Ectopic ureters are a congenital anomaly of the urinary system, in which the ureteral orifice is inappropriately positioned
caudal to the urinary bladder. This is the most common cause of urinary incontinence in juvenile female dogs. See how the
use of cystoscopic-guided laser ablation provides a minimally invasive alternative to surgery in cases with intramural ectopic
ureters, as was seen in this Golden Retriever puppy.
Signalment: 4-month-old intact female Golden Retriever
Presenting complaint: Owner is unable to housetrain; urine staining around hind end
Pertinent history: Always wet around back end; bad-smelling urine; urine culture results positive for Escherichia coli that is sensitive to amoxicillin-clavulanic acid; with treatment, odor resolved, but incontinence persisted
Medications: Amoxicillin-clavulanic acid (15 mg/kg orally b.i.d.), phenylpropanolamine (1.5 mg/kg orally t.i.d.)
Physical examination findings: Bright, alert, good body condition; urine staining around fur of tail, vulva and medial aspect of both hindlimbs; slightly
recessed vulva; normal neurologic examination with good anal tone. The remainder of the examination was within normal limits.
Rectal examination palpated a wide urethra with evidence of the bladder neck at the level of the pubis.
Blood pressure: 130 mm Hg systolic
Complete blood count: Slight normochromic normocytic nonregenerative anemia of 33 percent
Serum chemistry profile: BUN 13, creatinine 0.4, phosphorus 12
Urinalysis: USG 1.021, no white blood cells, no red blood cells/hpf, no crystals, no bacteria, pH 6.5
Urine culture: Negative (while still receiving amoxicillin-clavulanic acid)
Abdominal radiography: Within normal limits
Abdominal ultrasonography: Loss of architecture to both kidneys; minimal pyelectasia (2.5 mm) bilaterally; empty bladder, unable to perform cystocentesis
See Figure 1
Figure 1: Endoscopic images of a dog with ectopic ureters. The dog is in dorsal recumbency during a cystourethroscopy. A)
The left ectopic ureteral opening is visualized inside the urethral lumen (yellow asterisk). B) An open-ended ureteral catheter
is placed inside the ectopic ureteral lumen (black arrow). C) A diode laser (red arrow) is cutting the medial ureteral wall
over the ureteral catheter (black arrow) to advance up the neo-ureteral orifi ce to the bladder lumen. D) The neo-ureteral
orifi ce is now inside the urinary bladder lumen (yellow asterisk). A guidewire (black arrow) is still inside the ureteral
• Retrograde ureteropyelography: See Figure 2
Figure 2: A fl uoroscopic image of a dog during retrograde ureteropyelography and concurrent cystourethrography. The bladder
is fi lled with contrast material. The rigid cystoscopy is at the level of the bladder trigone, and a guidewire is inside
the ureteral lumen coursing through the intramural tunnel and then transitions extramurally beyond the bladder trigone.
• Vaginoscopy: See Figure 3
Figure 3 (far right photo): Endoscopic images with the dog in dorsal recumbency after the cystoscopic-guided laser ablation
procedure. The top image shows a thick vaginal band (persistent paramesonephric remnant) pulling the urethral orifi ce open.
This band splits the vaginal opening into two compartments. The middle image is the remnant of the vaginal band after it is
laser-ablated with a diode laser. This band went all the way back to the cervix and was completely cut down with the laser
to the level of the cervix seen here. The bottom image is the vaginal (bottom) and urethral orifi ce (top) after thepersistent
paramesonephric remnant is lasered open showing an open vagina.