Long‐term outcome of female dogs treated for intramural ectopic ureters with cystoscopic‐guided laser ablation

Abstract

Objective To report the complications and long‐term outcome of female dogs with intramural ectopic ureter(s) (iEU) undergoing cystoscopic‐guided laser ablation (CLA) and determine the effect of post‐CLA neutering on urinary continence. Study Design Retrospective clinical study. Animals or Sample Population Thirty‐four client‐owned dogs. Methods Medical records of female dogs that had iEU‐CLA were reviewed. A 10‐point continence score was assigned before, immediately after, and at a minimum of 12 months postprocedure via owner telephone contact. Neutering status prior to and postprocedure was recorded. Results Continence scores increased in all dogs after CLA (p < .0001, mean duration of follow‐up: 63.9 ± 5.7 months) with an increase of the median score from 2 (preprocedure) to 10 (postprocedure). A urethral tear occurred in 2/34 dogs immediately after the procedure, successfully managed conservatively. Mild hematuria was present in 2/34, lasting less than 48 h. Postoperative urinary tract infections were documented in 6/34 dogs. Two dogs died of urinary‐related issues at 1 and 5 months after CLA. Complete and near‐complete urinary continence (scores 9 and 10/10) was achieved in 26/32 dogs including 3 dogs requiring medical (2) or surgical interventions (1). Post‐CLA neutering did not affect continence scores (p = .44). Conclusion A large proportion of dogs regained and maintained full continence after CLA alone. Subsequent medical or surgical therapy allowed further improvements when needed. Post‐CLA neutering did not negatively impact urinary continence score. Clinical Significance The beneficial effect of iEU‐CLA in female dogs is long standing and not affected by postprocedural neutering.

Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic‐guided laser ablation

“…Interestingly, medical treatment was successful in all dogs with incontinence recurrence, but was effective in only 1/5 cases who never regained continence after surgery. These data prompt us to suggest that (i) dogs that are continent after surgery have a good long‐term prognosis even if medical treatment may be needed, and (ii) dogs that fail to respond to EU correction are less prone to respond to medical treatment and have a worse long‐term continence prognosis as described in previous studies 8,11,20 . Factors to explain this finding may include more complex congenital or functional abnormalities in dogs with incontinence persistence compared than those who experienced incontinence recurrence.…”

“…10,11,14,19 This imaging modality may be used to confirm the anatomical position of the ureter and confirm the correct position of the newly formed ureterovesical junction within the bladder, potentially reducing the risk of urethral tear during CLA. 20 The limitations of this study pertained to its retrospective nature, the small number of cases (which precluded multivariate analysis), the absence of systematic cystoscopic control, and the absence of UPP in all incontinent dogs that would have confirmed the cause of incontinence. In addition, the >1 month continence status was assessed by phone interview rather than physical examination.…”

“…In addition, no prognostic factor has been identified to explain incontinence persistence after surgery or to understand incontinence recurrence in continent dogs after surgery, a phenomenon sparsely described in some studies. 2,7,8,11,12,14,20 In particular, despite the increasing description of CLA, no study compared the influence of the technique of correction of EU on continence outcome. 10,19 The objectives of this study were (i) to report complications and short-term and long-term outcomes after EU correction by open surgery or CLA in female dogs; (ii) to compare neoureterostomy and CLA in terms of complications and both short-term and long-term outcomes in female dogs with iEU.…”

“…These procedures, which require an open laparotomy, are associated with significant postoperative morbidity, with surgical revision needed in up to 21% of the reported cases 4,8,18 . Recently, cystoscopic‐guided laser ablation (CLA) has been described as an alternative to open surgery for treating iEU in dogs 10,11,14,19,20 . In addition to the minimally invasive approach, which is thought to reduce morbidity, few complications have been reported in association with this technique 20 .…”

“…The outcome after EU correction seems inconsistent, irrespective of the technique used, with a reported postoperative continence rate ranging from 36% to 72%. In addition, no prognostic factor has been identified to explain incontinence persistence after surgery or to understand incontinence recurrence in continent dogs after surgery, a phenomenon sparsely described in some studies 2,7,8,11,12,14,20 . In particular, despite the increasing description of CLA, no study compared the influence of the technique of correction of EU on continence outcome 10,19 …”