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