An ectopic ureter is one that opens somewhere other than into the bladder. 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. Females show symptoms more often and it affects certain breeds more than others. The evaluation may consist an ultrasound and voiding cystourethrogram (VCUG), but these may not be diagnostic and further evaluation may be necessary. Often the urine leakage will cause a rash in this area. As a result, these patients may present with constant urinary leakage that is usually of small volume. All five patients were hospitalized with complaints of gynecologic disease. [1] [2] In males this site is usually the urethra, in females this is usually the urethra or vagina. Normally the ureter drains via the internal ureteral orifice at the trigone of the urinary bladder . Instead of connecting to the bladder, the ureters connect to the urethra, the vagina, colon, or even the uterus. Dogs are born with this problem, so it's usually diagnosed in young dogs. Symptoms of Ectopic Ureters in Dogs. This is the most common cause of urinary incontinence in juvenile female dogs. Ectopic ureter is a congenital defect that causes urinary incontinence in dogs. The affected dog is born with this problem and the resulting urinary incontinence usually begins at birth. Persistent urinary incontinence is the most common complication after surgical repair of unilateral or bilateral ectopic ureters. Male dogs can be affected as well, but less commonly. Thomas P C & Yool D A (2010) Delayed onset urinary incontinence in five female dogs with ectopic ureters. 2, 3, 6-10 Female . 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. Ectopic ureter is the most common congenital abnormality that causes urinary incontinence in dogs. Girls with ectopic ureters may leak urine since the ureter drains into or near the vagina. The condition is present at birth but can be difficult to diagnose. 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. Surgery can correct the problem and prevent kidney damage. We reviewed our experience with imaging modalities used to make the diagnosis of ureteral ectopia. 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. Vet Rec 130 (20), 437-442 PubMed. Urinary incontinence can also happen in males, where it is usually caused by prostate problems (males only) and perineal hernia (more common in males . In most cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. Frequent urination. Signs are often noticed soon after weaning, although some dogs do not show signs until they reach adulthood. This condition should be strongly suspected in the girl whose has persistently damp underwear. Holt P E & Gibbs C (1992) Congenital urinary incontinence in cats: a review of 19 cases. Introduction. urine leaking or dribbling at times but normal urination at other times. UI is the most common clinical sign in dogs with EUs and is usually diagnosed in dogs prior . In all . As a result, your puppy cannot control the flow or urine. JAVMA 237 (2), 191-195 PubMed. Other reported signs are perivulvar or preputial derma-titis, recurrent cystitis, and secondary pyelonephritis [9]. The diagnosis is made by a combination of history, clinical signs, laboratory tests, and imaging. It is one of the most common causes of juvenile urinary incontinence in the dog and cat . A blocked ureter or incontinence (leaking urine) can be signs of an ectopic ureter. However, incontinence from organic causes such as ectopic ureter (EU) is particularly important because of the potential for cure by surgical correction [ 1 ]. By exercising patience during physical exam, urine . If excision is not possible, the SV cyst can be treated with transrectal aspiration or transurethral unroofing without significant recurrence. An ectopic ureter is defined as a ureteral opening in any area other than the normal position in the trigone of the bladder. As ectopic ureters usually drain poorly functioning renal segments with low urine production, these patients may also present with intermittent incontinence as well. Since none of these organs are designed for storing urine, leakage or urinary incontinence is most likely to occur. Ectopic ureters are an uncommon congenital anomaly in which the ureteral orifice is abnormally positioned, most commonly emptying into the urethra. Pelvic examination is indicated in girls with urinary incontinence, sometimes the orifice of the ureter can be identified in the vagina or vulval vestibule. Boys with ectopic ureters do not often have incontinence, since the ureter drains inside the body. 2-6 Regardless, the usual clinical outcome is juvenile onset, persistent urinary incontinence. Since these organs are not equipped for