Delayed-onset urinary incontinence in five female dogs with ectopic ureters

This case series describes five female dogs with congenital ectopic ureter presenting with delayed-onset urinary incontinence out of 22 female dogs diagnosed with ectopic ureter over a 102-month period at a veterinary teaching hospital. All five dogs improved following surgical treatment of ectopic ureter, but only three remained continent long-term without further intervention. Delayed-onset urinary incontinence in female dogs with ectopic ureters may be more common than the current literature suggests. Congenital ectopic ureter should be considered and investigated as a possible contributing factor in female dogs presenting with delayed-onset urinary incontinence.     

Bilateral ectopic ureters in a male dog with unilateral renal agenesis

A 1-year-old neutered male mixed-breed dog was evaluated because of signs of urinary incontinence. Retrograde positive contrast urethrocystography and excretory urography with pneumocystography revealed bilateral intramural ectopic ureters and absence of the right kidney. During abdominal exploratory surgery, only the left kidney was located. The left intramural ectopic ureter was repaired by neoureterostomy (creation of a new opening for the ureter to enable urine to empty into the bladder). The right ectopic ureter was ligated at its entrance into the urinary bladder serosa. Results of excretory urography (performed immediately after surgery and repeated 8 weeks later) revealed successful correction of the left intramural ectopic ureter. Twelve weeks after surgery, the dog remained continent. To the authors' knowledge, there are few reports of ectopic ureters in male dogs; furthermore, the urinary tract abnormalities detected concurrently in this dog are also unusual.     

Clinical outcomes of surgically managed ectopic ureters in 33 dogs

Factors that predict postoperative continence and incontinence were evaluated in 33 female dogs with surgically corrected ectopic ureters. The current study found that intramural or extramural, left- or right-sided, and unilateral or bilateral ectopic ureters were not significant factors influencing postoperative incontinence in affected dogs. The presence of either hydroureter or urinary tract infection was also not significantly associated with postoperative incontinence. Dogs with ectopic ureters that were incontinent postsurgically tended to remain unresolved.     

Congenital Ureteral Ectopia in Continent and Incontinent‐Related Entlebucher Mountain Dogs: 13 Cases (2006–2009)

Background: Ectopic ureters (EUs) associated with varying combinations of urinary incontinence, hydronephrosis, and urinary tract infection have been identified in related North American Entlebucher Mountain Dogs. Objectives: To characterize the disease phenotype in affected dogs and evaluate possible modes of inheritance. Animals: Twenty client‐owned Entlebucher Mountain Dogs. Nine dogs had clinical signs of urinary tract disease. Methods: Prospective case series in which 17 dogs were evaluated with excretory urography, ultrasonography, and urethrocystoscopy. Three additional dogs were evaluated by necropsy alone. Clinical and pedigree histories from 165 North American Entlebuchers were compiled for analysis. Results: Eleven female and 2 male dogs were found to have EUs. Six females and 1 male were continent. Bilateral intravesicular ectopic ureters (IVEUs) were identified in 9 dogs, bilateral extravesicular ectopic ureters (EVEUs) in 3 dogs, and 1 dog had IVEU and EVEU. Hydronephrosis was identified in 5 dogs, 3 of which had bilateral IVEUs. Two necropsied dogs had bilateral hydronephrosis with presumed ureterovesical junction obstruction associated with chronic granulation tissue or lymphoplasmacytic inflammation. Twenty‐six dogs with EUs were identified in the pedigree. Because of incomplete penetrance, mode of inheritance could not be determined. Conclusions and Clinical Importance: Ureteral ectopia is common in North American Entlebucher Mountain Dogs and clinical signs alone could not reliably predict disease phenotype. EVEUs were associated with urinary incontinence and occasionally hydronephrosis. IVEUs were clinically silent or associated with hydronephrosis. Further analyses are necessary to confirm and characterize the hereditary nature of the disorder.     

