Clinical Case Example

Solitaire had been living with her breeder since approximately 4 weeks of age and her breeder recognized that the pup was always “wet” along her back legs and perivulvar region.  Solitaire appears to be continuously dribbling urine, however she does urinate voluntarily as well. The breeder felt that the pup did not seem to be bothered by the incontinence. She was concerned about the strong “urine odor” and the risk of urine scald. Solitaire was seen by her referring veterinarian who suspected an ectopic ureter. She was treated with a 10 day course of Clavamox for a suspected urinary tract infection. She was also treated with a 7 day trial of phenylpropanolamine to treat urethral sphincter mechanism incompetence which did not seem to help with the incontinence. The degree of incontinence prevented Solitaire to be an acceptable indoor companion.

On presentation to Tufts Foster Hospital for Small Animals, Solitaire was bright, alert and responsive with an ideal body condition score of 6/9. Physical examination was otherwise unremarkable except for urine staining along both rear limbs and a strong  odor of malodorous urine. There was mild urine scalding around the perivuvlar area. Otherwise, she was a happy “normal” puppy.

The differential diagnosis included ectopic ureter(s), ureterocele, pelvic bladder with urethral dysplasia and urethral sphincter mechanism incompetence. The initial workup included a complete blood count, serum chemistry profile, urinalysis and culture. The complete blood count revealed a neutrophilic leukocytosis, but was otherwise unremarkable. The chemistry profile was within normal limits. The urinalysis revealed concentrated urine with a relatively unremarkable sediment. Urine culture revealed a Proteus mirabilis urinary tract infection with sensitivity to multiple antibiotics.

An abdominal ultrasound was performed and revealed left hydronephrosis and hydroureter extending to the level of the urinary bladder. There was a question as to whether a ureterocele was present as well.

Solitaire was scheduled for cystoscopy and possible laser ablation of ectopia.  Cystoscopy revealed bilateral ectopic ureters. The right ureter was found to open in the distal urethra. This tunneling ureter was ablated using a Holmium YAG laser to the level of the trigone. The left ureter was ectopic as well and opened more distally in the urethra at the level of the external papilla. This ureter was ablated proximally to the level of the trigone. It was extremely dilated at the level of the bladder.  A neoureterosotmy was performed at the time of ovariohysterectomy. Urine was visualized empyting into the bladder from both ureters.

Solitaire recovered uneventfully from the procedure and immediately following post-operation the incontinence was minimal. She was discharged on Amoxicillin potassium clavulanate to treat the urinary tract infection and also given meloxicam as an anti-inflammatory agent post procedure. Future treatment options such as phenylpropanolamine or placement of a urethral occlusion device were discussed with the new foster owner.

Solitaire was completely continent for 5 days after the procedure and then incontinence returned when she was asleep or excited, but was much improved from her initial presentation. She was then prescribed 1mg/kg phenylpropanolamine every 12 hrs.