Ectopic Ureters in Dogs

Overview of Ectopic Ureters in Dogs

Ectopic ureter is an abnormality present at birth in which one or both of the ducts that bring urine from the kidneys to the bladder fail to open into the bladder in the normal way. The affected dog is born with this problem and the resulting urinary incontinence usually begins at birth. Siberian huskies, golden retrievers, Labrador retrievers and miniature poodles may be more predisposed than other breeds. This problem is diagnosed in females 20 times more often than in males.

Urinary incontinence in a young dog is often misinterpreted as difficulty in housebreaking the pet. Ectopic ureters can predispose the animal to urinary tract and kidney infections. Urinary incontinence can persist even after surgical correction and often leads owners to elect euthanasia for the dog.

Diagnosis of Ectopic Ureters in Dogs

Tests to diagnose ectopic ureters in dogs may include:

• Complete physical examination
• Complete blood count
• Chemistry profile
• Urine analysis and culture
• Abdominal radiographs
• Contrast radiographs
• Cystoscopy
• Abdominal ultrasound examination
• Urethral pressure measurements

Treatment of Ectopic Ureters in Dogs

• Antibiotic therapy for concurrent urinary tract infections
• Medications to increase the urethral muscle tone and minimize dribbling
• Surgical correction of the abnormal ureter(s)

Home Care and Prevention

After surgery and discharge from the hospital, your dog will be restricted from excessive activity. She may be given anti-inflammatory medications or analgesics (pain killers) for the first few days to keep her comfortable. Some dogs may be sent home with oral antibiotics for several days if a urinary tract infection is also present or suspected.

Your dog may be given medications to increase the urethral muscle tone in order to minimize dribbling after surgery or if no surgery was done.

Watch for potential complications after surgery, including:

• Persistent urinary incontinence
• Incision problems such as swelling or discharge
• Blood-tinged urine
• Straining or inability to urinate
• Distension of the abdomen

This abnormality is present at birth and cannot be prevented. Although the cause of the developmental abnormality is not completely known, it is advisable not to breed the affected dog.

In-depth Information on Ectopic Ureters in Dogs

A ureter is the tube through which the urine passes from the kidney to the bladder. Ectopic ureter is an abnormally placed opening of the ureter, either into the urinary bladder or at another site in the lower genitourinary tract.

Urine traveling in the ureters normally enters the bladder in a region called the trigone near the narrow tip of the bladder where the urethra carries urine out. Animals with ectopic ureters have abnormal ureteral openings at the trigone, or the ureters bypass the bladder and open directly into the urethra, uterus or vagina. Regardless of the actual anatomic abnormality, the muscles of the urethra often function improperly and the urine is poorly contained. This results in the urinary incontinence or dribbling that prompts the owner to seek veterinary help. Some animals may have partial urethral muscle function allowing them to retain their urine, urinate normally at times and only dribble occasionally.

Ectopic ureter is a developmental abnormality that occurs early in fetal life. An underlying cause for the anomaly is not known but other developmental abnormalities of the urogenital system are often present in the same animal.

It is not known why some breeds are more commonly affected with this condition than others; genetic factors are suspected in some family lines. Siberian huskies, golden retrievers, Labrador retrievers and miniature poodles are the commonly affected breeds with this condition.

Ectopic ureters are diagnosed much more frequently in females than in males. It is believed that because of the relatively long length of the male urethra, males infrequently experience urinary incontinence when ectopic ureters are present. Although the true occurrence of ectopic ureters is not known in males, it is likely that it happens as often as it does in females.

Young puppies are usually adopted just after weaning from their mothers. Urinary incontinence or dribbling urine may be tolerated in the beginning by an owner believing that the animal is simply difficult to house train. But when the dribbling continues even after a recent urination outside on a walk, owners usually realize that something is not right and bring the problems to the attention of their veterinarian.

The aberrant location of the ureteral openings and malfunctioning of the urethral sphincter muscles can allow bacteria to gain access into the bladder or even up into the kidneys. Bladder infections (cystitis) may exacerbate these animals’ urinary symptoms by causing frequent and painful urinations, and bloody urine. Infections in the kidneys (pyelonephritis) can severely damage the kidneys and lead to systemic illness.

As many of these animals also have malfunctioning of their urethral sphincter muscles, urinary incontinence may persist after surgical correction. Some medications may help to strengthen the urethral muscle, but if the incontinence continues, many owners opt for euthanasia.

