Morgan Tannenbaum

 Usually young (congenital)
 Primarily clinical condition in females
 Males have longer external urethral sphincter
 Incidence unknown- estimated at 0.016-0.045%
 Breed predisposition
 Cats- no breed disposition
 Dogs
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Siberian husky
West Highland white terrier, fox terrier
Labrador and golden retrievers

 Continuous or intermittent urinary incontinence- but may urinate normally
 Urinary tract infections

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Most commonly bilateral but can be unilateral
Presentations
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Intramural (most common)
Extramural
Double ureteral openings
Trough
Ureter may empty into
 Neck of bladder
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Urethra
Uterus
Vagina or vestibule

Intramural Extramural

 Ultrasound
 helpful ultrasound findings include:
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Ureter jet
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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- contrast
 CT

 4 month old F/I Golden Retriever
 Presented to referring veterinarian 1 month ago with history of intermittent incontinence
 Has dribbled urine since they acquired her at 2 months of age
 Urinalysis was performed and Brandy was diagnosed with a UTI
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Was treated with 2 week course of Clavamox
UTI resolved but dribbling continued
 Was treated with PPA- no improvement over past 2 weeks

 Brandy presented to NCSU-VTH earlier this week for evaluation of urinary incontinence
 She is able to posture to urinate and produce an appropriate stream of urine
 When left in kennel owners sometimes find her rearend to be urine soaked
 She eats and drinks normally and is otherwise a happy and healthy dog

 Ectopic Ureter
 Ureterocoele
 Urinary tract infection
 Urethral sphincter incompetence
 Behavioral
 Neurogenic

 Physical exam unremarkable
 Urinalysis- USG (1.026), pH (6.5), blood 2+, bacteria
2+ 4. Urine culture: pending
 Abdominal Ultrasound
 Marked pyelectasia
 The left ureter is severely dilated, up to 10.7 mm in diameter
 The left ureter is seen inserting into proximal urethra

 Excretory 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

 Plan to have Ureteroneocystostomy following results of urine culture and a course of antibiotics
 The ureter is resected from the urethra and anastamosed to a more proximal location in the bladder
 Other surgical options for ectopic ureters
 Intramural EU
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Neoureterocystostomy
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About 30% remain incontinent
Laser transection of wall between EU and wall of bladder
 Alpha agonist therapy may improve outcome

CT is the gold standard for diagnosis of ectopic ureters but is not commonly used due to availability and expense