Intramural Ectopic Ureters Research Articles

Persistent urinary incontinence in female Golden Retrievers following laser ablation of intramural ectopic ureters may be associated with the presence of historical urinary tract infection.

To identify predictive factors for postoperative continence in female Golden Retrievers following cystoscopic-guided laser ablation of intramural ectopic ureters (CLA-EU). 41 client-owned female entire Golden Retrievers with uni- or bilateral intramural ectopic ureter(s) were retrospectively enrolled. Patients were diagnosed with ectopic ureters with a combination of ultrasonography and cystoscopy. CLA-EU was performed for all dogs so that each ureteral opening was considered to be in an appropriate position by a single operator. All dogs had short-term follow-up 4 weeks and long-term follow up > 10 weeks after the procedure via telephone, which included urinary continence scoring. Clinical factors and ultrasonographic and cystoscopic findings from initial presentation were evaluated to identify predictive factors for postoperative continence. Short-term urinary continence was achieved in 46.3% of dogs with no additional medical therapies. Presence of historical urinary tract infections prior to CLA-EU (OR, 0.130; 95% CI, 0.020 to 0.621; P = .018) was negatively correlated and ureteral dilatation (OR, 34.260; 95% CI, 1.813 to 2,143; P = .043) was positively correlated with likelihood of urinary continence. Long-term urinary continence was achieved in 63.4% of dogs, and presence of historical urinary tract infections was negatively prognostic (OR, 0.173; 95% CI, 0.023 to 0.856; P = .048). Female Golden Retrievers undergoing CLA-EU have similar outcomes to those reported for other mixed-breed cohorts with > 30% of dogs failing to regain urinary continence. Historical urinary tract infections were significantly associated with both short- and long-term urinary continence in our population.

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.

A unique complication: Iatrogenic renal pelvis perforation following accidental urinary catheterisation of an intramural ectopic ureter in a dog

AbstractA 5‐month‐old, female, entire golden retriever presented for investigation of urinary incontinence and recent urinary tract infection. While under general anaesthesia, a urinary catheter was placed to fill the bladder, aid accurate visualisation of the ureteral vesicular junction and facilitate a retrograde contrast study. The preliminary computed tomography was deemed unremarkable, and a computed tomography intravenous urethrogram was performed, followed by retrograde of contrast in an attempted vaginourethrogram. The post‐contrast retrograde study highlighted an unusually straight distal right ureter and contrast escaping into the right retroperitoneal space. Contrast‐enhanced ultrasonography supported haemorrhage into the perirenal space, and on retrospective analysis of preliminary pre‐contrast computed tomography sequences, the urinary catheter was identified in the right renal pelvis. Accidental catheterisation of the right intramural ectopic ureter and iatrogenic renal perforation was ultimately concluded. The dog made a full recovery with conservative management and to date has no chronic repercussions of the injury.

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)

To evaluate the safety and efficacy of cystoscopic-guided scissor transection of ectopic ureters (CST-EU) in female dogs. 8 incontinent female dogs with intramural ectopic ureters. 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. 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. 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.

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

To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic-guided laser ablation (CLA) in female dogs. Retrospective study from 2011 to 2018. Twenty-five female dogs. 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). 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 24.9months 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). 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. 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.

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

BackgroundCytoscopic‐guided laser ablation (CLA) is a technique that can be used to correct intramural ectopic ureters (EUs) in dogs.Hypothesis/ObjectivesTo 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.AnimalsThirty‐one client‐owned dogs undergoing CLA between 2009 and 2019.MethodsRetrospective 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.ResultsMedian 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.ConclusionsCystoscopic‐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.

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. Retrospective clinical study. Thirty-four client-owned dogs. 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. Continence scores increased in all dogs after CLA (p < .0001, mean duration of follow-up: 63.9 ± 5.7months) 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). 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. The beneficial effect of iEU-CLA in female dogs is long standing and not affected by postprocedural neutering.

