Cystoscopic-guided scissor transection of intramural ectopic ureters as a novel alternate minimally invasive treatment option to laser ablation in female dogs: 8 cases (2011–2020)

Abstract

OBJECTIVE To evaluate the safety and efficacy of cystoscopic-guided scissor transection of ectopic ureters (CST-EU) in female dogs. ANIMALS 8 incontinent female dogs with intramural ectopic ureters. PROCEDURES For this retrospective case series, data were collected from medical records of dogs that underwent CST-EU to relocate the ectopic ureteral orifice to an anatomically normal trigonal location between June 2011 and December 2020. Outcome after hospital discharge was determined using owner telephone questionnaires. RESULTS Ectopic ureters were bilateral in 4 of the 8 dogs, and all dogs had other urogenital tract anomalies. Owner questionnaire follow-up was available for 7 dogs, and results indicated 6 dogs had improved urinary continence immediately following the procedure. At the last follow-up (44 to 3,384 days after CST-EU), 3 of the 7 dogs were completely continent with CST-EU alone, 3 others became continent or were markedly improved with the addition of medications for urethral sphincter mechanism incompetence, and 1 required ureteroneocystostomy, colposuspension, and an artificial urethral sphincter to become fully continent. Owners of 5 of the 7 dogs reported that they considered the outcome of CST-EU as good to excellent, and all owners reported that they would consider having CST-EU performed again should they have another incontinent dog. Complications were minor, and only 3 dogs showed transient lower urinary tract signs after CST-EU. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated CST-EU could provide a safe, effective, minimally invasive alternative in the absence of laser technology for the treatment of intramural ectopic ureters in female dogs.

Laparoscopic ureteroneocystostomy in the treatment of urinary incontinence due to ectopy of the ureters in female dogs: A pilot study

“…Laparoscopic ureteroneocystostomy was feasible in 10/10 cases (100%) without the need for conversion. Jacobson et al [ 14 ] showed in their work that they were able to completely transect the medial wall of the ectopic ureter in 7/8 of the operated cases, obtaining an anatomically correct position of the terminal ureteral orifice. However, Hooi et al [ 21 ] in a retrospective review demonstrated that the UE could not be corrected in 9.7% of all cystoscopy-guided laser ablation cases owing to the presence of extramural EU or an extramural portion of the EU and bladder mucosa injury secondary to cystoscopy.…”

“…Interestingly, cystoscopy-guided laser ablation in female dogs has shown similar results, with urinary continence rates of 31% and 47% [ 3 , 4 ]. However, after cystoscopy-guided scissor transection of intramural ectopic ureters, three of the seven dogs regained urinary continence as a result of the procedure alone [ 14 , 26 ]. It is recognized that several factors may influence the persistence or recurrence of urinary incontinence after EU correction, such as lower urinary tract infection (UTI), recanalization of the ligated ureter, disturbed urethral closure due to residua intramural EU, congenital urethral sphincter mechanism incompetence (USMI), poorly developed trigone, hypoplastic bladder, vestibulovaginal stenosis, neurogenic abnormalities, hormonal imbalance or inadequate surgery [ 2 , 7 , 13 , 23 , 25 ].…”

“…It is worth emphasizing that the average time of the surgery itself was less than 80 min, and the time of individual procedures decreased with each procedure in the operated group, up to 61 min. The median duration of cystoscopy-guided scissor transection of intramural ectopic ureters was 105 min (range, 40–170 minutes) [ 14 ], whereas that of cystoscopy-guided laser ablation of the EU was 113 min (range, 57–280 minutes).…”

“…Ideally, all dogs would have had repeated cystoscopy to assess how the transplanted ureter healed and for any stenosis of the ureteral opening. However, given that most dogs improved and were doing well, this additional procedure, according to Jacobson et al [ 14 ] report, was difficult to justify. Incontinence recurred in three dogs treated with laparoscopic ureteroneocystostomy, and cystoscopy was repeated during the urethral bulking injection.…”

“…When using the open surgical technique, both ureteroneocystostomy and neoureterostomy are associated with major abdominal and bladder trauma due to the wide surgical access [ 4 ]. Cystoscopy-guided laser ablation of intramural ectopic ureters is a minimally invasive treatment option, but requires specialized equipment (such as a laser) and appropriate training [ 14 ]. A procedure similar to cystoscopy-guided laser ablation is the recently described cystoscopic-guided scissor transection of intramural ectopic ureters [ 14 ].…”