Megaureter gigante por ectopia ureteral intramural em cadela / Giant megaureter by intramural ureteral etopia in a bitch

Background: The urinary tract is composed by kidneys, urinary bladder and urethra. The kidneys produce urine that achieve urinary bladder by ureters. These have the origin in the renal pelvis, run through the retroperitoneum, end up at the dorsolateral superficies of the urinary bladder, and empty at the trigone. Ureters abnormalities are the rarest congenital defects in the canine urinary tract and ureteroceles are cystic dilatations of the distal segment of the ureter that could be associated to partial or complete urinary obstructions and could lead to megaureter and hydronephrosis. So, the aim of the present study was to describe a case of megaureter by intramural ureteral ectopia in a bitch. Case: A 1-year-old-and-8-month bitch Akita, weighing 18 kg, was referred to the Uniube Veterinary Hospital with vaginal secretion, prostration, hypodipsia, hyporexia and pyrexia related by the tutor. On physical examination, an increase in vulva volume and a vaginal discharge were observed. Nevertheless, others physical exams, blood count and biochemical tests were considered to be within normal parameters. Urinalysis showed cloudy aspect, proteinuria, occult blood, erythrocytes, pyuria, leucocytes, and discreet presence of bacteria. Abdominal ultrasonography revealed a megaureter with right uterocele and excretory urography showed absence of glomerular filtration by right kidney. The patient was submitted to surgery for right kidney and ureter exeresis. Histopathology evaluation showed intense dilation of the ureter and severe multifocal renal fibrosis. The surgery was well succeeded, and the patient recovered completely. Discussion: Once megaureter are associated with congenital abnormalities like ectopic ureter and ureterocele, it is usually diagnosed in young patients with medium age of 10 months, which is below the age of the patient in this case report. Additionally, in the patient here reported, the unilateral alteration could explain the absence of kidney fail symptoms. In more than 90% of the cases, the ureteral ectopia was associated with multiple anomalies in the urinary tract, as was observed in this patient, that presented besides ectopic ureter, ureterocele, megaureter and renal dystrophy. All these morphological alterations made impossible the complete urine elimination, which predispose to urinary tract infection, that was observed in this report. According to literature, urinary tract anomalies are associated with infection in 64 to 85% and 50% of the cases also present hydronephrosis and hydroureter. It was also described that ureteral ectopia is diagnosed by visualization of hydroureter in abdominal ultrasonography. The findings present in this report differs a little, once the right kidney was atrophic possibly by malformation or even so by a chronic renal lesion due to the difficulty in urine flow. The excretory urography showed no filtration in the right kidney, indicating non-functionality that was confirmed by histopathology, in which was observed small glomerulus and large amount of connective tissue deposition. In cases of unilateral megaureter with ipsilateral kidney commitment, there is indication of nephroureterectomy, that was performed in the patient of the present report. As far as we know, this is the first report of megaureter, ureterocele and ectopia ureteral together in the same patient. In conclusion, the procedure was secure, efficient and promote a better quality of life for the patient and prevent the recurrence of urinary tract infections.