Four cases of lowered urethral pressure in canine ectopic ureter

To evaluate the function of the constrictor urethrae of dogs that had urinary incontinence and were diagnosed as having ectopic ureter, the urethral pressure profile (UPP) was measured by means of a microchip catheter transducer. The UPPs (14.5 +/- 3.3 mmHg) of the four dogs suffering from ectopic ureter were much lower (p<0.001) than the UPPs of clinically healthy female dogs (35.3 +/- 5.7 mmHg). In the cases of ectopic ureter, it was shown that the UPP was lowered, and it was suggested that this would lead to the expression of urinary incontinence.     

Ectopic ureter in the horse: Three cases and a review of the literature

Ureterovesicular anastomosis resulted in resolution of the clinical signs of urinary incontinence in three horses with unilateral ectopic ureter. Follow-up of two of the horses ten months and three years later indicated no further urinary tract problems; the third horse died four days after surgery from intestinal infarction.

Diagnosis can be readily confirmed by antegrade or retrograde ureterography, or endoscopic visualization of the ectopic ureteral openings. Nephrectomy appears indicated in cases of unilateral ectopic ureter with associated ipsilateral urinary tract infection or hydronephrosis, providing the contralateral kidney has normal function. Ureterovesicular anastomosis appears to be indicated in the management of unilateral ectopic ureters in the absence of ascending urinary tract infection or hydronephrosis, and in cases of bilateral ectopic ureters.

     

ULTRASONOGRAPHIC FINDINGS IN 14 DOGS WITH ECTOPIC URETER

To evaluate ultrasonography as an alternative to contrast radiography for diagnosis of ectopic ureter in dogs, ultrasonography of the urinary tract was performed prospectively in a series of urinary incontinent dogs anesthetized for contrast radiography. Fourteen dogs had ectopic ureter based on surgical, necropsy or unequivocal contrast radiographic findings. There were eight females and six males of a variety of breeds; five were Labrador retrievers. Mean (range) age at the time of diagnosis was 1.2 (0.2–4) years for females and 3.5 (0.3–5) for males (p < 0.05). Ectopic ureters were unilateral in five dogs (2 left; 3 right) and bilateral in nine dogs. Both ultrasound images and contrast radiographs were positive for 21 (91%) ectopic ureters; the same two ectopic ureters were not detected using either modality. The termination of each of the five normal ureters was visible on ultrasound images; two (40%) were visible on radiographs. Other ultrasonographic findings included dilatation of the ectopic ureter and/or ipsilateral renal pelvis in ten (43%) instances, evidence of pyelonephritis in two dogs (with enlargement of the contralateral kidney in one dog), and urethral diverticuli in one dog. Ultrasonography is a practical diagnostic test for ectopic ureter in dogs. In this series there was close correlation between the ultrasonographic and contrast radiographic findings for each ectopic ureter, but ultrasonography enabled more accurate determination of normal ureteral anatomy.     

Reduction of hydronephrosis and hydroureter associated with ectopic ureters in two dogs after ureterovesical anastomosis

Severe hydronephrosis and hydroureter associated with ectopic ureters were diagnosed in 2 dogs. Surgical transplantation of the ectopic ureters into the urinary bladder resulted in urinary continence in both dogs. Intravenous urography revealed a marked decrease in the size of hydronephrosis and hydroureter in both dogs 28 to 35 weeks after surgery. In 1 dog with bilateral ureteral ectopia, kidney size and renal function remained normal for 5 years after surgery. A dog with one ectopic ureter and an associated ureterocele had a marked reduction in size of the affected kidney and an apparent decrease in function of that kidney, as indicated by decreased opacification on an intravenous urogram.     

