Ureter Flashcards
What is ectopic ureter?
failure of one or both ureters to terminate in the normal location
What is the typical signalment for ectopic ureter?
- Huskies, Labs, Goldens, Westies
- rare in cats
- females
- young patients
What are the clinical signs associated with ectopic ureter?
- incontinence
- failure to house train
- UTI
- urine scalding
How is ectopic ureter diagnosed?
- excretory urography
- CT
- ultrasound
- cystoscopy
Describe an extramural ectopic ureter
- enters and exits in the wrong location
- less common
Describe an intramural ectopic ureter
- enters normally, but exits abnormally
- transverses across the bladder wall
- most common in dogs
How are ectopic ureters treated?
- neoureterocystotomy (side to side, and end to side)
- laser transection of wall between ectopic ureter and bladder or urethra
Describe end to side neoureterocystotomy
- re-implantation of ureter for extramural EU
- transect ureter where it enters the bladder, ligate, and place stay suture at the end
- stab incision into bladder
- pull suture through bladder wall and secure ureter
Describe side to side neoureterocystotomy
- intravesicular diversion for intramural EU
- perform cystotomy
- occlude abnormal ureter exit and watch for urine buildup
- make slit in that area
- suture ureter to that location
Describe laser transection of wall between EU and bladder/urethra
- find where abnormal ureter exits the bladder
- obliterate wall between ureter and bladder up to normal location
What is the prognosis for ectopic ureter?
- other functional abnormalities may still exist
- incontinence improves in 60%
- 90% improvement with medication
What is a ureterocele?
dilation of distal ureter
What are the two classifications of ureteroceles?
- intravesicular (in normal location)
- ectopic
What are the clinical signs associated with ureteroceles?
- UTI
- incontinence
- azotemia if obstruction
How is a ureterocele diagnosed?
- IV urography (cobra head sign)
- ultrasound
How are ureteroceles treated?
- intravesicular: ureterocelectomy
- ectopic: neoureterocystotomy with ureterocelectomy
What are the causes of ureteral trauma?
- iatrogenic is #1 (clamp injury)
- blunt trauma
- obstruction
How is ureteral trauma diagnosed?
- uroretroperitoneum
- uroabdomen
- radiographs
- IV urography
What are the treatment options for ureteral trauma?
- nephroureterectomy
- ureteroureterostomy
- neoureterocystotomy
- urinary diversion
What are the two methods of urinary diversion?
- ureteral stent
- nephrostomy tube
What treatment is used when the proximal ureteral length is insufficient to reach the bladder?
transureteroureterostomy
Describe renal descensus
mobilize the kidney and suture caudally to the musculature
Describe nephrocystopexy
- dissect kidney out of fossa
- suture kidney to the cranial edge of the bladder
When is a bladder wall flap performed?
Describe it
- significant loss of distal ureter
- elevated bladder flap
- implant ureter to end of flap
- suture flap in a tube and close the defect
What are the clinical signs associated with ureterolithiasis?
- can be asymptomatic
- UTI, hematuria
- anorexia, lethargy, pain
What is the medical management for ureterolithiasis?
- dissolution is not an option for Ca oxalate
- IV fluids and diuretics
- smooth muscle relaxants
What are the indications for surgical treatment of ureterolithiasis?
- complete obstruction
- azotemia
- pyelonephritis
- medical failure
What are the surgical treatment options for ureterolithiasis?
- cystotomy, retrograde flushing, and removal via pyelithotomy
- ureterotomy
- permanent ureteral stenting
What are the advantages of permanent ureteral stenting?
- decreases morbidity
- shorter hospitalization
- less complications
What are the indications for permanent ureteral stenting?
- stone
- tumor
- stricture
- blood clot
What are the different ureteral stent techniques?
- endoscopic
- surgical
- subcutaneous ureteral bypass