Minimally invasive treatment of an intramural monolateral ectopic urether in a French bulldog with 78, XX (SRY‐negative) ovotesticular disorder of sexual development

AbstractA one‐year‐old phenotypically female French Bulldog was referred for urinary incontinence. Physical examination disclosed the presence of hypertrophic clitoris. Computer tomography highlighted the presence of a left intramural ectopic ureter, in presence of a fully constituted female reproductive tract. Retrograde cystoscopy confirmed the presence of the ectopic ureter that was treated with cystoscopic‐guided laser ablation although incontinence persisted. Ovariohysterectomy and clitoridectomy were performed and histopathology of gonads was consistent with ovotestis. The subject's karyotype was defined as XX SRY‐negative and the case was diagnosed with a 78 XX (SRY‐negative) disorder of sexual development. A treatment with phenylpropanolamine led to the resolution of the incontinence. The association of such disorder with ectopic ureter and urinary incontinence has never been reported in dogs. Our findings suggest that the displacement of the ureter might be related to an incorrect secretion of sexual hormones in fetal life due to the presence of ovotestis.

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.

Ureteral Stent Placement Using a Double J-Catheter in the Treatment of Ectopic Ureter in a Dog

Background: Ectopic ureter is a congenital anomaly in which the final segment of one or both ureteral orifices is located distal to the bladder trigone. It may be classified as intra- or extramural. Surgical treatment of ectopic ureters in dogs is recommended and the approach varies with the classification. In the postoperative period, complications are common. When stenosis of the new ureteral ostium occurs, immediate repeated surgery is recommended. This study aimed at using the double J catheter placement following neoureterostomy to treat urethral obstruction secondary to the surgical treatment of an intramural ectopic ureter in a dog.Case: An 8-month-old female French bulldog with dysuria and urinary incontinence was seen at a private veterinary hospital in Jaboticabal, São Paulo. The patient had previously been diagnosed with an intramural ectopic ureter on the right side following imaging tests (ultrasound, computed tomography, and abdominal radiography, excretory urography) and had undergone neoureterostomy and closure of the intramural pathway approximately a year ago. Ultrasonographic examination showed dilation of the caudal portion of the ureter and hydroureter, which was suggestive of right ureteral stenosis. Computed tomography was also performed to evaluate the kidneys, ureters, and bladder; an increase in the diameter of the right ureter in its middle portion and close to the bladder triangle was observed. A new surgical intervention was indicated and performed. The ureteral route was identified in a region of the bladder trigone, incised, and probed with a urethral probe No. 04. The intramural course in the proximal urethra was identified and probed with a 16G epidural catheter. It was necessary to perform a neoureterostomy. A longitudinal incision (spatulation) of approximately 5 mm was made in the distal portion of the right ureter to increase the circumference of the anastomosis. The double J 4.7 French (Fr) catheter was inserted through the new ureter ostium into the bladder and advanced into the right kidney in a retrograde manner. Once the proximal end of the double J catheter reached the renal pelvis, the guidewire was withdrawn slowly to allow the catheter to bend in the areas of the renal pelvis and the trigone. The distal end of the double J catheter that extended beyond the bladder lumen was sectioned for better bladder closure. The patient underwent clinical evaluation and laboratory tests (complete blood count and serum creatinine concentration, urine test with bacteriological culture and susceptibility test) 2 weeks after the procedure and, subsequently, every 3 months. Ultrasonography of the urinary tract was performed every 2 months.Discussion: We used a double J catheter in the patient due to a previous obstruction of the ureter ostium after the first surgical procedure. In this way, complications such as postoperative obstructions due to ureteritis and ureteral constriction were avoided and ureteral anastomosis was facilitated. It has been reported that animals subjected to ureteral stent placement have high incidences of dysuria and urinary tract infection, and low incidences of stent migration and occlusion. In this case, no signs of occlusion or obstruction of the implant were identified, but there was a recurrence of urinary tract infections. These frequently cause urethral obstruction associated with the healing of the new ureteral ostium. Patient follow-up and findings associated with the long-term insertion of the double J catheter provide support for the clinical relevance of the present report.

