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