Retrospective evaluation of cystoscopic‐guided laser ablation of intramural ectopic ureters in female dogs

Abstract

Background Cytoscopic‐guided laser ablation (CLA) is a technique that can be used to correct intramural ectopic ureters (EUs) in dogs. Hypothesis/Objectives To describe clinicopathologic, imaging, and cystoscopic findings in dogs undergoing CLA for intramural EU correction, and whether any of these findings are associated with continence outcomes. Animals Thirty‐one client‐owned dogs undergoing CLA between 2009 and 2019. Methods Retrospective cohort study. Data collected from medical records included signalment, clinical findings (including continence score at presentation), clinicopathologic findings (serum biochemistry profile, urinalysis, and urine culture results before CLA), ultrasonography, and cystoscopy findings. Follow‐up information was collected at 1 day to 1 week, 1 week to 1 month, and at >1 month time points after CLA. Final continence score was determined based on this follow‐up information. Multiple logistic regression was used to determine factors that were associated with final continence score. Results Median continence score of dogs at initial evaluation was 2 (range, 2‐4). Median continence score after CLA alone was 3 (range, 1‐5). Seventeen of 31 (54.8%) dogs received adjunctive medical management after CLA. Median continence score after CLA with or without adjunctive medical management was 5 (range, 1‐5). Overall, 67.7% of dogs were considered continent after CLA with or without adjunctive medical management. No preoperative or perioperative factors were found to be associated with final continence score. Conclusions Cystoscopic‐guided laser ablation for intramural EU in female dogs provides improvement in incontinence. Dogs remaining incontinent after CLA may improve with adjunctive medical management. Surgical management is required to manage incontinence in dogs with extramural EU.

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

“…These findings prompt us to recommend CLA to treat iEU in female dogs. In contrast to previous studies, fluoroscopy was not used in the present study 10,11,14,19 . This imaging modality may be used to confirm the anatomical position of the ureter and confirm the correct position of the newly formed ureterovesical junction within the bladder, potentially reducing the risk of urethral tear during CLA 20 …”

“…Several studies have previously reported the use of CLA for iEU correction in both female and male dogs. 10,11,14,19,20 Proposed advantages of CLA include its minimally invasive nature, the ability to diagnose and treat the EU simultaneously and resect the entire length of some distally opening iEU. Nearly 90% (8/9) of dogs treated by CLA were continent at short-term evaluation in our study although no difference in incontinence persistence after iEU correction was detected when compared to dogs treated with neoureterostomy.…”

“…The outcome after EU correction seems inconsistent, irrespective of the technique used, with a reported postoperative continence rate ranging from 36% to 72%. In addition, no prognostic factor has been identified to explain incontinence persistence after surgery or to understand incontinence recurrence in continent dogs after surgery, a phenomenon sparsely described in some studies 2,7,8,11,12,14,20 . In particular, despite the increasing description of CLA, no study compared the influence of the technique of correction of EU on continence outcome 10,19 …”

“…These procedures, which require an open laparotomy, are associated with significant postoperative morbidity, with surgical revision needed in up to 21% of the reported cases 4,8,18 . Recently, cystoscopic‐guided laser ablation (CLA) has been described as an alternative to open surgery for treating iEU in dogs 10,11,14,19,20 . In addition to the minimally invasive approach, which is thought to reduce morbidity, few complications have been reported in association with this technique 20 .…”

“…Concurrent congenital conformational or functional abnormalities have been described in more than 80% of cases; renal dysgenesis or agenesis, hydroureter, ureterocele, pelvic bladder, congenital urethral sphincter mechanism incompetence (USMI), vestibulovaginal septal remnants (VVSR), and recessed vulva have all been reported in dogs with EU. 1,2,7,8,[10][11][12][13][14][15] Traditional open approaches for EU correction include neoureterostomy with either ligation of the distal ureteric tunnel or reconstruction of the urethral-trigonal region and neocystoureterostomy (ureteral reimplantation). 3,12,16,17 Extramural ectopic ureter is treated using neocystoureterostomy whereas iEU is typically treated using neoureterostomy or, less commonly, neocystoureterostomy.…”