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Surgical management of ectopic ureters in dogs
P age 8
AD V ANCE S
Surgical Management of Ectopic Ureters in Dogs Background Long-term incontinence after surgical correction of ectopic ureters (EU) is a debilitating postoperative complication that is more common in female dogs. Reported postoperative continence rate after surgical correction of EU without adjunct treatment ranges from 2% to 72%. In male dogs, a continence rate of 82% has been reported. Postoperative adjunct medical treatment, mostly phenylpropanolamine (PPA) or estrogens, generally improves continence rates. The persistence or recurrence of urinary incontinence after correction of EU have been attributed to several factors, such as lower urinary tract infection (UTI), recanalization of the ligated ureter, disturbed urethral closure due to residual intramural EU, congenital urethral sphincter mechanism incompetence (USMI), poorly developed trigone, hypoplastic bladder, vestibulovaginal stenosis, neurogenic abnormalities, hormonal imbalance, or inadequate surgery. The type, side, number of EU, as well as the presence of preoperative hydroureter and UTI did not influence postoperative continence in affected dogs. Studies evaluating the impact of colposuspension and neutering on urinary continence after surgical correction of EU are lacking. Such knowledge would provide evidence to guide recommendations for dogs with EU and potentially improve their post operative continence rates.
Objectives
••To determine outcomes after surgical correction of EU.
••To identify prognostic factors for longterm continence.
Procedure Medical records (1999-2016) of dogs with surgical correction of EU were reviewed. A continence score (15 incontinent, 25 sporadic incontinence, 35 continent) was attributed preoperatively, at discharge, 1 month postoperatively, and at longterm evaluation.
Results Twenty-eight dogs had unilateral EU, and
19 dogs had bilateral EU (57 intramural and 9 extramural). Nineteen dogs had a pelvic bladder. Neoureterostomy with dissection, ureteroneocystotomy, or nephroureterectomy was performed. Thirty-three dogs were neutered: 32 before or during the surgery and 1 after surgery. Colposuspension was performed during surgical correction in 15 dogs. Adjuvant medical treatment improved postoperative continence scores. Median continence scores were greater at discharge (3), at 1 month postoperatively (3), and at longterm evaluation (3) than before surgery (1). At long-term evaluation (mean 46.1 months), a score of 1 was observed in 19%, a score of 2 in 7%, and a score of 3 in 74% of the dogs.
Author Conclusions A good-to-excellent, long-term overall continence rate of 81% can be reached after successful correction of EU. Longterm continence can be improved by adjunct medical treatment. The lack of association between neutering and postoperative incontinence should be interpreted with caution due to the small number of cases in this study and warrants further prospective investigation in a larger population.
Inclusions One figure, 3 tables, 57 references.
Editor Annotation Long-term success rates following surgical treatment of ectopic ureters have been variable and sometimes disappointing. In some cases, persistent or recurrent incontinence develops. While this study was unable to identify any risk factors for persistent or recurrent incontinence after surgery, it did suggest that longterm continence could be improved with the addition of medications. The favorable response to medications suggests that many patients are likely to have causes for incontinence separate from EU. Future prospective study may help to identify additional reasons for longterm incontinence following surgery. Specifically, the indications for concurrent colposuspension and the timing of gonadectomy are areas that would benefit from additional study. This may lead to improved surgical recommendations, identification of prognostic factors, and better long-term outcomes. Until then, it is important that owners understand
Journals Monitored • American Journal of Veterinary Research • Australian Veterinary Journal • Australian Veterinary Practitioner • Avian Diseases • British Veterinary Journal • Canadian Journal of Veterinary Research • Canadian Veterinary Journal • Journal of Avian Medicine and Surgery • Journal of the American Animal Hospital Association • Journal of the American Veterinary Medical Association • Journal of Small Animal Practice • Journal of Small Exotic Animal Medicine • Journal of Veterinary Dentistry • Journal of Veterinary Emergency and Critical Care • Journal of Veterinary Internal Medicine • Journal of Veterinary Pharmacology and Therapeutics • Journal of Zoo and Wildlife Medicine • New Zealand Veterinary Journal • Research in Veterinary Science • Veterinary and Comparative Orthopaedics and Traumatology • Veterinary Dermatology • Veterinary Immunology and Immunopathology • Veterinary Pathology • Veterinary Radiology & Ultrasound • Veterinary Record • Veterinary Research Communications • Veterinary Surgery ... and more than 20 others
that surgical treatment can be successful, but some pets may still require long-term medical management for urinary incontinence. (TW) Noel SM, Claeys S, Hamaide AJ. Surgical management of ectopic ureters in dogs: Clinical outcome and prognostic factors for long-term continence. Vet Surg 2017;46:631-641.
