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

Bianchi, Simone Passos; Gouvêa, Aline Silva; Macedo, Aline Schafrum; Valente, Fernanda Soldatelli; Ledur, Gabriela Reis; Alievi, Marcelo Meller; Contesini, Emerson Antonio.
Acta sci. vet. (Impr.); 41(supl.1): Pub. 1, 2013. ilus
Artigo em Português | VETINDEX | ID: biblio-1372971


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.
Biblioteca responsável: BR68.1