Ultrasonography as a sensitive and specific diagnostic modality for the detection of ectopic ureters in urinary incontinent dogs

Abstract

Ultrasonography is a widely available diagnostic modality for the identification of dogs with suspected ureteral ectopia; however published studies detailing its sensitivity and specificity are currently lacking. The aim of this retrospective, descriptive, diagnostic accuracy study was to evaluate the sensitivity and specificity of ultrasonography for the diagnosis of ureteral ectopia in incontinent dogs presenting to a referral institution, using cystoscopy as the gold standard. Medical records of urinary incontinent dogs presenting to a single institution (n = 38) were retrospectively reviewed for the presence of ureteric insertion abnormalities and concurrent urinary tract abnormalities. Ultrasonographic findings were compared with those from cystoscopic examination to determine diagnostic accuracy. The relationship between the presence of concurrent urinary tract abnormalities and ureteral ectopia was assessed using an independent samples t‐test and Mann–Whitney test. Statistical significance was set at P ≤ 0.05. Ultrasonography had a sensitivity of 93.5%, specificity of 100%, and diagnostic accuracy of 95% when identifying dogs with ureteral ectopia. When classifying individual ureters as ectopic or non‐ectopic, sensitivity was 87.8% and specificity was 86.7%. Dogs with ureteral ectopia had significantly more concurrent urinary tract abnormalities on ultrasound than unaffected dogs (P = 0.004). Ectopic ureters were associated with significantly more concurrent ipsilateral upper urinary tract ultrasonographic abnormalities than unaffected ureters (P < 0.001). Ultrasonography performed by an experienced ultrasonographer is a sensitive and specific screening tool for canine ureteral ectopia, which eliminates the need for heavy sedation, general anesthesia, and advanced imaging, although it should not be relied upon as the sole diagnostic modality for the assessment of individual ureters.

Outcome of selective mating in the Entlebucher Mountain Dog for reduction of ureteral ectopia

“…7,29,39,58 Postoperative Komplikationen sind rekurrierende Harnwegsinfektionen, 45 seltener Uroabdomen, oder als Folge von Strikturen Hydroureter und -nephrose. 32,47,50,59,70 Die klinische Relevanz, die aufwändige Therapie und die mässige Prognose legen bei Hunderassen mit einer vermuteten erhöhten Prävalenz (Labrador Retriever, 25,26,[31][32][33]59 Golden Retriever, 1, [31][32][33]59,73 Münsterländer, 32,33 Sheltie, [31][32][33] Briard 44 ) oder einer nachgewiesenen erhöhten Prävalenz, wie beim Entlebucher Sennenhund (ES), 18,54,59 präventive Massnahmen nahe.…”

“…tus, Alter bei Screening, Elterntiere, Untersuchungsdatum, Untersuchungsort, EU-assoziierte Befunde (HI, HU, HN) sowie eine detaillierte HI-Anamnese erfasst. Beim Screening wurden mittels Ultraschall- 21,37,42,73 und/oder CT 5,17,46,62,64,66 -Untersuchung die ureterovesikalen Mündungen und der vesikourethrale Übergang, definiert als Prostataansatz bei Rüden und Beginn des parallelen Urethra-Wandverlaufs bei Hündinnen 3 , lokalisiert und zur Bestimmung der rechten und linken ureterovesikalen-vesikourethralen Distanz (Duv/vu) in Bilddateien dokumentiert. Die Phänotypisierung, die auf der weiter kaudal gelegenen Uretermündung, d.h. der geringeren Duv/vu beruht (Tabelle 1; Abbildung 1), wird anhand der Bilddateien zentral am Tierspital Zürich durchgeführt.…”

A unique complication: Iatrogenic renal pelvis perforation following accidental urinary catheterisation of an intramural ectopic ureter in a dog

“…4,5 Dogs born with EU can suffer from concurrent congenital urogenital abnormalities, which also contribute to urinary incontinence. 6 Therefore, incontinent dogs routinely undergo diagnostic imaging such as cystoscopy, intravenous urethrogram (IVU) and retrograde contrast studies during urinary incontinence investigations.…”

“…Ectopic ureters (EU) are the leading cause of juvenile incontinence in dogs, and their immediate impact on owner welfare leads to prompt presentation to primary care vets 4,5 . Dogs born with EU can suffer from concurrent congenital urogenital abnormalities, which also contribute to urinary incontinence 6 . Therefore, incontinent dogs routinely undergo diagnostic imaging such as cystoscopy, intravenous urethrogram (IVU) and retrograde contrast studies during urinary incontinence investigations.…”

Imaging characteristics of multiple unusual urogenital abnormalities in an incontinent dog

“…Urogenital tract abnormalities in urinary incontinent female dogs have been previously described, including urethral agenesis and unilateral kidney, paramesonephric remnant, bifid vagina, short urethral length and, most commonly, ectopic ureters. [1][2][3][4][5] Urogenital abnormalities and urinary incontinence have also been described in animals alongside disorders of genital development. [6][7][8][9][10] Congenital urethral sphincter mechanism incompetence (USMI) associated with marked urethral hypoplasia has been reported in cats and one dog.…”