Ectopic Ureters

What are ectopic ureters?

The ureters are tubes that carry urine produced by the kidneys to the bladder. Ectopic ureters are an abnormality whereby dogs and cats are born with ureters that do not enter the bladder in the correct position resulting in incontinence.  Most ectopic ureters (>95%) are classified as intramural which mean they tunnel inside the bladder wall and are amenable to minimally invasive laser correction. The vast majority of dogs with ectopic ureters are female and they often have other abnormalities including a small bladder, short urethras and persistent vaginal remnants.

How can I tell if my pet has an ectopic ureter?

Ectopic ureters in females are often associated with incontinence which is usually present from birth. In male dogs, the ectopic ureter is often not associated with incontinence since the ureter has a narrowing at its opening. This narrowing can lead to pressure and dilation of the entire ureter and kidney. Many dogs with ectopic ureters have urinary tract infections so you may see signs including straining to urinate, frequent urination and discoloured/bloody urine.

How is an ectopic ureter diagnosed?

Clinical signs raise the suspicion of an ectopic ureter but the diagnosis can be confirmed by ultrasound, CT scan or cystoscopy (passing a camera into the bladder).

How is an ectopic ureter treated?

Traditional surgical correction

Traditional surgical correction of an ectopic ureter is associated with an improvement in around 50% of cases. Traditional surgery involves an abdominal incision and surgically re-implanting the ureters into the bladder. A large number of cases can develop stricture (scar) formation at the site of re-implantation leading to obstruction of the ureter.  Cases having traditional surgery would require exercise restriction for at least two weeks to let the abdominal surgery site heal.

Laser correction

Minimally invasive laser correction is also associated with an improvement in 50% of cases.  As this procedure does not require any incision the patients undergoing laser correction are discharged the same day after a short anaesthetic and require minimal to no pain relief or exercise restriction.  The procedure is performed by cystoscopy (passing a camera into the bladder) to allow the ureter to be lasered back into the correct location. Concurrent persistent vaginal remnants which may contribute to recurrent infections can be corrected at the same time.

Further management

While 50% of cases will become continent following the procedure, in those that don’t, consideration can be given to then adding in medical management, which can increase continence to 70% and then placement of a hydraulic occluder device, which can increase continence to 80-90%.

Cystoscopy image of a normal and ectopic ureter

A cystoscopy image showing the normal urethra opening into the bladder at the top and an ectopic ureter below this. Following laser correction the patient was discharged 4 hours later and showed almost immediate improvement in continence.

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