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Ectopic Ureters

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

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  1. Ectopic Ureters Morgan Tannenbaum

  2. 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

  3. Clinical Signs • Continuous or intermittent urinary incontinence- but may urinate normally • Urinary tract infections

  4. 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

  5. Anatomical Presentation Intramural Extramural

  6. 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

  7. Retrograde Vaginal Urethrogram

  8. 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

  9. 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

  10. DDx • Ectopic Ureter • Ureterocoele • Urinary tract infection • Urethral sphincter incompetence • Behavioral • Neurogenic

  11. 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

  12. 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

  13. Excretory Urography

  14. 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

  15. Future CT is the gold standard for diagnosis of ectopic ureters but is not commonly used due to availability and expense

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