Steffey M A & Brockman D J (2004) Congenital ectopic ureters in a continent male dog and cat. The nursing care of these patients is based on observation of the degree of urinary continence following surgery. Affected dogs have ureters that are not attached to their normal location in the urinary bladder. An ectopic ureter can cause urinary incontinence, infections and swelling. More on that below. Her mum noticed that Daisy seemed to be leaking urine all the time, whether lying down or up and about. JSAP 51 (4), 224-226 PubMed. Male dogs can be affected as well, but less commonly. Ectopic ureters are an uncommon congenital anomaly in which the ureteral orifice is abnormally positioned, most commonly emptying into the urethra. The most common cause of urinary incontinence in juvenile intact female dogs is ectopic ureter (EU). Dogs are born with this problem, so it's usually diagnosed in young dogs. The aim of this article is to present two patients with duplex kidney and ureteral ectopia. This abnormality is something that cats and dogs are born with and can affect one or both of the ureters. An ectopic ureter is often associated with a ureterocele, a cystic dilation of the terminal ureter (Fig. Contralateral VUR. Any problems with nerves in the spine that control the bladder can cause incontinence e.g. This condition is usually apparent after toilet training. of the action of the bladder sphincter by the ureteral muscle; incontinence may appear only in old age [2,5]. A 5-year-old girl presented with urinary incontinence regardless of the successful toilet training and a suspicion of left duplex kidney on a previous . Other reported signs are perivulvar or preputial derma-titis, recurrent cystitis, and secondary pyelonephritis [9]. Finding a small or normal bladder on physical examination points towards a true incontinence which is most commonly caused by one of two conditions, USMI or ectopic ureters. and 3D computed tomography scanning revealed presence of the ectopic ureter with urinary incontinence. The condition is present at birth but can be difficult to diagnose. Instead of connecting to the bladder, the ureters connect to the urethra, the vagina, colon, or even the uterus. It's a life-threatening condition that requires immediate veterinary assistance. Most ectopic ureters (>95%) are classified as intramural which mean they tunnel inside the bladder wall and are amenable to minimally invasive laser correction. This is a congenital anomaly of the urinary tract in which the ureteral orifice is inappropriately . Median age at presentation was 5 years (6 weeks-9 years), while at surgery was 8 years (2-13 years). For example, incontinence interferes with housetraining and, as with Tala, can cause urine scalding of the skin. Therefore, males with an ectopic ureter do not have urinary incontinence, but typically present secondary to a prenatal diagnosis of hydroureteronephrosis or symptomatic urinary tract infection (UTI). Ectopic ureters (EUs) associated with varying combinations of urinary incontinence, hydronephrosis, and urinary tract infection have been identified in related North American Entlebucher Mountain . All five patients were hospitalized with complaints of gynecologic disease. Those affected are typically younger than six months of age, and certain breeds of over-represented. An ectopic ureter opening distal to the external sphincter or into the mullerian system may be associated with incontinence which is a major social stigma for the patient. Boys with ectopic ureters do not often have incontinence, since the ureter drains in the body. 130-2B ). Physiology This condition results from an aberration in embryologic development in which the terminal ureteral opening is located at a site other than the bladder trigone. In females, the mesonephric remnants are in close relation . Ectopic ureter is diagnosed when the ureteral orifice is caudal to the normal insertion on the trigone of the bladder. The ureters are thus bringing urine to an area inequipped for urine storage and leaking results. Both patients presented symptoms of continuous urinary incontinence and became symptomatic in the adult life. An ectopic ureter is a physical abnormality in some dogs that causes bladder leakage due to the dog's ureter allowing the bladder to leak. Incontinence occurs because the ureter enters the bladder distal to the normal location at the urinary bladder trigone leading to an ineffective urethral sphincter mechanism. Pediatric incontinence Ectopic ureter Urologic imaging abstract Ectopic ureter is a rare cause of urinary incontinence in children. Frequent urination. The presence of an ectopic ureter may be indicated by continuous wetting, despite a normal voiding pattern, especially in girls. Here, we presented five cases of ectopic ureter opening into the vagina, whose clinical symptoms and malformations were rarely described in previous case reports. Cystoscopy and retrograde pyelography: Cystoscopy and retrograde pyelography to search for ureteral orifices. Signs of an ectopic ureter: Almost exclusively diagnosed in females. Results: Five patients were diagnosed with a duplex system associated with an ectopic upper pole ureter. As a result, these patients may present with constant urinary leakage that is usually of small volume. Infections of the urinary tract, bladder and kidney are common. While ectopic ureters can occur in males, females are affected far more commonly. An ectopic ureter is a congenital renal anomaly that occurs as a result of abnormal caudal migration of the ureteral