urine storage, like the bladder, leakage results, and the puppy is incontinent. Ectopic ureters occur much more frequently in females, and the insertion sites can include the vagina and the vulva, with resulting incontinence. Daisy's story - ectopic ureter. Ectopic ureter is defined when it opens into a region apart from the usual place on the trigone of the bladder [ 2 ]. Nearly all dogs with ectopic ureter had no trigonal ureteral openings; 1 had an opening in the trigone and also in the urethra. The signs of ectopic ureters are the same as many other conditions, such as urinary tract infection. Ectopic ureter is one of the most common urinary tract anomalies. The most common sign of ectopic ureters is urinary incontinence, or urine dribbling, in a young female dog. It can also be identified in older dogs. Contralateral VUR. Girls with ectopic ureters may leak urine since the ureter drains into or near the vagina. Blood in the urine. This condition is usually apparent after toilet training. Incontinence and infection are the usual outcome. Ectopic ureter can cause several problems. Smith A L, Radlinsky M G & Rawlings C A (2010) Cystoscopic diagnosis and treatment of ectopic ureters in female dogs: 16 cases (2005-2008). [3] 130-2B ). In girls, ectopic ureter can cause incontinence. Urinary incontinence (UI) in adult women results from acquired causes rather than congenital factors. ABSTRACT: The ectopic ureter is predominantly a congenital abnormality. In the following section, different clinical entities will be discussed briefly regarding clinical presentation, diagnostic workup, management, and long-term outcome. 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). 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. This defect is most commonly identified in 3- to 6-month-old dogs, with females affected 8 times more frequently than males. 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 . The presence of an ectopic ureter may be indicated by continuous wetting, despite a normal voiding pattern, especially in girls. With ectopic ureters, one or both of the ureters do not connect normally to the bladder. Urinary incontinence (dripping or leaking urine at times) Constant licking of the genitals. As many dogs with ectopic ureters can have other concurrent urinary tract abnormalities, incontinence can remain in some cases. We, herein, present a case of a giant ureter with ectopic orifice, mimicking pelvic organ prolapse, which is the first in the . The nursing care of these patients is based on observation of the degree of urinary continence following surgery. Normally, each ureter enters the urinary bladder before the urethral sphincters. Incontinence i.e. If infection is present blood tinged urine can sometimes be seen. There are several possible causes in a puppy with incontinence. But they will nevertheless have signs and symptoms of swelling or a UTI. Any problems with nerves in the spine that control the bladder can cause incontinence e.g. Plus, it is not a life-threatening medical issue. More than 95% of ectopic ureters . An ectopic ureter can cause urinary incontinence, infections and swelling. 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. While ectopic ureters can occur in males, females are affected far more commonly. Boys with ectopic ureters do not often have incontinence, since the ureter drains inside the body. Pediatric incontinence Ectopic ureter Urologic imaging abstract Ectopic ureter is a rare cause of urinary incontinence in children. Another cause of urinary incontinence is an ectopic ureter. An ectopic ureter is often associated with a ureterocele, a cystic dilation of the terminal ureter (Fig. Infections of the urinary tract, bladder and kidney are common. For example, incontinence interferes with housetraining and, as with Tala, can cause urine scalding of the skin. An ectopic ureter is a congenital defect characterized by the ureter connecting to the urinary bladder in an abnormal location. Affected dogs have ureters that are not attached to their normal location in the urinary bladder. An ectopic ureter is a ureter that does not correctly connect to the trigone of the bladder and drains outside of the bladder. "Incontinence in young animals is often caused by a birth defect known as ectopic ureter(s). A blocked ureter or incontinence (leaking urine) can be signs of an ectopic ureter. Ectopic ureters (EUs) associated with varying combinations of urinary incontinence, hydronephrosis, and urinary tract infection have been identified in related North American Entlebucher Mountain . Redness and rash in the genital area. Those affected are typically younger than six months of age, and certain breeds of over-represented. of the action of the bladder sphincter by the ureteral muscle; incontinence may appear only in old age [2,5]. Not uncommonly these patients undergo evaluation by multiple healthcare providers prior to such consideration. Cystoscopy and retrograde pyelography: Cystoscopy and retrograde pyelography to search for ureteral orifices. 