Excretory Urography and Ultrasonography in the Diagnosis of Bilateral Ectopic Ureters in a Foal

Abstract

A 7-week-old Appaloosa filly was admitted for persistent urinary incontinence since birth. Vaginal speculum examination revealed urine flowing from an opening in the right vaginal wall. Cystoscopy demonstrated that the ureters did not terminate at the bladder. The endoscope passed easily from the vagina directly into a dilated right ureter. An excretory urogram confirmed the vaginal termination of at least one ureter, based upon extensive filling of the vagina with contrast media in the absence of bladder filling. Bilateral hydroureter and dilated renal pelves were demonstrated both by excretory urography and by ultrasonography. Euthanasia was requested by the owner in lieu of attempted surgical correction. At necropsy, it was confirmed that the right ureter entered the vagina and the left ureter terminated at the urethra. The diagnosis of bilateral ectopic ureter in this foal was suggested by the history and clinical signs, supported by endoscopy and ultrasonography , and confirmed by excretory urography and necropsy. This case establishes the value of diagnostic imaging techniques in the antemortem diagnosis of ectopic ureter.

Bilateral Ureterocystostomy to Correct Left Ureteral Atresia and Right Ureteral Ectopia in an 8‐Month‐Old Standardbred Filly

“…Of 13 reported horses with surgical correction of ectopic ureter, 3 had nephrectomy and 10 had ureterocystostomy 4,9–17 . Of those 10, 4 had the submucosal tunneling technique performed.…”

“…URETERAL ECTOPIA, the most commonly reported congenital anomaly of the equine urinary tract, is a rare cause of urinary incontinence in horses, 1,2 caused by faulty differentiation of the metanephric and mesonephric ducts during development. Ectopic ureter may occur unilaterally or bilaterally, without apparent side predisposition 1–4 . No breed or sex predilection has been reported although the clinical presentation of males may differ from that of females 1 .…”

“…Physical examination, renal function testing, and serum biochemistry values are usually within normal limits, unless the condition has become chronic and led to the development of hydronephrosis 1–3 . Diagnosis is confirmed by locating the ectopic opening either directly (using a vaginal speculum, vaginoscopy, or cystoscopy) or indirectly (contrast radiography or ultrasonography) 1–5 . Systemic administration of dyes to discolor the urine may be useful for diagnosis of ectopic ureter 1–6 .…”

Diseases of the Equine Urinary System

“…59,72,74 Diagnosis can be made by cystoscopy, ultrasound, or excretory urography. 59,[75][76][77][78] Uroliths are composed mostly of inorganic crystalloid components with a smaller proportion of organic matrix. 79 In horses, the crystalloid component is most commonly calcium carbonate with a mucoprotein organic matrix.…”

Ectopia ureteris - A contribution to diagnostic therapy and pathology

“…Häu-fig ist aber wegen der Schwächen in der exakten röntgeno-logischen Darstellbarkeit gerade der distalen Ureterabschnitte eine definitive Diagnose der Ectopia ureteris mittels Ausscheidungsurographie letztlich nicht zu stellen (Rubin, 1993), Eine weitere Möglichkeit der Beurteilung der Nieren und Ureteren bietet die ultrasonographische Untersuchung. Sie wird bei sehr jungen Tieren transkutan durchgefuhrt oder aber transrektal und dient der Kontrolle auf Vorliegen von Ureterdilatation und Nierenbeckendilatation (Blikslager et al, 1992;Odenkirchen et al, 1994).…”