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Ettinger General - 9th Ed EW > Ch313 Congenital Lower Urinary Tract Disorders > Flashcards

Ch313 Congenital Lower Urinary Tract Disorders Flashcards

1
Q

What is an ectopic ureter?

A

A congenital abnormality in which at least 1 ureteral opening is located distal (caudal) to the bladder trigone.

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2
Q

What are the two main types of ectopic ureters?

A
  1. Intramural (86-100% of cases in dogs) - tunnels submucosally through bladder/urethra wall
  2. Extramural - bypasses bladder and inserts directly into urethra, vagina, or uterus
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3
Q

Which breeds are predisposed to ectopic ureters?

A

Golden Retriever, Labrador Retriever, Newfoundland, Siberian Husky, Poodle, Soft Coated Wheaten Terrier, and Entlebucher Mountain Dog (confirmed hereditary)

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4
Q

What is the primary clinical sign of ectopic ureters?

A

Urinary incontinence, though some animals may show no clinical signs due to high urethral tone and retrograde flow of urine into the bladder

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5
Q

What is the preferred diagnostic method for ectopic ureters in female dogs vs male dogs/cats?

A
  • Female dogs: Cystoscopy (100% sensitivity)
  • Male dogs and cats: Computed tomographic excretory urography (CTEU)
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6
Q

What is a ureterocele?

A

A cystic dilatation of the submucosal portion of the distal ureter

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7
Q

What are the two types of ureteroceles?

A
  1. Orthotopic - ureterocele and ureteric opening located within bladder
  2. Ectopic - any portion of ureterocele located within urethra
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8
Q

What are the three types of urachal anomalies?

A
  1. Patent urachus - open communication between bladder and umbilicus
  2. Urachal cyst - isolated section with epithelial secretory lining
  3. Vesicourachal diverticulum - persistent communication of proximal urachus with bladder apex
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9
Q

What is bladder hypoplasia most commonly associated with?

A

It’s most commonly secondary to other conditions causing urinary incontinence in juvenile animals, such as ectopic ureters or congenital urethral sphincter mechanism incompetence

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10
Q

What is hypospadias?

A

A failure of fusion of the urogenital folds resulting in incomplete formation of the ventral aspect of the urethra

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11
Q

What is the difference between hypospadias and epispadias?

A
  • Hypospadias: Incomplete formation of ventral urethra
  • Epispadias: Incomplete formation of dorsal urethra
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12
Q

What are the main signs associated with urethrorectal/rectovaginal fistulae?

A
  • Feces or urine exiting from incorrect orifice
  • Possible perineal bulging if fecal material cannot pass
  • Common urinary tract infections
  • Hematuria, stranguria, and pollakiuria may occur
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13
Q

What are the three main vestibulovaginal junction anomalies?

A
  1. Vestibulovaginal stenosis
  2. Vestibulovaginal septal remnant (VVSR)
  3. Dual vagina
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14
Q

What is a vestibulovaginal septal remnant (VVSR)?

A

A vertical band of tissue resulting from retention of epithelium at the point of mesonephric duct fusion, ranging from thin lesions to thick bands extending into the vagina

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15
Q

What percentage of dogs with ectopic ureters also have vestibulovaginal septal remnants?

A

93% of dogs with ectopic ureters have concurrent VVSRs

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16
Q

What percentage of female dogs experience persistent urinary incontinence after ectopic ureter treatment?

A

35-63% of female dogs experience persistent incontinence after treatment

17
Q

What is the success rate of treating ectopic ureters in male dogs?

A

Much better than females - 100% continence reported with laser ablation in one study of 4 dogs, and 82% continence rate reported in 16 male dogs treated with conventional surgery

18
Q

What concurrent congenital abnormalities are commonly seen with ectopic ureters?

A
  • Renal dysplasia/hypoplasia/aplasia
  • Ureterocele
  • Urethral hypoplasia
  • Vestibulovaginal abnormalities
19
Q

What secondary complications can develop with ectopic ureters?

A
  • Hydronephrosis
  • Hydroureter
  • Bladder hypoplasia
  • Recurrent urinary tract infections
20
Q

What is the typical age of presentation for ectopic ureters?