bud during its insertion to the urinary bladder. Another cause of urinary incontinence is an ectopic ureter. Introduction. Boys with ectopic ureters do not often have incontinence, since the ureter drains inside the body. In the following section, different clinical entities will be discussed briefly regarding clinical presentation, diagnostic workup, management, and long-term outcome. Continuous incontinence in a girl past the toilet training age should also raise concerns for an ectopic ureter. Ectopic ureters occur much more frequently in females, and the insertion sites can include the vagina and the vulva, with resulting incontinence. This condition should be strongly suspected in the girl whose has persistently damp underwear. Ultrasound imaging . Pelvic examination is indicated in girls with urinary incontinence, sometimes the orifice of the ureter can be identified in the vagina or vulval vestibule. Incontinence and infection are the usual outcome. Pups can be born with one or two ectopic ureters. If infection is present blood tinged urine can sometimes be seen. One patient was noted to have a non-functional kidney associated with an ectopic ureter. An ectopic ureter is a ureter with an abnormally located ureteral orifice. Incontinence is common in girls with an ectopic ureter. Ureteral ectopia in females can present as continuous drip incontinence in cases in which the ureteral orifice is located in the vagina, septum, or the urethra, below the sphincter mechanism.. Ultrasonography and excretory urography are the most common imaging . Blood in the urine. In all . Although an uncommon cause of incontinence in all dogs, it is estimated to be responsible for up to 50% of cases of urinary incontinence in juvenile female dogs. Burbridge H M, Jones B R & Mora M T (1989) Ectopic ureter in a male cat. An ectopic ureter is a ureter that does not correctly connect to the trigone of the bladder and drains outside of the bladder. This case series of 2 older childrenwith missed ectopic ureters by the urologic community outline workup for . Unfortunately, UI with cystitis was developed two months postoperatively. Smith A L, Radlinsky M G & Rawlings C A (2010) Cystoscopic diagnosis and treatment of ectopic ureters in female dogs: 16 cases (2005-2008). Ectopic ureters could empty urine into the urethra (the tube used for urination), or in females, the uterus or vagina. In many instances, an ectopic ureter is not detected because the affected individual is asymptomatic. The ureters carry urine from the kidneys to the bladder, and if one or both ureters bypass the bladder and connect to an abnormal location, such as the urethra or vagina, the puppy may drip urine." Advanced imaging is required for definitive diagnosis. Ectopic ureter is one of the most common urinary tract anomalies. More than 95% of ectopic ureters . Signs are often noticed soon after weaning, although some dogs do not show signs until they reach adulthood. Urinary incontinence (dripping or leaking urine at times) Constant licking of the genitals. Ectopic ureters are the most common cause of urinary incontinence in young, female dogs, and this is the most common presenting sign. An ectopic ureter is defined as a ureteral opening in any area other than the normal position in the trigone of the bladder. An ectopic ureter is a congenital condition, which means that the anatomical defect is already present at birth. At times, these symptoms may be due to an ectopic ureter inserting below the external sphincter. Ectopic ureter is a congenital defect that causes urinary incontinence in dogs. Considering the exact implantation of the ureter will be important for future clinicians offering operative management for anatomic aberrations such as these. 11-month-old Black Labrador Daisy at home in the garden. UI is the most common clinical sign in dogs with EUs and is usually diagnosed in dogs prior . Fortunately, ectopic ureter is a rare problem in dogs. Owner compliance is key to successful surgical aftercare and should involve ongoing monitoring for incontinence and discomfort. Boys with ectopic ureters do not often have incontinence, since the ureter drains inside the body. Ectopic ureters (EU) are the most common cause of urinary incontinence in juvenile female dogs. Unlike in boys, an ectopic ureter in girls may insert distal to the urethral sphincter. An ectopic ureter is an abnormality of the ureter (the tubular tissue that connects the kidney to the urinary bladder) where the ureter does not enter into the urinary bladder in the correct anatomic position. [3] Incontinence. As a result, your puppy cannot control the flow or urine. The causes of urinary incontinence classically are divided into neurogenic or non-neurogenic categories. As ectopic ureters usually drain poorly functioning renal segments with low urine production, these patients may also present with intermittent incontinence as well. This is the most common cause of urinary incontinence in juvenile female dogs. Normally, each ureter enters the urinary bladder before the urethral sphincters. Girls with ectopic ureters may also leak urine since the ureter drains into or near the vagina. However, an ectopic ureter can produce symptoms, including urinary incontinence (only in females), urinary tract infection . The incidence of ureteral ectopia has been estimated to be approximately 1/1900 but several studies have suggested the true prevalence may be higher than commonly thought. However, it has to be . Nearly all dogs with ectopic ureter had no trigonal ureteral openings; 1 had