ISSN 2398-2969      

Ureter: ectopic

icanis
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Introduction

  • Congenital; may be associated with other anomalies.
  • Uncommon.
  • Breed predilection: Golden Retriever, Poodle, Siberian Husky.
  • Signs: usually incontinent from birth, often with urine scalding around external genitalia.
  • Diagnosis: excretory urography, retrograde urethrography, vaginourethrography , urethroscopy/cystoscopy, ultrasound examination and computed tomography.
  • Treatment: vesico-ureteric re-implantation, neoureterocystotomy, ureteronephrectomy or cystoscopic-guided laser ablation.
  • Prognosis: incontinence may continue in approximately 50% due to concurrent abnormalities with the trigone and/or urethra. Medical management (phenylpropanolamine) may help an additional 25%.

Pathogenesis

Etiology


Congenital development of ureteric termination other than proximal to trigone of bladder
  • Beyond trigone in urethra.
  • Directly into vagina.
  • Occasionally into uterus.

Predisposing factors

General
  • Breed.
  • Sex.

Pathophysiology

  • Usually terminate in proximal urethra.
  • Equal proportion of bilateral and unilateral ectopia in male but unilateral more common than bilateral in female.
  • Two types of ectopia recognized:
    • Intramural(most common type): ureter enters bladder wall at normal site → continue through bladder musculature and submucosa → terminates in urethra or vagina.
    • Extramural: ureter totally bypasses bladder and terminates in urethra (20%), vagina (70%), uterus (3%) or bladder in abnormal site (8%).
  • May be associated with hypoplastic bladder.
  • May be associated with urethral sphincter mechanism incompetence Urinary incontinence: urethral sphincter mechanism incompetence ; urinary incontinence Urinary incontinence may persist after surgical correction of ectopic ureter.

Timecourse

  • Not applicable; congenital lesion.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Ho L K, Troy G C & Waldron D R (2011) Clinical outcomes of surgically managed ectopic ureters in 33 dogs. JAAHA 47 (3), 196-202 PubMed.
  • Smith A L, Radlinsky M G & Rawlings C A (2010) Cystoscopic diagnosis and treatment of ectopic ureters in female dogs: 16 cases (2005-2008). JAVMA 237 (2), 191-195 PubMed.
  • Thomas P C & Yool D A (2010) Delayed onset urinary incontinence in five female dogs with ectopic ureters. JSAP 51 (4), 224-226 PubMed.
  • Berent A C, Mayhew P D & Porat-Monsenco Y (2008) Use of cystoscopic-guided laser ablation for treatment of intramural ureteral ectopia in male dogs: 4 cases (2006-2007). JAVMA 232 (7), 1026-1034 PubMed.
  • Samii Y F, McLoughlin M A, Mattoon J S et al (2004) Digital fluoroscopic excretory urography, digital fluoroscopic urethrography, helical computed tomography, and cystoscopy in 24 dogs with suspected ureteral ectopia. JVIM 18 (3), 271-281 PubMed.
  • Holt P E & Moore A H (1995) Canine ureteral ectopia - an analysis of 175 cases and comparison of surgical treatments. Vet Rec 136 (14), 345-349 PubMed.
  • Lane I F, Lappin M R & Seim H B (1995) Evaluation of results of preoperative urodynamic measurements in nine dogs with ectopic ureters. JAVMA 206 (9), 1348-1357 PubMed.

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