Use of cystoscopic-guided laser ablation for treatment of intramural ureteral ectopia in male dogs: four cases (2006-2007)

OBJECTIVE: To describe and evaluate the outcome of cystoscopic-guided laser ablation of intramural ureteral ectopia in male dogs. DESIGN: Retrospective case series. ANIMALS: 4 incontinent male dogs with intramural ureteral ectopia. PROCEDURES: Intramural ectopic ureters were diagnosed via preoperative computed tomography-IV urography and subsequent cystoscopy. Transurethral cystoscopic-guided laser ablation (diode laser [n = 3 dogs] and holmium:yttrium aluminum garnet laser [1]) was performed to proximally relocate the ectopic ureteral orifice to the urinary bladder. Fluoroscopy was used during the procedures to confirm that the ureteral tract was intramural and the ureteral orifice was intravesicular after the procedure. In 1 dog with bilateral ureteral ectopia, staged laser ablation was performed at 6-week intervals because of difficulty viewing the second ureter on the first attempt. All ureteral orifices were initially located in the middle to proximal portion of the prostatic portion of the urethra. Six weeks after surgery, imaging was repeated in 3 of 4 dogs. RESULTS: Postoperative dysuria or hematuria did not develop. All dogs were immediately continent after laser treatment and remained so at a median follow-up period of 18 months (range, 15 to 20 months) without medical management. Conclusions and CLINICAL RELEVANCE: Ureteral ectopia can cause urinary incontinence in male dogs and is usually associated with other urinary tract abnormalities. Cystoscopic-guided laser ablation provided an effective and minimally invasive alternative to surgical management of intramural ureteral ectopia.     

Unilateral renal agenesis associated with additional congenital abnormalities of the urinary tract in a Pekingese bitch

An eight-month-old Pekingese bitch with urinary incontinence was found to have three congenital anomalies of the urinary tract: left renal agenesis, bilateral ectopic ureters with a left cranial blind-ending ureter, and urinary bladder hypoplasia. The diagnoses were made by retrograde vaginourethrography, excretory urography, ultrasonography and duplex Doppler ultrasonography. Although urological anomalies associated with renal agenesis have been frequently observed, a cranial blind-end ectopic ureter has not, to the authors' knowledge, been described in the bitch. The dog was managed medically with a restricted protein diet because of a compromised unilateral kidney with hydronephrosis and hydroureter.     

Evaluation of transurethral cystoscopy and excretory urography for diagnosis of ectopic ureters in female dogs: 25 cases (1992-2000)

OBJECTIVE: To evaluate transurethral cystoscopy and excretory urography for diagnosis of ectopic ureter in female dogs and identify concurrent urogenital abnormalities. DESIGN: Retrospective study. ANIMALS: 25 female dogs. PROCEDURE: Medical records of female dogs that underwent transurethral cystoscopy, excretory urography, and ventral cystotomy were reviewed for signalment, history, physical examination findings, results of bacteriologic culture of urine, and surgical findings. Videotapes of transurethral cystoscopy and radiographic studies were reviewed systematically without knowledge of surgical findings. RESULTS: Ectopic ureters were diagnosed in 24 of 25 (96%) of the dogs, bilaterally in 22 of 24 (91.6%) dogs. Cystoscopic evaluation yielded a correct diagnosis in all dogs when results of ventral cystotomy were used as the diagnostic standard. Cystoscopic evaluation identified a terminal ureteral opening for all ureters. Urethral fenestrations, troughs, striping, and tenting were identified. Abnormalities of the vestibule were identified in all examinations available for review (24/25). The paramesonephric septal remnant and its association with ectopic ureters were identified and characterized by cystoscopy. Radiographic findings were discordant with surgical findings and correctly identified 36 of 46 (78.2%) ectopic ureters and 2 of 4 normal ureters. Hydroureter and renal abnormalities were associated with distal urethral ectopic ureters on radiographic evaluations. CONCLUSIONS AND CLINICAL RELEVANCE: Transurethral cystoscopy was accurate and minimally invasive for identification and classification of ectopic ureters in dogs. Contrast radiography had limitations in diagnosis of ectopic ureters. Cystoscopic findings and associated vaginal and vestibular abnormalities support abnormal embryologic development in the pathogenesis of ectopic ureters.     

