Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic‐guided laser ablation

Abstract

Objective To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic‐guided laser ablation (CLA) in female dogs. Study design Retrospective study from 2011 to 2018. Animals Twenty‐five female dogs. Methods Data collected included signalment, clinicopathologic data, procedural data, complications, and short‐term and long‐term outcomes. Complications were graded as minor or major if a surgical revision was required. Continence status was scored subjectively (1 = completely incontinent to 10 = fully continent). Results Fifteen dogs had bilateral EU and 24 had intramural EU (iEU). Open surgical correction included 13 neoureterostomies, 2 neocystoureterostomies, and a combination of these in 2 dogs. Eight dogs underwent CLA. Eighteen dogs experienced minor complications (72%), and 2 experienced major complications (8%). One‐month postoperative continence was achieved in 20/25 (80%) dogs (median score of 10). Incontinence recurred at a median time of 24.9 months in 5 dogs but responded to medical treatment. Overall, dogs remained continent for 66 months (median) and 22/25 (88%) dogs achieved continence with adjunction of medical/surgical treatment in incontinent ones. Fewer minor complications and postoperative recurrences of incontinence were documented after CLA than neoureterostomy (P < .01 and P < .05). Conclusion Ectopic ureter correction by open surgery or CLA resulted in a subjectively good prognosis, most dogs reaching continence within a month of surgery, although incontinence occasionally recurred in the long term. CLA was associated with fewer complications and incontinence recurrences than neoureterostomy. Clinical significance Cystoscopic‐guided laser ablation should be preferred to correct iEU to prevent short‐term complications and the recurrence of incontinence. Further studies should investigate the cause of postoperative recurrence of urinary incontinence.

Prognostic factors for continence after surgical correction of ectopic ureters of 51 dogs with long-term follow-up

“…A recent publication by Hoey et al . [ 15 ] did not show a significant increase in incontinence scores if neutering of female dogs was performed after surgical correction of EU, but in the study of Dekerle et al [ 16 ], 3 of the 5 dogs that were spayed after EU correction had recurrence of urinary incontinence. Results of our study did not show a significant increase in the risk of postoperative urinary incontinence in dogs with EU that were already neutered at the time of surgical correction.…”

“…Although recently endoscopic laser ablation was identified as a technique with a more favourable outcome [ 16 ], surgical technique was not included as a dependent variable in this study because only 1 of 69 intramural EU was treated with laser ablation. Although the choice of surgical technique is often elective in intramural EU and not specifically case related, in the future prediction modelling surgical technique should be considered as a confounder for outcome.…”

“…Although surgical correction of EU is frequently performed, the outcome of surgery varies greatly, with reported rates of complete resolution of urinary incontinence varying between 25 and 82% [ 1 , 2 , 8 – 16 ]. Previous studies have investigated possible predictive prognostic factors for continence after surgery.…”

“…In these studies, no significant association was identified between postoperative continence and sex [ 2 , 17 ], EU characteristics (intra- vs extramural types) [ 1 ], age at surgery [ 9 ], preoperative urinary tract infection [ 9 ], pelvic bladder and other urogenital anatomic abnormalities [ 10 , 14 ], neuter status [ 17 ], concurrent colposuspension [ 17 ] and surgical technique [ 1 , 10 , 11 ]. A recent study showed that cystoscopic-guided laser ablation had a significantly lower rate of recurrence of urinary incontinence when compared with neoureterostomy [ 16 ]. A study by Wiegand et al .…”

ACVIM consensus statement on diagnosis and management of urinary incontinence in dogs

“…Cystoscopic‐guided ablation of EU (CA‐EU) can be performed using a diode laser, holmium YAG laser, or electrocautery 83‐85,120‐122 . Multiple studies comparing outcomes between CA‐EU and open surgical correction of EU are not available.…”