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Ectopic Ureters in dogs

The kidneys produce urine continuously and the tiny pipelines through which the urine is transported from the kidneys
to the bladder are the ureters (one for the left kidney and one for the right kidney). The bladder stores the urine until it
can be voluntarily unloaded.
Ectopic ureter(s) is a congenital error in the development of the ureter(s). Instead of connecting to the bladder, the
ureters connect directly to the urethra. The ureters are then bringing urine to an area that is unable to store urine and
leaking ensues. One or both ureters can be affected.

Ectopic ureter(s) are commonly diagnosed in puppies and mostly female dogs (female to male ratio: 20:1). Often
clinical signs include urine leaking/dribbling almost constantly or intermittently, discolored fur around the vulva.
Licking of the genital area (irritation from urine) and recurrent urinary tract infections.

Several diagnostic tools can be used to diagnosed ectopic ureter in dogs.
1. Abdominal ultrasound: The normal ureter is too small to be seen with ultrasound. If the ureter is distended,
it provides some clues that one may be dealing with an ectopic ureter. In female dogs, about 50% of the
dogs will have dilated ureter(s); in male dogs up to 80%. However, a lack of ureteral dilation does not
exclude the possibility of an ectopic ureter.
2. Cystoscopy: Cystoscopy is the diagnostic method of choice for the diagnosis of ectopic ureter in females
dogs (less so in male). Cystoscopy employs a tiny camera on the end of a probe which can be used inside
the urethra, vagina, or bladder to locate the ureteral openings. An advantage of cystoscopy is that laser
ablation (see below) can often be performed during the same anesthesia thus confirming and correcting the
problem all in one procedure.
3. CT scan: CT scanning is an excellent diagnostic method for the diagnosis of ectopic ureters especially in
male dogs. It is highly accurate and reveals the exact location of the ureter attachment. This form of imaging
also requires general anesthesia.

Several treatments are available for the correction of ectopic ureter(s).
1. Cystoscopy-assisted laser ablation: Cystoscopy-assisted laser ablation is a less invasive approach with less
incidence of post-operative incontinence when compared to surgery. Laser ablation is best used for
“intramural” ectopic ureters (most common type). These are ureters that start to enter the bladder where
they are supposed to but do not actually penetrate all the way in. Instead, they continue inside the bladder
wall and open up in the urethra. The laser will be used to cut/ablate the ectopic ureter (s) back into the
bladder. Most patients are able to leave the hospital within 12-24 hours after the procedure. Males typically
become urinary continent (80%) but some 40% of females ultimately require additional treatment to remain
continent.
2. Surgery: Surgery is recommended in cases where the ectopic ureter is considered “extramural” i.e. directly
attach to the urethra (i.e. no tunneling). Extramural ectopic ureters are rare (1%) and their path is often
determined at the time of the cystoscopy or CT scan.

AVIM&O Morning Rounds – A Breadth of Expertise and Experiences

As the main caregiver for your companion pet, you may at some point be faced with seeking out specialty veterinary services.  Your pet’s primary care veterinarian may have advised this, you may just be aware and prefer a “next” level of expertise, or it may be a needed transfer from one of the associated emergency services. No one wants to have their companion in a position needing such care as it means that there is illness and need. We want to help you with the emotional considerations and surprise, understanding the financial implications, and the sense of uncertainty. We hope to be a comfort by having advanced care be available.

 

Your pet has come to us because something persists as unanswered, there is a combination of health issues, special diagnostic skills or tests are needed, perhaps critical care is required, or simply the expertise that comes with a specialist consultation is being sought. But what happens if there are unique medical or oncologic questions, or a complex cluster of issues? As the saying goes, “Not every patient reads the “book”? Well, for us at Atlantic Veterinary Internal Medicine & Oncology (AVIM&O), we combine all of our team members’ experiences and expertise in a collegial environment. One way we enhance the exchange of ideas is via our getting together each morning. Our hospitalized patient stories are presented and discussed at “morning rounds”.

At our morning rounds, our technicians (ICU, receiving, chemotherapy, medical, procedures, etc.) and our doctors are present as may be scheduled for any given day. A patient’s case history is presented by their attending doctor so that the day’s medical plan is made clear. In addition, the internists and oncologists, and our very knowledgeable and experienced technical staff, ask questions, add the smaller details of planned care, make suggestions, and if needed, speak openly to any concern. Morning Rounds are a strong part of AVIM&O’s 25-year heritage. We build a team around your furry companion. We also ask each other about our difficult cases that are not hospitalized, or seek out thoughts on odd lab or test results. We have a sense of open-minded support from our colleagues. About 20-40 minutes of our standard mornings at each of our facilities (Towson, Columbia, Annapolis) is spent in this interactive process.

We strive to provide the best care we can by integrating our actions as a team with a clear focus on the patients. If you call and we are not available because we are in “rounds”, well, now you know that the delay is for a good cause.