Intravesical ureterocele with concurrent renal dysfunction in a dog: a case report and proposed classification system

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.

[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.

Cystoscopic-Guided Laser Ablation of an Ectopic Ureterocele in a Female Dog

An intact female dog was examined for urinary incontinence. A right-sided ectopic ureterocele with bilateral hydroureter and pyelectasis was diagnosed via ultrasonography, with concurrent complicated urinary tract infection. Following a course of antibiotics, cystoscopic-guided laser ablation was performed, and the dog remained continent at 3 mo follow-up. Cystoscopic-guided laser ablation provides a minimally invasive alternative to open surgery and is the treatment of choice in humans, and this case report demonstrates it is feasible in canine patients.

Endoscopic laser-ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008-2017)

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.

Use of cystoscopic-guided laser ablation for treatment of unilateral ureterovesicular stenosis and secondary orthotopic ureterocele in a female dog

CASE DESCRIPTION A 4-year-old spayed female Beagle was evaluated because of a 2-month history of intermittent pollakiuria, stranguria, dysuria, and abdominal pain. A diagnosis of bacterial cystitis was initially made, but clinical signs persisted despite appropriate antimicrobial treatment, so the dog was referred for further evaluation and treatment. CLINICAL FINDINGS Abdominal ultrasonography revealed a large, thin-walled, cystic structure in the urinary bladder at the level of the expected right ureterovesicular junction that communicated with the uniformly dilated right ureter. Severe right-sided pyelectasia was also detected. A presumptive diagnosis was made of a right-sided orthotopic ureterocele with secondary hydroureter and pyelectasia. TREATMENT AND OUTCOME Cystoscopy revealed a large cystic structure in the region of the right ureterovesicular junction without obvious communication between the ureter and urinary bladder. Portable C-arm fluoroscopy was used to confirm the presence of an intramural orthotopic tract and to measure the diameter of the ureter and renal pelvis via retrograde contrast ureteropyelography. Complete laser ablation of the ureterocele was performed by incising it circumferentially near its base. Clinical signs resolved immediately following the procedure. Six weeks later, the dog remained free of clinical signs and abdominal ultrasonography revealed resolution of hydroureter with persistence of mild right-sided pyelectasia. CLINICAL RELEVANCE Cystoscopic-guided laser ablation of an orthotopic ureterocele secondary to ureterovesicular stenosis was a safe and effective minimally invasive treatment for the dog of this report, resulting in immediate and continued improvement of clinical signs and ultrasonographic changes. Laser ablation should be considered as an alternative to surgery for the treatment of orthotopic ureteroceles in dogs.

Ureterocele ectópica em cão: relato de caso

Relataram-se o quadro clínico, o diagnóstico, o tratamento e o acompanhamento de um cão com ureterocele ectópica e hidronefrose/hidroureter associados. Após as informações obtidas nos exames laboratoriais e de diagnóstico por imagem, o animal foi submetido à ureterocelectomia e à neoureterostomia. O cão apresentou evolução favorável após a conduta terapêutica. Apesar de pouco frequente, a ureterocele deve ser considerada como diagnóstico diferencial em animais jovens com histórico de incontinência urinária.

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.

Diagnosis and management of ureteroceles in two female dogs

Two intact female dogs were examined for refractory pollakiuria and stranguria. One of these two dogs also exhibited urinary incontinence. Ectopic ureteroceles were diagnosed via ultrasonography and cystoscopy in both dogs. Both dogs were taken to surgery for ureterocele resection and neoureterostomy, resulting in complete resolution of clinical signs. Although uncommonly reported in the veterinary literature, ectopic ureteroceles can be associated with recurrent lower urinary tract infection with and without urinary incontinence. With a correct diagnosis and appropriate treatment, prognosis for ectopic ureteroceles can be good provided there is not a concurrent significant loss of renal function.

Ectopic Ureterocele in a Male Dog: A Case Report and Review of Surgical Management

A 16-week-old, male border terrier was presented for urinary incontinence. Intravenous urography demonstrated a right-sided, extravesical ectopic ureterocele. Neoureterocystostomy and ureterocele omentalization were performed. Urinary incontinence persisted after surgery. Retrograde urethrography revealed communication between the ureterocele and urethra. Urinary incontinence resolved following partial ureterocelectomy and reconstruction of the proximal urethra.

Ectopic Ureterocele in a Cat

A 9-month-old, castrated male domestic shorthair cat with urinary incontinence was referred for surgical correction of an ectopic ureter. Excretory urography revealed hydronephrosis of the right kidney, right hydroureter, and ureterocele. A partial ureterocelectomy and neoureterocystostomy were performed. This report describes the surgical modification of the ureterocele and ectopic ureter to correct ipsilateral hydronephrosis, hydroureter, and urinary incontinence.

Excretory urography

Excretory urography is a type of contrast study used to verify and localize upper urinary tract disease. In some instances, information regarding renal function and disease pathophysiology can also be obtained. With the recent advances in small animal ultrasonagraphy, excretory urography has become an underutilized procedure. This article will help explain why excretory urography remains, and will remain, a ubiquitous test that gives excellent detail of the entire urinary tract, and remains an essential tool for the assessment of the renal pelves and especially the ureters. Specifically, this article will focus on technique and interpretation of a properly performed excretory urogram.

Management of ureteral obstruction

The most common cause of ureteral obstruction in dogs and cats is ureteral calculi. Common clinical signs associated with ureteral obstruction include abnormalities in urination, persistent urinary tract infection, abdominal pain, vomiting, anorexia, weight loss,and depression or lethargy. Medical management of ureteral obstruction includes fluid diuresis, muscle relaxants, and treatment of azotemia using nephrostomy tubes or hemodialysis. Surgical techniques used to restore patency to the ureter include ureterotomy,partial ureterectomy and ureteroneocystostomy, and ureteral resection and anastomosis. Lithotripsy has been used in dogs to remove ureteral calculi. Renal function can be preserved if complete ureteral obstruction is relieved within several days of onset.