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