Use of Monopolar Cauterization for Ectopic Intramural Ureter Correction by Cystoscopy in Bitch

Background: The ectopic ureter (EU) is considered a congenital anomaly in which the ureteral aperture opens in a position other than the bladder neck. The diagnosis involves the use of different methods or combination of image exams, including excretory urography, pneumocystography, ultrasonography, cystoscopy and computed tomography. The technics for surgical repair should be considered evaluating the number and functionality of the EU, the location of the ureteral opening, functional condition of ipsilateral kidney and the presence of other abnormalities. The case reports aims to show the surgical repair of an intramural EU in an English Bulldog bitch by cystoscopy-guides monopolar cautery.Case: A 1-year-old English Bulldog bitch received medical care due to a history of urinary incontinence since a few months of life. The animal had laboratory abnormalities compatible with lower urinary tract infection, followed by a profound growth of Klebsiella sp in urine culture, and received antibiotic treatment for 21 days based on antibiogram results. Due to a suspect EU, a urinary tract tomography was performed and indicated a congenital kidney malformation (renal dysplasia), enlargement and distal insertion of the left ureter (in comparison with the contralateral one), rising suspiciously of its intramural progression. We choose to proceed to cystoscopy examination, in which both right and left ureteral ostium could be seen in the urethral region. A guide of a pigtail catheter was inserted through both ureteral ostia in order to orient the ureteral incision. The monopolar cautery was inserted in cystoscopy working channel to section the mucosa of EU channel on urethra region, separating the lumen of EU from the urethra and extending the incision cranially inside the urinary bladder lumen. After a complete section of the ectopic tissue, a pigtail urinary catheter was correctly placed in both ureters. After bilateral repair of EU, the bitch showed a significative decrease of urinary incontinence, although completer resolution could not be obtained.Discussion:Studies showing the treatment of EU using the ablation of the tissue separating the ureteral and urethral or bladder lumen using cystoscopy-guided laser showed lower post-operative pain and hospitalization time, besides being a minimally invasive technique in comparison with traditional surgery. The limiting factor is the specialized equipment required for the procedure. In our surgical routine, there is a cystoscope, however, we do not own a diode laser or radiofrequency equipment. The adaptation of a monopolar cautery with the objective of correct an intramural EU proved to be feasible in practice since we achieved satisfactory recovery of the patient, similar than what is seen with lasers. Even after surgical repair of both EU, the patient sustained urinary incontinence, although lesser than before surgery. The remaining of the clinical sign, in this case, is compatible with the low rate of postoperative urinary continence in bitches, irrespective of the surgical technique, varying between 25% and 58% with or without medical treatment. To our knowledge, there was no published report on the use of monopolar cautery to treat EU. The monopolar cautery can be used as a less invasive and alternative technique to traditional surgery in the treatment of intramural EU through cystoscopy in bitches.

Assessment of individual kidney function in a dog with congenital anomalies of the urinary tract

A 21-month-old entire female labrador retriever was presented for polyuria, pollakiuria, haematuria and intermittent urinary incontinence. Clinical signs were absent during antibiotic treatment but reoccurred shortly after completion of a...

Treatment of congenital distal ureteral orifice stenosis by endoscopic laser ablation in dogs: 16 cases (2010-2014).

OBJECTIVE To determine characteristics of and outcomes for dogs with congenital distal ureteral orifice stenosis (CDUOS) treated by cystoscopic-guided laser ablation (CLA). DESIGN Retrospective case series. ANIMALS 16 client-owned dogs with CDUOS treated by CLA at 2 veterinary hospitals between 2010 and 2014. PROCEDURES Medical records were reviewed and data collected regarding clinical findings, imaging results, surgery characteristics, treatment, and outcome. Follow-up information was collected from dog owners and referring veterinarians via standardized interview. RESULTS Dogs included 10 males and 6 females; median age was 11.5 months (range, 4 to 112 months). Labrador Retriever (n = 6; 3 males) was the most common breed. Intramural ectopic ureteral openings were identified at the site of stenosis in 15 dogs (18/20 stenotic ureteral openings). Treatment with CLA to enlarge and relocate the stenotic opening was successful in all dogs. Median duration of anesthesia and hospitalization was 105 minutes and 24 hours, respectively. No complications were noted. Fourteen dogs remained alive (2 lost to follow-up) during a median follow-up period of 14.5 months. Owners of 11 of 13 dogs reported improvement in their dog's quality of life after CLA. The treated ureteral orifice remained patent in the 2 dogs that were reimaged. CONCLUSIONS AND CLINICAL RELEVANCE CDUOS should be considered as a differential diagnosis for dogs with idiopathic distal ureteral obstruction, particularly young male Labrador Retrievers, and was most often associated with an intramural ectopic ureter in this study. Treatment with CLA was safe and effective for opening the ureteral orifice.

