Ectopic ureter in dogs and cats
What is an ectopic ureter?
Ureters are the tubes that run from the kidneys to the bladder, so are a key part of the urinary tract. They’re ectopic when they don’t connect to the bladder in the right way (entering either the urethra or vagina in females, or the urethra in males), which causes incontinence.
More than 95% of ectopic ureters are intramural (where they burrow through the bladder wall), which means they can be corrected using non-invasive laser treatment. The rest are extramural – known as distal ureters – which implant into a different area without entering the tissue, and these require surgery.
What causes an ectopic ureter?
Dogs and cats can be born with ectopic ureters, so it’s not always possible to pinpoint a particular cause or prevent them.
Most dogs with ectopic ureters are female (they’re 20 times more likely to be diagnosed with ectopic ureters than males), and they often have other problems too, including:
- Small bladders
- Short urethras
- Vaginal remnants (where some parts of the dog’s reproductive organs remain inside its body after it has been spayed)
What are the symptoms of ectopic ureter?
Symptoms usually appear in young puppies and kittens, but sometimes don’t manifest until young adulthood.
- Incontinence in female animals (often from birth)
- Leakage or accidents when your pet is relaxed or sleeping
- Toilet training difficulties
Male animals don’t tend to become incontinent as the ureter narrows at its opening. Instead of leakage, this leads to pressure and dilation of the ureter and kidney.
Urinary tract infections are also common in dogs and cats with ectopic ureters, so you may see signs such as:
- Struggling or straining to urinate
- More frequent urination
- Bloody urine, or urine that’s discoloured
How is it diagnosed?
The symptoms of ectopic ureter are a good indicator of the condition, and diagnosis is usually confirmed by:
- X-rays (a special dye is injected beforehand to highlight the kidneys and urinary tract, including ectopic ureters)
- Ultrasound (to show any unusual anatomy or blood flow)
- CT scan (a special dye will reveal the urinary tract, highlighting any anomalies)
- Cystoscopy (running a camera into the bladder; usually only for medium or large breed dogs)
Your pet might also undergo a retrograde study, where dye is injected into the vagina, urethra and bladder to highlight ectopic ureters that weren’t observed through any of the other diagnostic methods.
These tests will also reveal if your pet has any other congenital kidney or urinary tract issues, so that they can be effectively treated.
How is ectopic ureter treated?
There are two ways to treat ectopic ureters, and the chosen route depends on whether they are intramural or extramural:
Extramural – surgery
This involves an abdominal incision and the surgical reimplantation of distal ureters into the bladder in the correct position.
While this method can lead to improvement in 50% of cases, some cases can develop scarring (stricture) where the ureters have been reimplanted. This can lead to obstruction of the ureter, so it’s important to attend follow-up appointments.
Exercise must be restricted for at least two weeks following the operation, so that the site has chance to heal.
Of course, operations are not risk-free, and some post-op issues can include:
- Unsolved incontinence
- Urine leaking into the abdomen
- Narrowing of the urethra (a result of the build-up of scar tissue and inflammation)
Intramural – laser
This procedure is carried out by cystoscopy (where a camera is run into the bladder) and a laser is used to move the ureter into the correct position. If your pet is female and also has vaginal remnants after being spayed (which can lead to recurrent infections), it’s possible to remove these at the same time.
Laser correction is non-invasive, so your pet is likely to be discharged on the same day once they’ve recovered from the anaesthetic, and they will need minimal to no pain relief or exercise restriction.
As with surgical treatment, laser correction is also successful in 50% of cases.
What’s the prognosis?
Whether your pet is treated surgically or through non-invasive lasering, there’s a 50% improvement in cases undergoing treatment.
Those that don’t see any improvement will have their condition managed medically to help improve urethral sphincter tone. They may also be fitted with an adjustable artificial urethral sphincter, helping improve continence to 70%.
Should they need it, a hydraulic occluder device can further increase continence to 80-90%.
Unfortunately, treatment – including surgery and medical management – doesn’t always work for female patients, with between 25-70% still suffering from urinary incontinence even after veterinary intervention. Male animals tend to have a better prognosis (70-80% success rate) following surgery.
How long is recovery?
If your pet undergoes surgery, they need rest and should be restricted from exercise for two weeks until the site has chance to heal.
If they undergo cystoscopy and lasering, recuperation is much faster and exercise can continue as normal.
In both cases, follow-up appointments should be scheduled to make sure your pet is healing properly and remains healthy.
If you think your dog or cat as an ectopic ureter, get in touch and we’ll be more than happy to help. If you’re a vet with a referral, start your case today.
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