Treatment of Ectopic Ureters Flashcards
Sex predisposition to ectopic ureter?
Female
Where to ectopic ureters run?
Continue submucosally and instead open in either the urethra (most often) or vagina
Define intramural ectopic ureter
Enter at the normal trigone region but continue submucosally.
Define Extramural ectopic ureters
enter directly into the urethra or more distally.
Breed risk of ectopic ureters? (3)
Golden retriever
Labrador
Skye terrier
What position makes incontinence worse?
Recumbent
Common signs of ecoptic ureter?
UTI - haematuria, pollakuira, dysuria
Perivulval dermatitis - urine scald
Imaging for ectopic ureters?
Fluoroscopy
Ultrasound
Endoscope
“Ectopic ureter-induced urinary incontinence is worse in female than male dogs.” – using anatomical considerations, explain why. (2)
Longer length of the urethra in males compared to females
Presence of the prostate in male dogs.
How are intramural ectopic ureters treated surgically?
neoureterostomy
What is a neoureterostomy?
Distal ureter ligated/resected and a new opening of the ureter is created in the correct position, or by cystoscopic laser ablation (CLA)
When may CLA treatment not be appropriate?
Too small to accept scope
How is intramural ectopic ureter approached surgically?
- Ventrallly and incise bladder.
-The intramural ectopic ureter is identified, aided by applying digital pressure to the distal part to cause bulging towards the bladder lumen. Alternatively, a small catheter can be introduced into the ectopic ureter opening, though this often requires extension of the bladder incision to the proximal urethra.
-An incision is made through the bladder mucosa and into the ureteral lumen at the trigone, the anatomically correct location of the ureteral orifice.
-The ureteral and bladder mucosae are sutured together using 5-0 to 9-0 monofilament absorbable interrupted sutures. Magnification is required.
-A catheter is placed in the distal ureteral segment, and one or two sutures are pre-placed through the dorsal bladder wall and around the catheter within the mucosa/submucosa using 3-0 or 4-0 non-absorbable suture material. The suture(s) should not enter the ureteral lumen.
-The catheter is removed, and the sutures are then tightened to close off the ureteral lumen.
What surgical technique can be used to prevents possible recanalization of the ureter, though it has not been shown to reduce the incidence of post-operative incontinence?
Distal segment of ureter can be excised, and the dorsal ureteral mucosa sutured to the bladder mucosa.
How is the bladder closed?
The bladder is closes routinely using simple interrupted or continuous pattern one or 2 layers - as the bladder is often very small and the incision typically extends into the proximal urethra, a single layer of sutures is preferred.
