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

Retrograde Vaginal Urethrogram

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 rearend 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

Excretory Urography

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