Ectopic Ureters in Dogs Page 2
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.