Ultrasonographic and radiographic diagnosis of ectopic ureter in a dog

Background: Ureteral ectopia (or ectopic ureter) is a congenital anomaly of the urinary system in which the ureter insertsanywhere other than the vesical trigone. This anatomical change may have unilateral or bilateral involvement. The mostevident clinical sign, occurring mostly in females, is urinary incontinence, however in some cases the condition may progressto nephritis and dilation of the renal pelvis. The diagnosis is established through imaging, and definitive treatment requiressurgical approach. The present study reports a case of ureteral ectopia in a dog which was diagnosed by ultrasound andcontrast radiography (excretory urography) and successfully treated by neoureterostomy.Case: A 10-month-old female American Pit Bull Terrier was attended at the Veterinary Hospital of the Federal Rural University of the Semi-Arid (UFERSA), in Mossoró, RN. Her owner reported incontinence of dark, malodorous urine sincebirth as the chief complaint. After clinical examination, cystitis was suspected, and a complete blood count, urinalysis,and abdominal ultrasound was requested. The blood count and creatinine were within the reference values. The presenceof struvite crystals were found on urinalysis. Ultrasound examination revealed a tortuous, dilated right ureter from therenal pelvis to the urinary bladder; no uroliths were identified as a cause of potential obstruction, but the ipsilateral kidneyshowed increased cortical echogenicity, loss of corticomedullary definition, and moderate pelvic dilation. These findingssupported a presumptive diagnosis of ectopic ureter. For the purpose of confirming this suspicion, excretory urography wasperformed, revealing unilateral ureteral dilation and radiopaque contrast uptake following the path of the urethra. Once thediagnosis was confirmed, surgery was performed to correct the ureteral ectopia using the standard...

Ultrasonographic and radiographic diagnosis of ectopic ureter in a dog

Background: Ureteral ectopia (or ectopic ureter) is a congenital anomaly of the urinary system in which the ureter insertsanywhere other than the vesical trigone. This anatomical change may have unilateral or bilateral involvement. The mostevident clinical sign, occurring mostly in females, is urinary incontinence, however in some cases the condition may progressto nephritis and dilation of the renal pelvis. The diagnosis is established through imaging, and definitive treatment requiressurgical approach. The present study reports a case of ureteral ectopia in a dog which was diagnosed by ultrasound andcontrast radiography (excretory urography) and successfully treated by neoureterostomy.Case: A 10-month-old female American Pit Bull Terrier was attended at the Veterinary Hospital of the Federal Rural University of the Semi-Arid (UFERSA), in Mossoró, RN. Her owner reported incontinence of dark, malodorous urine sincebirth as the chief complaint. After clinical examination, cystitis was suspected, and a complete blood count, urinalysis,and abdominal ultrasound was requested. The blood count and creatinine were within the reference values. The presenceof struvite crystals were found on urinalysis. Ultrasound examination revealed a tortuous, dilated right ureter from therenal pelvis to the urinary bladder; no uroliths were identified as a cause of potential obstruction, but the ipsilateral kidneyshowed increased cortical echogenicity, loss of corticomedullary definition, and moderate pelvic dilation. These findingssupported a presumptive diagnosis of ectopic ureter. For the purpose of confirming this suspicion, excretory urography wasperformed, revealing unilateral ureteral dilation and radiopaque contrast uptake following the path of the urethra. Once thediagnosis was confirmed, surgery was performed to correct the ureteral ectopia using the standard...(AU)

Ureteral stent placement using a double J-catheter in the treatment of ectopic ureter in a dog

Background: Ectopic ureter is a congenital anomaly in which the final segment of one or both ureteral orifices is locateddistal to the bladder trigone. It may be classified as intra- or extramural. Surgical treatment of ectopic ureters in dogs isrecommended and the approach varies with the classification. In the postoperative period, complications are common.When stenosis of the new ureteral ostium occurs, immediate repeated surgery is recommended. This study aimed at usingthe double J catheter placement following neoureterostomy to treat urethral obstruction secondary to the surgical treatmentof an intramural ectopic ureter in a dog.Case: An 8-month-old female French bulldog with dysuria and urinary incontinence was seen at a private veterinaryhospital in Jaboticabal, São Paulo. The patient had previously been diagnosed with an intramural ectopic ureter on theright side following imaging tests (ultrasound, computed tomography, and abdominal radiography, excretory urography)and had undergone neoureterostomy and closure of the intramural pathway approximately a year ago. Ultrasonographicexamination showed dilation of the caudal portion of the ureter and hydroureter, which was suggestive of right ureteralstenosis. Computed tomography was also performed to evaluate the kidneys, ureters, and bladder; an increase in the diameter of the right ureter in its middle portion and close to the bladder triangle was observed. A new surgical interventionwas indicated and performed. The ureteral route was identified in a region of the bladder trigone, incised, and probed witha urethral probe No. 04. The intramural course in the proximal urethra was identified and probed with a 16G epiduralcatheter. It was necessary to perform a neoureterostomy. A longitudinal incision (spatulation) of approximately 5 mm wasmade in the distal portion of the right ureter to increase the circumference of the...