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. An ectopic ureter occurs when a person is born with a ureter in the wrong position (the tube drains pee to the wrong place). Both patients presented symptoms of continuous urinary incontinence and became symptomatic in the adult life. Results: Five patients were diagnosed with a duplex system associated with an ectopic upper pole ureter. Urology 216.444.5600 Implantation at this site may prohibit excision owing to risk of urinary incontinence. This case series of 2 older childrenwith missed ectopic ureters by the urologic community outline workup for . The ureters are thus bringing urine to an area inequipped for urine storage and leaking results. ANTATOMIC CAUSES FOR URINARY INCONTINENCE Ectopic ureters (EUs) are the most common cause of urinary incontinence in young dogs. Fortunately, ectopic ureter is a rare problem in dogs. A dog suffering from urinary incontinence that is not responding to treatment may have ectopic ureters. and 3D computed tomography scanning revealed presence of the ectopic ureter with urinary incontinence. This abnormality is something that cats and dogs are born with and can affect one or both of the ureters. Median age at presentation was 5 years (6 weeks-9 years), while at surgery was 8 years (2-13 years). Urinary incontinence in dogs is a relatively common problem, with obesity and castration among the predisposing factors. Four patients were referred for incontinence, 1 was . An ectopic ureter is a ureter with an abnormally located ureteral orifice. 11-month-old Black Labrador Daisy at home in the garden. Incontinence is common in girls with an ectopic ureter. Advanced imaging is required for definitive diagnosis. Steffey M A & Brockman D J (2004) Congenital ectopic ureters in a continent male dog and cat. Ectopic ureters are a congenital anomaly of the urinary system, in which the ureteral orifice is inappropriately positioned caudal to the urinary bladder. 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 patients with ureteral ectopia, one or both ureters insert after the urethral sphincters, allowing urine to leak out to cause urinary incontinence. J Am Vet Med Assoc 224 (10), 1607-1610 PubMed. Ectopic ureters (EU) are the most common cause of urinary incontinence in juvenile female dogs. However, an ectopic ureter can produce symptoms, including urinary incontinence (only in females), urinary tract infection . Bilateral disease. The aim of this article is to present two patients with duplex kidney and ureteral ectopia. Ectopic ureter (or ureteral ectopia) is a medical condition where the ureter, rather than terminating at the urinary bladder, terminates at a different site. But they may still have signs of swelling or a UTI. The ectopic ureter is always above the external urinary sphincter. To correct the . Ectopic ureter: Caudal ectopia results if the ureteric bud arises more proximal than usual location. Here, we presented five cases of ectopic ureter opening into the vagina, whose clinical symptoms and malformations were rarely described in previous case reports. Ultrasound imaging . In many instances, an ectopic ureter is not detected because the affected individual is asymptomatic. Ectopic ureter (above) is the most common congenital problem vets see in young dogs. Incontinence aside, recurrent episodes of vulvovaginitis and vaginal discharge are also commonly elicited on history. Ectopic ureter occurs as a consequence of embryologic malformation of the mesonephric and metanephric ducts and abnormal incorporation into the urogenital sinus. Unlike in boys, an ectopic ureter in girls may insert distal to the urethral sphincter. Ectopic ureter is diagnosed when the ureteral orifice is caudal to the normal insertion on the trigone of the bladder. 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. Incontinence. Ultrasonography and excretory urography are the most common imaging . Boys with ectopic ureters do not often have incontinence, since the ureter drains in the body. Signs of an ectopic ureter: Almost exclusively diagnosed in females. Spinal problems. 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. One patient was noted to have a non-functional kidney associated with an ectopic ureter. Ectopic ureter. 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