In-depth Information on Diagnosis

• The young animal that presents to the veterinarian with a history of urinary incontinence is given a complete physical examination. The examination is frequently unremarkable except for possible wet hair and moist dermatitis at the animal’s vulva or prepuce.
• Animals with symptoms of urinary incontinence often have a complete blood count and chemistry profile recommended by the veterinarian. These tests check for abnormal function of the kidneys and liver, electrolyte (sodium, potassium, calcium, chloride) imbalances, and can indicate if infection or anemia is present.
• Urine analysis and culture are done to see that the kidneys are properly concentrating the urine, and that there is no infection present.
• Abdominal radiographs allow the veterinarian to evaluate the size and shape of the bladder and kidneys, but used alone are not sufficient for a diagnosis.
• In order to demonstrate where the urine is going, contrast material is given intravenously for excretion into the urine by the kidneys. The urine can then be traced traveling through the ureters on subsequent radiographs. Sometimes, air may be placed into the bladder as well to help visualize the location and course of the ureters.
• Some veterinarians have access to very small cameras (cystoscopes) that can fit into the animal’s urethra. As the camera is advanced through the urethra into the bladder, the openings of the ureters can be visualized. This procedure is done under general anesthesia.
• An abdominal ultrasound allows the abdominal contents to be visualized and may find abnormalities in the bladder, ureters or kidneys.
• A relatively new diagnostic test in veterinary medicine is the measurement of the pressures within the animal’s urethra and bladder. This test can give the veterinarian information about how the urethral sphincter muscles are functioning. This can help determine whether or not the animal is likely to regain urinary continence after surgical correction. Urethral pressure profilometry is not performed by many hospitals in the country yet, and interpretation of the test’s results is still being worked out.

In-depth Information on Therapy

• Dogs with urinary tract infections are treated with antibiotic medications. As the infection is brought under control, some of the symptoms such as frequent urination, painful urination, bloody urine may improve. The underlying anatomic defect still remains, however, and the animal remains incontinent and may have recurrent bouts of infections.
• Some dogs may respond well to medications directed at strengthening the tone of the urethral sphincter muscle. The drug phenylpropanolamine (PPA) is one that can be effective in controlling the dribbling of urine in some animals. Another drug, diethylstilbestrol (“DES”), is a hormone that some veterinarians use for the same purpose.
• The definitive method of treatment is surgical correction of the defective ureter or ureters. Through an abdominal incision on the animal’s belly, the bladder, ureters and kidneys can be examined. The bladder is incised and the openings of the ureters are identified. Ectopic ureters that course through the wall of the bladder and open in the wrong place may be given a new opening in the correct location. Ectopic ureters that open directly on the urethral, uterus or vagina need to be transplanted into the wall of the bladder.
• Cases in which diagnostic testing shows the affected kidney to be non-functional secondary to improper flow of urine through the ectopic ureter or advanced pyelonephritis may require removal of the damaged kidney and ureter (nephrectomy).

Follow-up Care for Dogs with Ectopic Ureters

After discharge from the hospital, the dog must be kept quiet to heal properly. Activity must be restricted for a couple of weeks after surgery. Restricted activity means that the animal should be kept confined to a carrier, crate or small room whenever he cannot be supervised, the animal cannot play or roughhouse even if he appears to be feeling well, and the animal should be confined to a leash when taken outdoors.

Analgesics (pain medications) or anti-inflammatory medications should be given as directed by the veterinarian. Analgesics, such as butorphanol (Torbugesic®) can cause sedation, and anti-inflammatory drugs, such as aspirin or carprofen (Rimadyl), can cause upset stomach. Your veterinarian should be informed if any adverse side effects do occur.

Oral antibiotics may be given at home for several days if a urinary tract infection is present or suspected until culture results are complete.

The skin incision needs to be monitored daily for signs of excessive swelling or discharge. These can indicate problems with the incision or infection. Contact your veterinarian if these occur.

Approximately 1/3 of patients with ectopic ureters will continue to be incontinent after surgery. If the incontinence persists, the urethral sphincter medications may need to be given long-term. It is common for animals to have some blood in their urine after a repair of ectopic ureters. This bleeding should resolve within a few days. If it persists or becomes profuse, inform your veterinarian.

Straining to urinate is also common after surgery on the bladder. This straining usually decreases over the first few days after surgery. It is important to make sure that the animal is actually getting urine out while it is straining. If no urine is coming out, contact your veterinarian immediately.

Infrequently, the ureteral repair can break down and lead to leaking of urine into the abdomen. If the animal begins feeling poorly after some improvement after surgery, or if the abdomen appears to be getting larger, there could be a problem that needs to be addressed by your veterinarian.