Ureteral stent placement using a double J-catheter in the treatment of ectopic ureter in a dog

Background: Ectopic ureter is a congenital anomaly in which the final segment of one or both ureteral orifices is locateddistal to the bladder trigone. It may be classified as intra- or extramural. Surgical treatment of ectopic ureters in dogs isrecommended and the approach varies with the classification. In the postoperative period, complications are common.When stenosis of the new ureteral ostium occurs, immediate repeated surgery is recommended. This study aimed at usingthe double J catheter placement following neoureterostomy to treat urethral obstruction secondary to the surgical treatmentof an intramural ectopic ureter in a dog.Case: An 8-month-old female French bulldog with dysuria and urinary incontinence was seen at a private veterinaryhospital in Jaboticabal, São Paulo. The patient had previously been diagnosed with an intramural ectopic ureter on theright side following imaging tests (ultrasound, computed tomography, and abdominal radiography, excretory urography)and had undergone neoureterostomy and closure of the intramural pathway approximately a year ago. Ultrasonographicexamination showed dilation of the caudal portion of the ureter and hydroureter, which was suggestive of right ureteralstenosis. Computed tomography was also performed to evaluate the kidneys, ureters, and bladder; an increase in the diameter of the right ureter in its middle portion and close to the bladder triangle was observed. A new surgical interventionwas indicated and performed. The ureteral route was identified in a region of the bladder trigone, incised, and probed witha urethral probe No. 04. The intramural course in the proximal urethra was identified and probed with a 16G epiduralcatheter. It was necessary to perform a neoureterostomy. A longitudinal incision (spatulation) of approximately 5 mm wasmade in the distal portion of the right ureter to increase the circumference of the...(AU)

Ureter ectópico extramural em um cão Labrador Retriever: relato de caso / Ectopic ureter extramural in a Labrador Retriever dog: a case report

A ectopia ureteral é uma enfermidade congênita que se caracteriza quando um ou ambos os ureteres apresentam-se inseridos fora do seu local anatômico, com a inserção ocorrendo no útero, no colo da bexiga, na uretra ou na vagina, devido a uma diferenciação anormal dos ductos mesonéfricos e metanéfricos. Nos machos, a inserção pode ocorrer também nos ductos deferentes e na próstata. A incontinência urinária é o sinal clínico mais comumente associado ao ureter ectópico. O presente relato descreve um caso de ureter ectópico extramural unilateral, em um cão da raça Labrador Retriever de sete anos de idade, corrigido cirurgicamente, e mostra a importância dos exames radiográfico contrastado e ultrassonografia.(AU)

Ureteral ectopia is a congenital disease that is characterized when one or both ureters are shown inserted outside their anatomic site, with the possible insertion in the uterus, bladder neck, the urethra or vagina due to abnormal differentiation of ducts mesonephrics and metanephrics. In males the insertion can also occur in the vas deferens and prostate. Urinary incontinence is the most common clinical sign associated with ectopic ureter. This report describes a case of unilateral extramural ectopic ureter in a dog of the Labrador Retriever breed at seven years old surgically corrected, and shows the importance of contrast radiographic examination and ultrasound.(AU)