an opening in the trigone and also in the urethra. [10] An ectopic ureter is treated with surgery. Urinary incontinence can also happen in males, where it is usually caused by prostate problems (males only) and perineal hernia (more common in males . With ectopic ureters, one or both of the ureters do not connect normally to the bladder. Ectopic ureter is defined when it opens into a region apart from the usual place on the trigone of the bladder [ 2 ]. Urology 216.444.5600 Ectopic ureters are a congenital anomaly of the urinary system, in which the ureteral orifice is inappropriately positioned caudal to the urinary bladder. Urinary incontinence, or the inability to control urine flow, is one of the most common symptoms in girls. It can also be identified in older dogs. Instead, they bypass the bladder and go into the urethra, or in females, the vagina or the uterus. Four patients were referred for incontinence, 1 was . In one study around 50% of cases were continent with this procedure alone and the others required additional treatment (most commonly medical treatment of urethral sphincter mechanism incompetence). Urinary incontinence (UI) in adult women results from acquired causes rather than congenital factors. But they will nevertheless have signs and symptoms of swelling or a UTI. Urinary incontinence is the inability to hold urine, resulting in leaking or dribbling. However it can also be associated with recurrent urinary tract infections, kidney abnormalities and the formation of bladder or kidney stones. In patients with ureteral ectopia, one or both ureters insert after the urethral sphincters, allowing urine to leak out to cause urinary incontinence. There are several other possible abnormalities, but they are all quite rare. Vet Rec 130 (20), 437-442 PubMed. This is when the tube that goes from the kidney to the bladder connects in the wrong place. The diagnosis is made by a combination of history, clinical signs, laboratory tests, and imaging. Ectopic ureter. An ectopic ureter is one that opens somewhere other than into the bladder. Ectopic ureters are thought to result from the abnormal differentiation of mesonephric and metanephric duct systems, resulting in inappropriate ureteral tube termination and malposition of the ureteral orifice. Plus, it is not a life-threatening medical issue. Spinal problems. Any age. If excision is not possible, the SV cyst can be treated with transrectal aspiration or transurethral unroofing without significant recurrence. Redness and rash in the genital area. Not uncommonly these patients undergo evaluation by multiple healthcare providers prior to such consideration. She showed no signs of any other issues, but her mum decided . [1] [2] In males this site is usually the urethra, in females this is usually the urethra or vagina. Surgery can correct the problem and prevent kidney damage. JAVMA 237 (2), 191-195 PubMed. An ectopic ureter is a congenital defect characterized by the ureter connecting to the urinary bladder in an abnormal location. Incontinence: Girls with an ectopic ureter may present with continuously damp underwear, since the ureter is connected outside the bladder, below the sphincter mechanism (the "hold on" muscle). While this may initially be written off as a house-breaking problem or an ongoing bladder infection, it is possible that the puppy has "ectopic ureters." In most cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. The current literature is reviewed with special attention towards data published between 2000 and 2014. ABSTRACT: The ectopic ureter is predominantly a congenital abnormality. Urinary incontinence in dogs is a relatively common problem, with obesity and castration among the predisposing factors. Thomas P C & Yool D A (2010) Delayed onset urinary incontinence in five female dogs with ectopic ureters. Symptomatic cases are unlikely to resolve spontaneously, and incontinence are often associated with signicant psychological impact on these children. The affected dog is born with this problem and the resulting urinary incontinence usually begins at birth. Ectopic ureter (above) is the most common congenital problem vets see in young dogs. To correct the . Go to: CASE REPORT A 13-year-old girl presented with the history of persistent dribbling of urine per vaginally since childhood. Persistent urinary incontinence is the most common complication after surgical repair of unilateral or bilateral ectopic ureters. As many dogs with ectopic ureters can have other concurrent urinary tract abnormalities, incontinence can remain in some cases. Excessive licking of the genital area. Since these organs are not equipped for urine storage, like the bladder, leakage results, and the puppy is incontinent. ANTATOMIC CAUSES FOR URINARY INCONTINENCE Ectopic ureters (EUs) are the most common cause of urinary incontinence in young dogs. The ectopic ureter is always above the external urinary sphincter. This defect is most commonly identified in 3- to 6-month-old dogs, with females affected 8 times more frequently than males. 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. A blocked ureter or incontinence (leaking urine) can be signs of an ectopic ureter. Symptoms of Ectopic Ureters in Dogs. Ectopic ureter can cause several problems. Dog Leaking Urine All of a Sudden We, herein, present a case of a giant ureter with ectopic orifice, mimicking pelvic organ prolapse, which is the first in the . However, female patients suffering from persistent UI since birth rarely present with a congenital ectopic ureter opening into the vestibulum.1 Ectopic ureter is defined as a ureter opening into an area outside the posterolateral extremity of bladder trigone and more than 80% of . There are several possible causes in a puppy with incontinence. Females show symptoms more often and it affects certain breeds more than others. Normally the ureter drains via the internal ureteral orifice at the trigone of the urinary bladder . Urinary incontinence is the most common clinical manifestation of ectopic ureters. 