Computed tomographic excretory urography features of intramural ectopic ureters in 10 dogs.

To describe the morphologic and morphometric computed tomographic excretory urography features of intramural ectopic ureters in dogs. Retrospective evaluation of computed tomographic excretory urography studies in 10 dogs with surgical and/or cystoscopically confirmed intramural ectopic ureters. All studies were assessed for ureteral ectopia, dilatation, tortuosity, ureterovesicular junction morphology and ureteral orifice location. A total of 14 intramural ectopic ureters were confirmed at surgery/cystoscopy with reviewers correctly identifying 100% (14/14). Abnormalities on computed tomographic excretory urography included ureteral dilatation (7), ureteral tortuosity (3), lack of a normal ureterovesicular junction (14), urethral ureteral orifice location (14) and lack of ureteral divergence (14). Lack of a normal ureterovesicular junction, a urethral-ureteral orifice location and lack of ureteral divergence are common computed tomographic excretory urography findings in dogs with intramural ectopic ureters. This technique requires further investigation to determine whether it might allow differentiation of intramural and extramural ectopic ureters.

An Evaluation of Post-Operative Urinary Incontinence in Dogs with Intramural Ectopic Ureter Treated with Neoureterocystostomy

An Evaluation of Post-Operative Urinary Incontinence in Dogs with Intramural Ectopic Ureter Treated with Neoureterocystostomy

Endoscopic-guided laser ablation of vestibulovaginal septal remnants in dogs: 36 cases (2007–2011)

To describe the technique and evaluate short- and long-term outcomes in female dogs after endoscopic-guided laser ablation (ELA) of various vestibulovaginal septal remnants (VVSRs). Retrospective case series. 36 dogs. Medical records of dogs with VVSRs that underwent ELA were retrospectively reviewed. All patients underwent complete cystourethrovaginoscopy for diagnosis and treatment. Endoscopic-guided laser ablation (with a holmium:yttrium-aluminum-garnet or diode laser) was used to transect the vaginal membrane. Patients with intramural ectopic ureters were concurrently treated with ELA of their ectopic ureters. Endoscopy was repeated 6 to 8 weeks after ELA of vaginal remnants in some patients, and the procedure sites were reassessed. 36 female dogs with persistent paramesonephric septal remnants (n = 19), vaginal septa (11), or dual vaginas (6) were included. Twenty-six dogs had urinary incontinence, 2 had recurrent UTIs, and 8 had both. Thirty of 36 (83%) dogs had concurrent ectopic ureters. Endoscopic-guided laser ablation was performed with holmium:yttrium-aluminum-garnet and diode lasers in 8 and 28 dogs, respectively. Five dogs had mild postoperative dysuria for < 24 hours. One patient developed a complication involving inadvertent laser perforation of the vaginal wall. There were no negative effects from this event, and the perforation was fully healed within 8 weeks. At the time of follow-up, all defects were fully healed with no sign of recurrence in the 18 (50%) patients reevaluated. There was a significant improvement in continence scores and a significantly decreased incidence of UTIs after ELA. The median follow-up time was 34 months (range, 8 to 57 months). CONCLUSIONS AND CLINICAL RELEVENCE: The results of the present study indicated that ELA provided an effective, safe, and minimally invasive treatment option for various VVSRs in dogs, avoiding the need for more invasive surgery.

Surgical Correction of Ectopic Ureter in Dogs

A Maltese (case 1) and a Labrador Retriever (case 2) presented with urinary incontinence. General conditions were good and screening tests, including a complete blood count, serum chemistry and radiography, were performed. Excretory urography was conducted, and fluoroscopy was performed for case 1 and computed tomography was performed for case 2. The dogs were diagnosed as right extramural ectopic ureter in case 1 and bilateral intramural ectopic ureter in case 2. We performed surgical corrections, including a neoureterocystostomy for extramural ectopic ureter and neoureterostomy for intramural ectopic ureter. After surgery, the dogs were catheterized with an indwelling catheter for 3 days. Urinary incontinence improved completely and the clinical outcomes were good. The choice of adequate surgical procedure is important for correcting ectopic ureters in canines.