A
  • Dogs: Often <6 months of age, though males may present when older
  • Cats: Mean age of 1.4 years
  • Should remain on differential list lifelong for compatible clinical signs
21
Q

What percentage of dogs with ectopic ureters have urinary tract infections? and what is the most common bacteria?

A

Up to 83% of female dogs and 36% of cats, most commonly due to E. coli

22
Q

What is the sensitivity of ultrasound for diagnosing ectopic ureters?

A

95% in a recent study, but significantly lower sensitivities have been reported due to operator dependence

23
Q

What are the treatment options for intramural ectopic ureters?

A
  1. Preferred: Transurethral cystoscopic-guided laser ablation
  2. Alternative: Cystoscopic-guided scissor transection
  3. Surgical correction (intravesicular neoureterostomy or extravesicular ureteral re-implantation)
24
Q

What are the clinical signs of ureteroceles?

A
  • May be asymptomatic
  • Lower urinary tract signs (stranguria, pollakiuria, urinary incontinence)
  • Abdominal pain if upper urinary tract obstruction or infection present
25
Q

What is the preferred treatment for ureteroceles?

A

Endoscopic-guided laser ablation is the treatment of choice due to safety and low morbidity

26
Q

What is the frequency of vesicourachal diverticulae in a study of 28,714 ultrasounds:

A
  • Vesicourachal diverticulae: 96.7% in cats, 89.5% in dogs
27
Q

What is the frequency of urachal anomalies in a study of 28,714 ultrasounds:

A
  • Overall prevalence: 0.93% in cats, 0.18% in dogs
28
Q

What complications can arise from a patent urachus?

A
  • Urine leakage
  • Urine scald dermatitis
  • Omphalitis
  • Ascending UTI
  • Rarely, uroabdomen
29
Q

What are the key features of trigonal diverticulae?

A
  • Result from abnormal detrusor muscle development
  • Lead to herniation of bladder mucosa
  • Predispose to infection and struvite calculi
  • Can cause urinary outflow obstruction or vesicoureteral reflux
  • Surgical diverticulectomy needed if symptomatic or >5cm diameter
30
Q

What is congenital urethral sphincter mechanism incompetence (USMI)?

A

A functional abnormality where urethral muscular tone is insufficient to retain urine in the bladder, particularly during recumbency

31
Q

What treatment options exist for congenital USMI?

A
  • May self-resolve after first estrus
  • Medical management with alpha-1 adrenergic agonists
  • Urethral lengthening procedures for severe urethral hypoplasia
32
Q

What are the characteristics of urethral duplication and what are the treatment options?

A
  • Rare congenital abnormality
  • Presents with urinary incontinence
  • Treatment options:
  • Surgical ligation of accessory urethra
  • Minimally invasive ablation using coil embolization and cyanoacrylate glue
33
Q

What percentage of female dogs with vestibulovaginal septal remnants have concurrent abnormalities?

A

89% of dogs with VVSR have concurrent abnormalities

34
Q

How can vestibulovaginal septal remnants be treated?

A
  • Endoscopic laser ablation (preferred)
  • Endoscopic scissors
  • Surgical resection (more invasive, requires episiotomy)
35
Q

What is the vestibulovaginal ratio and what is it used to diagnose?

A
  • Ratio of height of vestibulovaginal junction to height of vagina
  • <0.33 commonly quoted for stenosis
  • <0.20 more significant as clinical signs better correlate to severe stenosis
36
Q

What factors have been investigated but show no association with treatment outcome in ectopic ureters?

A
  • Breed
  • Uni- vs bilateral disease
  • Classification of EU
  • Age at presentation
  • Position of bladder/length of urethra
  • Concurrent UTI
37
Q

When should artificial urethral sphincter placement be considered for ectopic ureters?

A

Only after:

  • Initial treatment (e.g., laser ablation)
  • Persistent incontinence despite medical management
  • At least one estrous cycle has occurred
38
Q

What is the success rate of artificial urethral sphincter placement in dogs with persistent incontinence after EU treatment?

A

80% effective in one study

Ettinger General - 9th Ed EW (7 decks)

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