1 Phenotypically, EUs can be either intramural or extramural, with intramural EU being identified in 64% to 95% of dogs. Ureteral ectopia is an associated anomaly which may manifest as continuous incontinence. The condition is congenital which means it is present at birth. Siberian huskies, golden retrievers, Labrador retrievers . Ectopic ureter is the most common congenital abnormality that causes urinary incontinence in dogs. With laser or surgical intervention, the majority of dogs have a good prognosis. Since none of these organs are designed for storing urine, leakage or urinary incontinence is most likely to occur. ureters, which connect the kidneys to the bladder, and urethra, which connects the bladder to the outside world In some puppies, this plumbing doesn't develop properlythe urine travels from kidneys bypassing the bladder to places where it cannot be stored. Ectopic ureter (or ureteral ectopia) is a medical condition where the ureter, rather than terminating at the urinary bladder, terminates at a different site. Implantation at this site may prohibit excision owing to risk of urinary incontinence. Holt P E & Gibbs C (1992) Congenital urinary incontinence in cats: a review of 19 cases. This surgery reattaches the ureter appropriately to the bladder or removes the ureter altogether, depending on what the surgeon thinks will be most successful. But they may still have signs of swelling or a UTI. Ureteroneocystostomy was applied as the first choice of corrective procedure in this case, and clinical sings were corrected apparently after surgery. This hassle is clear after toilet education. Ectopic ureter occurs as a consequence of embryologic malformation of the mesonephric and metanephric ducts and abnormal incorporation into the urogenital sinus. Urinary incontinence has been reported to occur in 44 to 67% of patients after surgery . A dog suffering from urinary incontinence that is not responding to treatment may have ectopic ureters. Often the urine leakage will cause a rash in this area. 2, 3, 6-10 Female . Bilateral disease. Girls with ectopic ureters may leak urine since the ureter drains into or near the vagina. Daisy's story - ectopic ureter. 1)Incontinence-. Instead of draining into the . It is one of the most common causes of juvenile urinary incontinence in the dog and cat . The signs of ectopic ureters are the same as many other conditions, such as urinary tract infection. This type of incontinence differs from full loss of bladder control; ectopic ureter-related incontinence tends to cause a small amount of constant dripping, whichmay be most noticeable when toilet training a child. These common signs include: Frequent urination. Daisy is a lovely 11-month-old Labrador puppy who has been struggling with incontinence. A blocked ureter or incontinence (leaking urine) can be signs of an ectopic ureter. In males the mesonephric duct is incorporated in the proximal urethra and bladder trigone, so the ectopic ureter opens proximal to urethral sphincter; hence, there is no incontinence. Ectopic ureter: Caudal ectopia results if the ureteric bud arises more proximal than usual location. In some cases, the incontinence is due to problems such as vesical neoplasms, pelvic masses or urethral malformations, such as ectopic ureter.In fact, ectopic ureter is usually detected because of urine leakage, which is the most common reason for consultation. In girls, ectopic ureter can cause incontinence. However, incontinence from organic causes such as ectopic ureter (EU) is particularly important because of the potential for cure by surgical correction [ 1 ]. The evaluation may consist an ultrasound and voiding cystourethrogram (VCUG), but these may not be diagnostic and further evaluation may be necessary. Incontinence i.e. Ectopic ureters represent an embryological error in the development of this tract. We reviewed our experience with imaging modalities used to make the diagnosis of ureteral ectopia. "Incontinence in young animals is often caused by a birth defect known as ectopic ureter(s). Girls with ectopic ureters may leak urine since the ureter drains into or near the vagina. But they may still have signs of swelling or a UTI. By exercising patience during physical exam, urine . 2-6 Regardless, the usual clinical outcome is juvenile onset, persistent urinary incontinence. Incontinence aside, recurrent episodes of vulvovaginitis and vaginal discharge are also commonly elicited on history. urine leaking or dribbling at times but normal urination at other times. conditions such as spinal disc disease or degenerative myelopathy. The most common sign of ectopic ureters is urinary incontinence, or urine dribbling, in a young female dog. J Am Vet Med Assoc 224 (10), 1607-1610 PubMed. An ectopic ureter occurs when a person is born with a ureter in the wrong position (the tube drains pee to the wrong place). Ectopic ureters are an abnormality whereby dogs and cats are born with ureters that do not enter the bladder in the correct position resulting in incontinence. 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