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The term "ACVS Diplomate" refers to a veterinarian who has been board certified in veterinary surgery.

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Ectopic Ureter

The term "ACVS Diplomate" refers to a veterinarian who has been board certified in veterinary surgery. Only veterinarians who have successfully completed the certification requirements of the ACVS are Diplomates of the American College of Veterinary Surgeons and have earned the right to be called specialists in veterinary surgery.

Your ACVS board-certified veterinary surgeon completed a three-year residency program, met specific training and caseload requirements, performed research and had research published. This process was supervised by ACVS Diplomates, ensuring consistency in training and adherence to high standards. After completing the residency program, the individual passed a rigorous examination. Only then did your veterinary surgeon earn the title of ACVS Diplomate.

Overview: 

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.  

Signs and Symptoms: 

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
Diagnostics: 
  • 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

Treatment: 

Depending on the type of ectopic ureters, treatment options can vary.  Surgical options for intramural ectopic ureters may include surgical removal of abnormal tissue using an open surgical approach to the bladder.  An alternative minimally invasive technique employs the use of LASER equipment under video guidance to open the abnormal portion of the ureter back to its preferred location.  For ectopic ureters presumed to be extramural, although can be used for intramural as well, the recommended technique involves cutting of the distal ureter and re-suturing it in a more proper location into the urinary bladder.

Aftercare and Outcome: 

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.   

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Ectopic Ureter

This Animal Health Topic was written by and reviewed by Diplomates of the American College of Veterinary Surgeons.  Any opinions stated in this article are not necessarily the official position of the American College of Veterinary Surgeons.

The American College of Veterinary Surgeons recommends contacting an ACVS board-certified veterinary surgeon or your general veterinarian for more information about this topic.

To find an ACVS Diplomate, visit www.acvs.org/find-a-surgeon.