An ectopic ureter is an abnormality of the ureter (the tubular tissue that connects the kidney to the urinary bladder) where the ureter does not enter into the urinary bladder in the correct anatomic position. This abnormality is something that cats and dogs are born with and can affect one or both of the ureters. The ectopic ureter may tunnel within the bladder tissue before opening in an abnormal location (intramural) or the distal ureter may implant into an abnormal area without tunneling (extramural). Additional congenital abnormalities of the kidneys and urinary tract can also be observed.
Symptoms of an ectopic ureter can occur as a young puppy or kitten or sometimes as a young adult. Female dogs are known to be 20X more likely to be diagnosed with ectopic ureters with certain breeds more presented including but not limited to Golden and Labrador retrievers, Skye Terriers, etc.
- Continuous or intermittent urinary incontinence (leakage) or urinary accidents
- Difficulty potty training
- Urine leakage when laying down and/or sleeping
Bloodwork: complete blood count, chemistry panel, urine analysis and culture
Radiographs (x-rays) with contrast (special dye) given IV to help highlight the kidney and urinary tract. Figure 1
Ultrasound to assess for anatomic abnormalities and to evaluate for any abnormal urine flow
Computed tomography (CT) with contrast to evaluate the urinary tract. Figure 2
Vaginourethrograpy with cystoscopy: a camera introduced into the vagina, urethra and urinary bladder to evaluate the distal ureteral openings. Figure 3
Aftercare of these patients is dependent on the approach for treatment. If an open approach to the abdomen is performed then 2 weeks of activity restriction with incisional care is advised. If a minimally invasive approach using cystoscopy is recommended and performed then patients may return to normal activity much faster. Follow up serial urinalysis and cultures are advised
The main post-operative risks include continued incontinence, leakage of urine into the abdomen, stricture of the surgical site, urinary tract infection, etc. In some cases of continual incontinence further improvement may be achieved with incorporation of medications to help with urethral sphincter tone and/or the placement of an adjustable artificial urethral sphincter. Male patients with urinary incontinence secondary to ectopic ureters can have a higher success rates (70-80%) than females following surgical intervention. Unfortunately, even with surgical intervention and medical management 25-70% of female patients may still have persistent urinary incontinence.