Ectopic Ureter

November 21, 2013

_puppy harrisLast week during a busy consulting session, I was presented with a beautiful 8 week old Golden Labrador puppy. This beautiful puppy would have passed as a stunt double for the Andrex puppy!

 

Yet on examination, it was clear that something was badly wrong. The smell of urine was overpowering, the puppy was soaked with urine down her back legs with her golden hair being stained brown and her skin on her abdomen and back legs was inflamed and angry looking with the dog equivalent of nappy rash.

 

While puppies of this age are not house trained, normally the urine will build up in the bladder and, although they may pass it in the house, the uncontrolled dribbling that this puppy was doing was very abnormal.

 

I was concerned that the bladder sphincter was not controlling the flow of urine as it should have been doing and so we admitted the puppy for investigation.

 

The tubes that pass urine from the kidneys down to the bladder are very tiny in all dogs and in a 4kg puppy they are very small indeed. They cannot be visualised with conventional X rays or ultrasound scans so we employed a technique called IVP (intravenous pyelography) where we injected a radiographic dye into the vein in the front leg. The die is filtered from the circulation by the kidneys and so it highlights the urinary track on X ray.

 

We took a series of X rays mapping the flow of contrast and pretty soon, the cause of the problem became apparent. Rather than the ureters running from the kidneys into the bladder, they continued down into the pelvis. They were entering the lower urinary tract below the bladder sphincter so the puppy had no way of holding onto the urine and whatever the kidneys were producing, was dribbling out subconsciously. This is a condition called Ectopic Ureter and is really quite rare.

 

After discussions with the breeder, the puppy was prepared for surgery to relocate the ureters into their correct position. Inside the abdomen, the ureters were each located. They were detached from their point of entry into the lower urinary tract and were passed through some tiny holes that were created in the wall of the bladder and were anchored in position inside the bladder. The ducts were every bit as small as I had anticipated being only 0.3mm diameter. The size made the surgery very fiddly indeed but in the end, I was satisfied that the anchorage was as secure as it could be.

 

The puppy stayed in the surgery over the weekend on intensive care but by Monday it was very much improved.

 

It will take some time for the puppy to fully learn how to use its bladder. For the first 8 weeks of its life, she had no urine in her bladder whatsoever. She is currently squatting to pass urine very frequently but the good news is that she is not dribbling urine now and in time, as she trains her bladder, I hope that she will get normal bladder function and be able to live a full normal life.

 

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