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Ectopic Ureters. Morgan Tannenbaum. Signalment. Usually young (congenital) Primarily clinical condition in females Males have longer external urethral sphincter Incidence unknown- estimated at 0.016-0.045% Breed predisposition Cats- no breed disposition Dogs Siberian husky
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Ectopic Ureters Morgan Tannenbaum
Signalment • Usually young (congenital) • Primarily clinical condition in females • Males have longer external urethral sphincter • Incidence unknown- estimated at 0.016-0.045% • Breed predisposition • Cats- no breed disposition • Dogs • Siberian husky • West Highland white terrier, fox terrier • Labrador and golden retrievers
Clinical Signs • Continuous or intermittent urinary incontinence- but may urinate normally • Urinary tract infections
Anatomical Presentation • Most commonly bilateral but can be unilateral • Presentations • Intramural (most common) • Extramural • Double ureteral openings • Trough • Ureter may empty into • Neck of bladder • Urethra • Uterus • Vagina or vestibule
Anatomical Presentation Intramural Extramural
Diagnosis • Ultrasound • helpful ultrasound findings include: • Ureter jet • Difference in SpGr in ureter vs. bladder • Only suggestive, good for ruling out EU • Detection of ureter beyond the trigone • Implantation into urethra • Dilation of ureter or renal pelvis • Transurethral cystoscopy • Requires general anesthesia • Excretory urography- contrast • CT
Case – Brandy Magillicutty • 4 month old F/I Golden Retriever • Presented to referring veterinarian 1 month ago with history of intermittent incontinence • Has dribbled urine since they acquired her at 2 months of age • Urinalysis was performed and Brandy was diagnosed with a UTI • Was treated with 2 week course of Clavamox • UTI resolved but dribbling continued • Was treated with PPA- no improvement over past 2 weeks
History continued… • Brandy presented to NCSU-VTH earlier this week for evaluation of urinary incontinence • She is able to posture to urinate and produce an appropriate stream of urine • When left in kennel owners sometimes find her rear-end to be urine soaked • She eats and drinks normally and is otherwise a happy and healthy dog
DDx • Ectopic Ureter • Ureterocoele • Urinary tract infection • Urethral sphincter incompetence • Behavioral • Neurogenic
Diagnostics • Physical exam unremarkable • Urinalysis- USG (1.026), pH (6.5), blood 2+, bacteria 2+ 4. Urine culture: pending • Abdominal Ultrasound • Marked pyelectasia • The left ureter is severely dilated, up to 10.7 mm in diameter • The left ureter is seen inserting into proximal urethra
Diagnostics • Excretory Urography • A dilated renal pelvis is identified, due to filling with contrast medium. The left ureter is markedly dilated and courses caudally to insertion point in proximal urethra
Treatment • Plan to have Ureteroneocystostomy following results of urine culture and a course of antibiotics • The ureter is resected from the urethra and anastamosed to a more proximal location in the bladder • Other surgical options for ectopic ureters • Intramural EU • Neoureterocystostomy • About 30% remain incontinent • Laser transection of wall between EU and wall of bladder • Alpha agonist therapy may improve outcome
Future CT is the gold standard for diagnosis of ectopic ureters but is not commonly used due to availability and expense