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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 - PowerPoint PPT Presentation
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Ectopic UretersMorgan Tannenbaum
SignalmentUsually young (congenital)Primarily clinical condition in females
Males have longer external urethral sphincterIncidence unknown- estimated at 0.016-
0.045%Breed predisposition
Cats- no breed dispositionDogs
Siberian husky West Highland white terrier, fox terrier Labrador and golden retrievers
Clinical SignsContinuous or intermittent urinary
incontinence- but may urinate normallyUrinary tract infections
Anatomical PresentationMost commonly bilateral but can be unilateralPresentations
Intramural (most common)ExtramuralDouble ureteral openingsTrough
Ureter may empty intoNeck of bladderUrethraUterusVagina or vestibule
Anatomical PresentationIntramural Extramural
DiagnosisUltrasound
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- contrastCT
Retrograde Vaginal Urethrogram
Case – Brandy Magillicutty4 month old F/I Golden RetrieverPresented to referring veterinarian 1 month ago
with history of intermittent incontinenceHas dribbled urine since they acquired her at 2
months of age Urinalysis was performed and Brandy was
diagnosed with a UTIWas treated with 2 week course of ClavamoxUTI 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 incontinenceShe is able to posture to urinate and produce
an appropriate stream of urineWhen left in kennel owners sometimes find
her rear-end to be urine soakedShe eats and drinks normally and is
otherwise a happy and healthy dog
DDxEctopic UreterUreterocoeleUrinary tract infectionUrethral sphincter incompetenceBehavioralNeurogenic
DiagnosticsPhysical exam unremarkableUrinalysis- USG (1.026), pH (6.5), blood 2+,
bacteria 2+ 4. Urine culture: pendingAbdominal Ultrasound
Marked pyelectasiaThe left ureter is severely dilated, up to 10.7
mm in diameterThe left ureter is seen inserting into proximal
urethra
DiagnosticsExcretory 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
Excretory Urography
TreatmentPlan to have Ureteroneocystostomy following
results of urine culture and a course of antibioticsThe ureter is resected from the urethra and
anastamosed to a more proximal location in the bladder
Other surgical options for ectopic uretersIntramural EU
Neoureterocystostomy About 30% remain incontinent
Laser transection of wall between EU and wall of bladderAlpha agonist therapy may improve outcome
FutureCT is the gold standard for diagnosis of ectopic ureters but is not commonly used due to availability and expense