Surgical management of ectopic ureters in dogs: Clinical outcome and prognostic factors for long‐term continence*

Abstract

Objective: To determine outcomes after surgical correction of ectopic ureters (EU) and identify prognostic factors for long-term continence.Study design: Retrospective study.Animals: Forty-seven dogs (36 females and 11 males).Methods: Medical records (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) of dogs with surgical correction of EU were reviewed. A continence score (1 5 incontinent, 2 5 sporadic incontinence, 3 5 continent) was attributed preoperatively, at discharge, 1 month postoperatively, and at long-term evaluation.Results: Twenty-eight dogs had unilateral and 19 dogs had bilateral EU (57 intramural and 9 extramural). Nineteen dogs had a pelvic bladder. Neoureterostomy with dissection (n 5 50), ureteroneocystotomy (n 5 9), or nephroureterectomy (n 5 7) were performed. Thirty-three dogs were neutered: 32 before or during the surgery and 1 after surgery. Colposuspension was performed during surgical correction in 15 dogs. Adjuvant medical treatment improved postoperative continence scores. Median continence scores were greater at discharge (3), at 1 month postoperatively (3), and at long-term evaluation (3) than before surgery (1). At long-term evaluation (mean 46.1 months), a score of 1 was observed in 19%, a score of 2 in 7%, and a score of 3 in 74% of the dogs.Conclusion: Overall, good (score 2) to excellent (score 3) long-term outcome was achieved in 81% of dogs. Long-term continence was improved with medical treatment and neutering was not associated with an increased risk of recurrence of incontinence in this population of dogs.

Ureteral ectopia and urethral sphincter mechanism incompetence: an update on diagnosis and management options

“…This remains unproven, although continence rates in all studies are improved with the addition of medical management for USMI (Noel et al . ). For laser ablation, the reported long‐term continence rate is 31 to 47% without additional medication and 69 to 77% with medication (Smith et al .…”

“…There was a mix of males and females and many of the bitches underwent concurrent colposuspension at the same time as ectopic ureter correction, all of which make interpretation of this finding difficult (Noel et al . ). My preference is to avoid neutering of bitches when possible, or at least to wait until maturity has been reached before neutering.…”

“…Persistence of urinary incontinence has been reported to occur in 42 to 71% of dogs after surgical interventions, including neoureterostomy, ureteral re-implantation and ureteronephrectomy , McLaughlin Jr & Miller 1991, Holt & Hotston Moore 1995, Mayhew et al 2006, Ho et al 2011 and has been largely attributed to concurrent USMI. This remains unproven, although continence rates in all studies are improved with the addition of medical management for USMI (Noel et al 2017). For laser ablation, the reported longterm continence rate is 31 to 47% without additional medication and 69 to 77% with medication (Smith et al 2010, Berent et al 2012.…”

“…Thus, a delay in considering additional procedures until after at least the first oestrus cycle is recommended. A recent study reporting the surgical management of ectopic ureters in dogs with a mean age of 14 months, included 15 dogs in which concurrent colposuspension was performed, with no apparent benefit in long-term continence score (Noel et al 2017). A single study of nine adult, neutered dogs treated with a combination of surgical EU correction and colposuspension reported complete continence 2 to 3 months postoperatively, but long-term follow-up was lacking (Trebacz & Jurka 2013).…”

“…Only one study has attempted to examine neutering as a prognostic factor for persistent urinary incontinence in these dogs and found no negative effect although the number of intact dogs included in the study was relatively small. There was a mix of males and females and many of the bitches underwent concurrent colposuspension at the same time as ectopic ureter correction, all of which make interpretation of this finding difficult (Noel et al 2017). My preference is to avoid neutering of bitches when possible, or at least to wait until maturity has been reached before neutering.…”