Ureter ectópico extramural em cadela / Extramural Ectopic Ureter in a Bitch

Background: Ureteral ectopia is a congenital abnormality of the terminal segment of one or both ureters, in which the ureteral orifice is located distal to the trigone of the bladder. Ureteral ectopia results from dysembryogenesis of the ureteral bud due to its abnormal positioning along the mesonephric duct. It is frequently associated with other congenital anomalies of the lower urinary tract as urethral sphincter dysfunction, hydroureter and hydronephrosis. Ectopic ureters are classified into two categories: extramural and intramural. Extramural ectopic ureters completely bypass the urinary bladder without anatomic attachment, opening directly into the urethra, vagina or uterus. Continuous or intermittent urinary incontinence is the most frequently reported clinical symptom associated with ureteral ectopia, and it is far more frequent in young bitches than in male dogs. Repositioning the distal segment of the ureter and ureteral orifice directly into the bladder may restore urinary continence throughout neoureterocistostomy. Case: A 3-month-old female poodle weighting 4 kg was referred to the Teaching Veterinary Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS), State of Rio Grande do Sul, Brazil, due to urinary incontinence, dysuria and severe vulvar pyodermatitis since it was 9 weeks old. Normal posturing and voiding of urine did occur, although only small volumes of urine were eliminated. Abdominal ultrasound revealed hydronephrosis and hydroureter of both right kidney and ureter. The ureter terminated distal to the urinary bladder, although the exact location of the termination could not be determined, ectopic ureter was suggested. Exploratory celiotomy was performed in order to confirm the diagnosis and obtain surgical correction. During the surgery it was possible to identify the hydroureter attaching on the distal urethra bypassing the bladder. Surgical correction was performed using the standard neoureterocistostomy technique. Recovery was uncomplicated and lasted 4 weeks, certified with weekly ultrasound exams. Discussion: Although ureteral ectopia has been reported in both purebred and mixed breed dogs, it has been documented to occur with greater frequency in specific breeds such as toy poodle, as observed in this case. Urinary incontinence, as observed, is the most frequently reported clinical symptom of patients with ureteral ectopia. Physical examination is often within normal limits with the exception of moist or urine-stained hair in the perivulvar region. Mild to severe perivulvar dermatitis secondary to urine scalding are commonly reported clinical signs, and were present in this case. Ultrasound examination was an efficient method to identify anatomic anomalies of the inferior urinary tract leading correctly to an exploratory celiotomy, in order to both confirm and correct the congenital defect. The neoureterocistostomy was satisfactory to reimplant the ureter on the bladder without complications. The degree of urinary incontinence is variable and cannot be used to determine the specific location of the ureteral orifice, or distinguish between the presence of unilateral or bilateral ectopic ureters and cannot exclude other differential diagnosis. Incontinence in male dogs with this affection may not occur as commonly due to the longer external urethral sphincter that may oppose the passage of urine distally, resulting in retrograde bladder filling. Surgical prognosis and recovery was good considering the patient had no other clinical affections.

Ectopia ureteral unilateral congênita em uma cadela Teckel Dachshund com pelagem arlequim: relato de caso / Single congenital ureteral ectopy in a female dog Teckel Dachshund with merle colour pattern: case report

O presente relato apresenta a primeira descrição de ectopia ureteral congênita na raça Teckel Dachshund, diagnosticada em uma cadela com pelagem arlequim. O animal, aos dois meses de idade, apresentava sinais de incontinência urinária e cistite bacteriana, sendo submetido a um plano diagnóstico para confirmação de ureter ectópico. A urografia excretora revelou hidroureter direito com desembocadura caudal ao trígono da bexiga. O exame físico do animal evidenciou ainda hérnia inguinal bilateral, o que reforçou a caracterização da origem congênita das alterações. Aspectos de bem-estar animal são também discutidos.(AU)

The present work reports the first description of congenital ureteral ectopy in the canine breed Teckel Dachshund, diagnosed in a female dog with merle colour pattern. The two month old animal, presented with continuous dribbling of urine and bacterial cystitis, was subjected to a diagnostic plan for ectopic ureter. The excretory urography showed a right hidroureter, which had an orifice located caudally to the trigone of the bladder. The animal also presented a bilateral inguinal hernia, which confirmed the case description as a multiple congenital anomaly condition. Animal welfare aspects are also discussed.(AU)