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Imaging ectopic ureters
Advances
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Results Digital fluoroscopic excretory urography and CT permitted correct identification of ectopic ureters and their location. Urethrography did not reliably detect ectopic ureters. Cystoscopic findings usually agreed with findings during surgery, but one false-positive cystoscopic diagnosis of unilateral ureteral ectopia was made in a male dog. The best agreement was between CT and both cystoscopy and surgical or postmortem examination findings in determining the presence and site of ectopic ureters, compared with other imaging techniques. Author Conclusion CT was more useful than other imaging techniques for diagnosing canine ectopic ureters. Inclusions Four figures, 2 tables, 34 references.
Diagnostic Imaging Imaging Ectopic Ureters Background Contrast-enhanced computed tomography (CT) is the preferred method for evaluating ectopic ureters in humans. Cystoscopy requires operator expertise and does not permit evaluation of the upper urinary tract for concurrent diseases, such as hydronephrosis, hydroureter, and pyelonephritis. The renal pelvis, ureter, and ureterovesicular junction of normal dogs is easily identified by contrast-enhanced CT. Objectives To determine the diagnostic usefulness of CT for the diagnosis of ectopic ureters in the dog and to compare CT findings with those of digital fluoroscopic urography and urethrography. Procedure Ectopic ureters were confirmed or ruled out based on findings from cystoscopy and exploratory surgery or postmortem examination. Of 24 dogs (20 female, 4 male) evaluated, 17 had ectopic ureters.
Editor Annotation Diagnosis of ectopic ureters is challenging. Static excretory urography is only marginally accurate, increasing with improved interpretive skills. Other imaging modalities, i.e., fluoroscopy and CT, are available and better for successfully yielding the diagnosis of ectopia, but clinicians may either not have access to these or may not be aware of their higher success in diagnosing this anomaly. In the current study, the authors compared the use of digital fluoroscopic excretory urography, urethrography, contrast-enhanced helical computed tomography, and cystoscopy in dogs with suspected ectopic ureters. As expected, CT agreed with cystoscopy, surgery or post-mortem examination, and was the most reliable imaging modality for correct diagnosis of this condition. Crosssectional CT evaluation of the caudal abdomen is unimpeded by overlying structures that plague survey radiography (spine and pelvis) and allows for clear visualization of all anatomic structures. Tracing the contrast-filled ureters from their renal origins to their terminations, either into or beyond the urinary trigone, is made simple, provided one has reasonable experience with evaluating these images. Digital fluoroscopy, recorded during real-time performance for playback evaluation, is also a reliable modality for correct diagnosis of ectopic ureters because the animal can be manipulated during the
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evaluation to yield the best imaging planes. Given that urethrography is not as accurate, the clinician should consider referring these cases to veterinary centers that have CT or digital fluoroscopy for diagnostic work-up. (JDS) Samii VF, McLoughlin MA, Mattoon JS, et al. Digital fluoroscopic excretory urography, digital fluoroscopic urethrography, helical computed tomography, and cystoscopy in 24 dogs with suspected ureteral ectopia. J Vet Intern Med 2004;18:271-281.
Advances
Page 5
Results Digital fluoroscopic excretory urography and CT permitted correct identification of ectopic ureters and their location. Urethrography did not reliably detect ectopic ureters. Cystoscopic findings usually agreed with findings during surgery, but one false-positive cystoscopic diagnosis of unilateral ureteral ectopia was made in a male dog. The best agreement was between CT and both cystoscopy and surgical or postmortem examination findings in determining the presence and site of ectopic ureters, compared with other imaging techniques. Author Conclusion CT was more useful than other imaging techniques for diagnosing canine ectopic ureters. Inclusions Four figures, 2 tables, 34 references.
Diagnostic Imaging Imaging Ectopic Ureters Background Contrast-enhanced computed tomography (CT) is the preferred method for evaluating ectopic ureters in humans. Cystoscopy requires operator expertise and does not permit evaluation of the upper urinary tract for concurrent diseases, such as hydronephrosis, hydroureter, and pyelonephritis. The renal pelvis, ureter, and ureterovesicular junction of normal dogs is easily identified by contrast-enhanced CT. Objectives To determine the diagnostic usefulness of CT for the diagnosis of ectopic ureters in the dog and to compare CT findings with those of digital fluoroscopic urography and urethrography. Procedure Ectopic ureters were confirmed or ruled out based on findings from cystoscopy and exploratory surgery or postmortem examination. Of 24 dogs (20 female, 4 male) evaluated, 17 had ectopic ureters.
Editor Annotation Diagnosis of ectopic ureters is challenging. Static excretory urography is only marginally accurate, increasing with improved interpretive skills. Other imaging modalities, i.e., fluoroscopy and CT, are available and better for successfully yielding the diagnosis of ectopia, but clinicians may either not have access to these or may not be aware of their higher success in diagnosing this anomaly. In the current study, the authors compared the use of digital fluoroscopic excretory urography, urethrography, contrast-enhanced helical computed tomography, and cystoscopy in dogs with suspected ectopic ureters. As expected, CT agreed with cystoscopy, surgery or post-mortem examination, and was the most reliable imaging modality for correct diagnosis of this condition. Crosssectional CT evaluation of the caudal abdomen is unimpeded by overlying structures that plague survey radiography (spine and pelvis) and allows for clear visualization of all anatomic structures. Tracing the contrast-filled ureters from their renal origins to their terminations, either into or beyond the urinary trigone, is made simple, provided one has reasonable experience with evaluating these images. Digital fluoroscopy, recorded during real-time performance for playback evaluation, is also a reliable modality for correct diagnosis of ectopic ureters because the animal can be manipulated during the
Page 6
evaluation to yield the best imaging planes. Given that urethrography is not as accurate, the clinician should consider referring these cases to veterinary centers that have CT or digital fluoroscopy for diagnostic work-up. (JDS) Samii VF, McLoughlin MA, Mattoon JS, et al. Digital fluoroscopic excretory urography, digital fluoroscopic urethrography, helical computed tomography, and cystoscopy in 24 dogs with suspected ureteral ectopia. J Vet Intern Med 2004;18:271-281.
Advances