AD V ANCE S
Surgical Management of Ectopic Ureters in Dogs Background Long-term incontinence after surgical correction of ectopic ureters (EU) is a debilitating postoperative complication that is more common in female dogs. Reported postoperative continence rate after surgical correction of EU without adjunct treatment ranges from 2% to 72%. In male dogs, a continence rate of 82% has been reported. Postoperative adjunct medical treatment, mostly phenylpropanolamine (PPA) or estrogens, generally improves continence rates. The persistence or recurrence of urinary incontinence after correction of EU have been attributed to several factors, such as lower urinary tract infection (UTI), recanalization of the ligated ureter, disturbed urethral closure due to residual intramural EU, congenital urethral sphincter mechanism incompetence (USMI), poorly developed trigone, hypoplastic bladder, vestibulovaginal stenosis, neurogenic abnormalities, hormonal imbalance, or inadequate surgery. The type, side, number of EU, as well as the presence of preoperative hydroureter and UTI did not influence postoperative continence in affected dogs. Studies evaluating the impact of colposuspension and neutering on urinary continence after surgical correction of EU are lacking. Such knowledge would provide evidence to guide recommendations for dogs with EU and potentially improve their post operative continence rates.
Objectives
••To determine outcomes after surgical correction of EU.
••To identify prognostic factors for longterm continence.
Procedure Medical records (1999-2016) of dogs with surgical correction of EU were reviewed. A continence score (15 incontinent, 25 sporadic incontinence, 35 continent) was attributed preoperatively, at discharge, 1 month postoperatively, and at longterm evaluation.
Results Twenty-eight dogs had unilateral EU, and
19 dogs had bilateral EU (57 intramural and 9 extramural). Nineteen dogs had a pelvic bladder. Neoureterostomy with dissection, ureteroneocystotomy, or nephroureterectomy was performed. Thirty-three dogs were neutered: 32 before or during the surgery and 1 after surgery. Colposuspension was performed during surgical correction in 15 dogs. Adjuvant medical treatment improved postoperative continence scores. Median continence scores were greater at discharge (3), at 1 month postoperatively (3), and at longterm evaluation (3) than before surgery (1). At long-term evaluation (mean 46.1 months), a score of 1 was observed in 19%, a score of 2 in 7%, and a score of 3 in 74% of the dogs.
Author Conclusions A good-to-excellent, long-term overall continence rate of 81% can be reached after successful correction of EU. Longterm continence can be improved by adjunct medical treatment. The lack of association between neutering and postoperative incontinence should be interpreted with caution due to the small number of cases in this study and warrants further prospective investigation in a larger population.
Inclusions One figure, 3 tables, 57 references.
Editor Annotation Long-term success rates following surgical treatment of ectopic ureters have been variable and sometimes disappointing. In some cases, persistent or recurrent incontinence develops. While this study was unable to identify any risk factors for persistent or recurrent incontinence after surgery, it did suggest that longterm continence could be improved with the addition of medications. The favorable response to medications suggests that many patients are likely to have causes for incontinence separate from EU. Future prospective study may help to identify additional reasons for longterm incontinence following surgery. Specifically, the indications for concurrent colposuspension and the timing of gonadectomy are areas that would benefit from additional study. This may lead to improved surgical recommendations, identification of prognostic factors, and better long-term outcomes. Until then, it is important that owners understand
Journals Monitored • American Journal of Veterinary Research • Australian Veterinary Journal • Australian Veterinary Practitioner • Avian Diseases • British Veterinary Journal • Canadian Journal of Veterinary Research • Canadian Veterinary Journal • Journal of Avian Medicine and Surgery • Journal of the American Animal Hospital Association • Journal of the American Veterinary Medical Association • Journal of Small Animal Practice • Journal of Small Exotic Animal Medicine • Journal of Veterinary Dentistry • Journal of Veterinary Emergency and Critical Care • Journal of Veterinary Internal Medicine • Journal of Veterinary Pharmacology and Therapeutics • Journal of Zoo and Wildlife Medicine • New Zealand Veterinary Journal • Research in Veterinary Science • Veterinary and Comparative Orthopaedics and Traumatology • Veterinary Dermatology • Veterinary Immunology and Immunopathology • Veterinary Pathology • Veterinary Radiology & Ultrasound • Veterinary Record • Veterinary Research Communications • Veterinary Surgery ... and more than 20 others
that surgical treatment can be successful, but some pets may still require long-term medical management for urinary incontinence. (TW) Noel SM, Claeys S, Hamaide AJ. Surgical management of ectopic ureters in dogs: Clinical outcome and prognostic factors for long-term continence. Vet Surg 2017;46:631-641.