Congenital ectopic ureters in a continent male dog and cat

A male dog and cat were evaluated because of clinical signs associated with hydronephrosis. Both animals had ectopic ureters, but neither had urinary incontinence. The diagnoses were made by use of ultrasonography, excretory urography, retrograde urethrocystography, and surgery. In both animals, hydronephrosis was bilateral but of unequal severity, such that unilateral ureteronephrectomy could be performed. Both animals underwent ureteroneocystostomy of the remaining ureter. This treatment resulted in good clinical outcome during follow-up periods of 18 months and 3 years.     

Ectopic ureters in the cat – a report of two cases

Two cases of ectopic ureters in cats are described. In both the male and the female cat urinary incontinence was the prominent feature. Diagnosis was made by excretion urography. In both cats the ectopia was bilateral. The ureters were surgically reimplanted in the bladder, which gave total relief of the incontinence. A follow–up study is described, and the results are discussed.     

Unusual anatomic variation of bilateral ectopic ureters in a dog

An unusual anatomic variation of bilateral ectopic ureters was diagnosed in a 6-week-old female Siberian Husky with urinary incontinence. Assessment during surgery revealed bilateral ectopic ureters with a common opening in the proximal portion of the urethra. Ureteroneocystostomy was performed bilaterally. After surgery, intermittent urinary incontinence continued, but was less severe. After resection of a persistent hymen in the 6-month-old dog, incontinence appeared to resolve, but then recurred, and has been controlled by phenylpropanolamine administration.     

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.     

Surgical treatment of a duplicated and ectopic ureter in a dog

An eight‐month old female bull mastiff was referred for evaluation of urinary incontinence. Contrast‐enhanced computed tomography identified complete duplication of the left ureter with ectopic insertion of the duplicate ureter into the proximal urethra. Ureteroneocystostomy was performed, which improved but did not resolve urinary continence. To the authors’ knowledge, this report details only the second reported case of duplicated ectopic ureter in the dog and the first documenting surgical reimplantation; thus, double‐system ureteral ectopia should be considered as a possible differential diagnosis for urinary incontinence.     

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.     

Urinary incontinence in a dog with an ectopic ureterocele.

A 7-month-old, female English cocker spaniel was examined because of a complaint of urinary incontinence. Excretory urography revealed a small right kidney and right-sided hydroureter, ectopic ureter, and ureterocele. Ureteronephrectomy and ovariohysterectomy were performed, but the distal ureter and ureterocele were left in situ. Recurrent urinary tract infections and intermittent urinary incontinence persisted after surgery. Vaginourethrography demonstrated the presence of a urethral diverticulum associated with the ureterocele. Ureterocelectomy was performed, and the dog remains continent 4 years after ureterocelectomy. Persistent urinary incontinence and urinary tract infection were attributed to failure to resect the ureterocele.     

Extramural Ectopic Ureter in a Domestic Ferret (Mustela putorius furo)

Ectopic ureter is the most common cause of congenital urinary incontinence in the dog and cat. The occurrence of ectopic ureter in the dog has been estimated to be 0.016%. A 6-month-old ferret was evaluated for urinary incontinence and urine scalding around the perineal and inguinal areas. Ultrasonography showed a nondistended urinary bladder that contained a possible intraluminal blood clot. Excretory urography revealed a left ectopic ureter. The ferret was initially treated with oral amoxicillin-clavulanate and topical silver sulfadiazine ointment for the perineal and inguinal dermatitis associated with the incontinence. Because of the potential for complications and additional surgery with ureteral transplantation, a left nephroureterectomy was performed. Surgical recovery was uneventful and the incontinence improved, although a small amount of incontinence-associated dermatitis was still present 24 days after discharge. Phenylpropanolamine therapy was initiated to address a suspected dysfunction of the urethral sphincter. Urinary incontinence improved with the phenylpropanolamine therapy; however, a small amount of incontinence persisted throughout the 3 months in which the ferret was evaluated. To the authors' knowledge, this is the first report of an ectopic ureter in a domestic ferret.     

Ectopic ureter in a male cat

A male cat with persistent urinary incontinence is described. Definitive diagnosis of unilateral ectopic ureter was obtained by intravenous urography, after which surgical re-implantation of the ureter into the bladder was performed. The literature on ureteral ectopia in cats is discussed.