyer-Lindenberg
- Chirurgische und Gynäkologische Kleintierklinik, Zentrum für klinische Tiermedizin, Ludwig-Maximilians-Universität München
| | - Sandra Felten
- Medizinische Kleintierklinik, Zentrum für klinische Tiermedizin, Ludwig-Maximilians-Universität München
| | - Katrin Hartmann
- Medizinische Kleintierklinik, Zentrum für klinische Tiermedizin, Ludwig-Maximilians-Universität München
| | - Roswitha Dorsch
- Medizinische Kleintierklinik, Zentrum für klinische Tiermedizin, Ludwig-Maximilians-Universität München
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Rogatko CP, Berent AC, Adams LG, Weisse CW, Bagley D. Endoscopic laser-ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008-2017). J Vet Intern Med 2019; 33:670-679. [PMID: 30740771 PMCID: PMC6430922 DOI: 10.1111/jvim.15424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/11/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Ureteroceles are a rare condition in dogs in which conventional treatments can result in substantial morbidity. Cystoscopic and fluoroscopic-guided laser ablation (CLA) of ureteroceles can successfully relieve obstruction. OBJECTIVES To describe the technique and outcomes of attempting CLA for treatment of ureteroceles in dogs. ANIMALS Thirteen client-owned dogs that underwent CLA for treatment of ureteroceles. METHODS Retrospective multicentered study. Medical records were reviewed in all dogs that underwent CLA for ureterocele(s). A laser was used to extend the opening of the ureteral orifice (UO) unless surgical conversion was necessary. Data collected included signalment, clinicopathologic data, imaging, procedural findings, complications, and short- and long-term outcome. RESULTS Thirteen dogs with 13 ureteroceles associated with 14 UOs resulting in ureteral obstruction were included. One ureterocele extended bilaterally. Treatment was initiated via retrograde cystoscopy (7 females), percutaneous perineal urethrocystoscopy (4 males), or percutaneous antegrade cystoscopy (2 males). Surgical conversion was necessary in 2 males. Ten of 14 (71%) UOs associated with the ureteroceles were ectopic. Thirteen of 14 had stenotic or imperforate UOs. No postoperative complications were noted. Preoperative incontinence or pollakiuria was present in 9 of 13 and 3 of 13 dogs and resolved in 8 of 9 and 3 of 3 dogs, respectively. Follow-up imaging showed resolution of all ureteroceles and improved ureteral/renal pelvic dilatation. Median follow-up time was 27 months (range, 3-96 months). CONCLUSIONS AND CLINICAL IMPORTANCE Cystoscopic-guided laser ablation was effective for the treatment of ureteroceles(s) in 11 of 13 dogs.
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Affiliation(s)
- Cleo P Rogatko
- Department of Interventional Radiology/Interventional Endoscopy, The Animal Medical Center, New York, New York
| | - Allyson C Berent
- Department of Interventional Radiology/Interventional Endoscopy, The Animal Medical Center, New York, New York
| | - Larry G Adams
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana
| | - Chick W Weisse
- Department of Interventional Radiology/Interventional Endoscopy, The Animal Medical Center, New York, New York
| | - Demetrius Bagley
- Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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