Correction of intramural ureteral ectopia by ureteral transection and neoureterostomy with the distal ureter left in situ

Retrospective study to determine postoperative continence when correcting intramural ureteral ectopia by transection of the ureter and neoureterostomy, leaving the distal ureter in situ. We hypothesised that the technique would achieve results comparable to previously described surgical techniques. Medical records for dogs that underwent surgery for correction of unilateral intramural ureteral ectopia were reviewed. Cases (n = 9) of a neoureterostomy where the distal ureter was left in situ were included. Postoperatively, owners were contacted by telephone or email and asked to complete a questionnaire, scoring their dog's urinary continence on a scale from 0 to 2 where 0 was completely continent, 1 was occasional incontinence during excitement or while recumbent and 2 was no improvement in postoperative urinary continence, with the dog having constantly wet perivulvar fur and constant dribbling of urine. All dogs showed signs of severe urinary incontinence prior to surgery, including constantly wet perivulvar fur and constant dribbling of urine. Postoperatively, six dogs had a score of 0 and three dogs improved to a score of 1. Time to follow-up after surgery ranged from 1 to 62 months. The results of this study support our hypothesis. The technique was simple to perform and urinary continence achieved was comparable to that of other techniques. We suggest that this technique should be considered as an alternative for the correction of intramural ureteral ectopia.

Ectopic Ureters in Dogs: Clinical Features, Surgical Techniques and Outcome

To compare clinical features of ectopic ureter (EU) in male and female dogs and outcome after neoureterostomy with resection restricted to the intravesical part of the ureter for intramural ectopic ureter (iEU) or of ureteroneocystostomy for extramural ectopic ureter (eEU). Retrospective case series. Female dogs (n = 26) with 32 iEU and 8 eEU; male dogs (n = 24) with 25 iEU and 18 eEU. Data were collected from medical records (1992-2008). Long-term follow-up information after surgical correction by modified neoureterostomy or ureteroneocystostomy was gathered by owner questionnaire. Median age at first occurrence of UI was significantly lower in females (<2 months) than in males with EU (8 months; P = 0.0015). Bilateral occurrence and an extramural course of the ureter were more common in males (n = 19 and n = 20, respectively) compared with females (14 and 12, respectively), but the outcome of surgical treatment was comparable in both genders. The prognosis after surgery is fair with a success rate of 72% and a complication rate of 26%. Resection of only the intravesicular ectopic ureter resulted in resolution of incontinence in a high percentage of dogs and thus is an acceptable alternative to removal of the entire ureteral remnant.

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

To describe and evaluate the short- and long-term outcomes in female dogs after cystoscopic-guided laser ablation of ectopic ureters (CLA-EU). Prospective case series. 32 incontinent female dogs with intramural ectopic ureters. A diagnosis of intramural ectopic ureters was made via cystoscopy and fluoroscopy in all patients. Transurethral CLA-EU (via diode laser [n = 27] or Holmium:yttrium aluminum garnet laser [3]) was performed to relocate the ectopic ureteral orifice cranially into the urinary bladder. All vaginal anomalies were treated with the laser concurrently. Follow-up evaluation was standardized and included urinary continence scoring, serial bacteriologic culture of urine samples, and a follow-up cystoscopy 6 to 8 weeks after CLA-EU. Ectopic ureteral orifices of all dogs were initially located in the urethra. Eighteen of 30 dogs had bilateral ectopic ureters, and 12 had unilateral ectopic ureters. All dogs had other concurrent urinary anomalies. At the time of last follow-up (median, 2.7 years after CLA-EU, [range, 12 to 62 months]), 14 of 30 (47%) dogs did not require any additional treatments following CLA-EU to maintain urinary continence. For the 16 residually incontinent dogs, the addition of medical management, transurethral bulking-agent injection, or placement of a hydraulic occluder was effective in 3, 2, and 4 dogs, respectively, improving the overall urinary continence rate to 77% (23/30 dogs). One dog had evidence of polypoid cystitis at the neoureteral orifice 6 weeks after CLA-EU that was resolved at 3 months. CLA-EU provided an effective, safe, and minimally invasive alternative to surgery for intramural ectopic ureters in female dogs.