Step 2
The ureter is catheterized just distal to the neoureterostomy and a linear incision is made through the bladder mucosa, but not through the ureter. A ligature of polydioxanone or polypropylene is placed around the ureter just distal to the neoureterostomy site and is tied as the catheter is withdrawn.
Step 3
The bladder mucosal incision is apposed with fine suture to the incised urethral mucosa at the neoureterotomy site. As an alternative, the suture may be placed and tied around the EU from the outside of the bladder. The ventral cystotomy incision is closed routinely.
CYSTOSCOPIC-ASSISTED LASER SURGERY In one study, 4 of 13 patients had complete resolution of urinary incontinence with laser surgery alone, 5 of 13 had complete resolution with laser surgery and phenylpropanolamine and 4 of 13 remained incontinent.
It is important to note that this procedure can be used only for intramurally located EUs.
Step 1 By way of urethroscopy, the EU is catheterized with a polypropylene catheter or guide wire.
Step 2
A diode laser or radiofrequency is used to longitudinally incise the ureter from the ectopic ureteral orifice to the level of the trigone.
(A) The plastic stent has been placed in the EU and the laser (green tip) is ablating the tissue over the stent.
(B) Completion of the ablation with plastic stents in place.
(C) Completion of EU ablation with resultant remnants of the previous EUs visible (arrows).
(Photos courtesy of Dr. John Kruger, Michigan State University)
EU = ectopic ureter
Author Insight
If the patient fails to respond to surgery alone, the addition of phenylpropanolamine may improve urinary continence.
POSTOPERATIVE CARE- Indwelling urinary catheter: An indwelling urinary catheter should be placed if urethral swelling is expected, especially if the resective technique has been used and required extensive dissection. The catheter should remain in place for 48hours.
- Antibiotic therapy: Based on culture results or empirical impression, antibiotic treatment should be continued for a minimum of 2 weeks after surgery. If evidence of pyelonephritis is present, antibiotic therapy should be continued for 6 to 8 weeks.
- Pain management: Administer nonsteroidal antiinflammatory drug(s) for 1 week and narcotics for a few days after surgery.
- Incontinence after surgery: Repeat diagnostics to rule out contralateral EU.
- Alpha-adrenergic agents: Prescribe phenylpropanolamine (1.5–2.2 mg/kg PO Q 8-24 H) or ephedrine sulfate (1–4 mg/kg PO Q 8-12 H) if urinary continence is not achieved and no other problems can be found.
- Urethral bulking injections: See Urethral Bulking Procedures, page 61.
COLPOSUSPENSION
In addition to corrective surgery to reposition the opening of the EU into the bladder, the sphincter region of the bladder may be tightened using the colposuspension technique. Generally, about 50% of dogs will be continent with the corrective ureteral surgery and, in refractory cases, with the addition of phenylpropanolamine. In a small series of EU cases, urinary continence was achieved in 71% of cases that received corrective ureteral surgery and colposuspension.
This procedure involves retracting the vagina cranially and placing 2 horizontal mattress nonabsorbable sutures, such as 0 to 2-0 polypropylene, through the left and right prepubic tendons and the ventrolateral vaginal walls. After the sutures have been tied, only a small finger should be able to be passed between the ventral abdominal wall and the vagina.