By Dr. Becker
The ureters are tubes that carry urine from the kidneys to the bladder, which collects urine before it's excreted from the body through the urethra. An ectopic ureter — ectopic means "displaced" — opens into the urethra or the vagina rather than into the bladder. One or both ureters can be involved.
In cats, an ectopic ureter completely bypasses the bladder and enters the urethra from outside the bladder wall. In dogs, typically the ureter bypasses the bladder floor and enters through the bladder wall. Less often, the ureter opens into the bladder floor and continues as a sort of drain into the urethra.
Pets at Highest Risk for Ectopic Ureters
Fortunately, this is a rare condition in both dogs and cats and is congenital, which means present at birth. The mode of inheritance is not well understood, nor is it consistent. Pregnant females with ectopic ureters don't necessarily pass on the abnormality to their litters.
Vitamin imbalances or deficiencies in pregnant females have been suggested as possible contributors when members of a litter are born with the condition.
Females are much more likely to be born with ectopic ureters than males. When they do occur in males, they are usually diagnosed later in life, perhaps because males have stronger urethral sphincter tone and are able to control and compensate for urine dribbling as youngsters.
Dog breeds that may be predisposed to ectopic ureter include the Bulldog, Fox Terrier, Golden and Labrador Retrievers, Newfoundland, Miniature and Toy Poodles, the Siberian Husky and the Skye and West Highland White Terriers.
Symptoms of an Ectopic Ureter
It can be difficult to know if a pet is affected by this condition. In some cases, there are no obvious symptoms and no apparent problems with urination. Sometimes, however, there is urine scalding and urinary tract infections, which can cause a significant amount of discomfort for the animal.
There can also be intermittent or continuous urine dribbling from the bladder or urethra. In a female dog or cat, there can be inflammation of the vagina (vaginitis) from urine scalding of the vaginal tissue. Other signs to look for include:
- Inappropriate urination
- Dampness around the external genitalia
- Urine that is cloudy from pus
- Foul-smelling urine, which indicates an infection in the urinary tract
- Redness, inflammation and/or irritation of the hair and skin around a female dog's vulva and vagina
Diagnosing an Ectopic Ureter
Your veterinarian will take a complete history of your pet's symptoms, and perform a thorough physical examination. Diagnostic tests will include a urinalysis and bloodwork, including a complete blood count (CBC) and serum biochemistry profile to check organ function.
Unless your pet has a kidney or a bladder infection or another urinary tract disorder, the results of these tests will usually be normal. A urine sample should be cultured to check for a bacterial infection, which is very common in pets with ectopic ureters.
Your vet may also want to perform an ultrasound of your pet's urinary tract structures, which depending on his or her skill in ultrasonography can usually diagnose ectopic ureters. In addition, CT scans are used quite effectively to diagnose this disorder.
There's also a technique called urethrocystoscopy, which is an insertable tube with a camera that is used to examine the inside of the bladder and the opening into the urethra or vagina.
This procedure also allows your veterinarian or veterinary specialist to check for perforations in the structure of the urethra, depressions, striping (streaking) and tenting in the bladder, all of which can occur with this condition.
Treating an ectopic ureter means surgically creating a new ureteral opening into the bladder to allow urine to collect in the bladder and exit the body through the urethra as normally as possible.
Surgery to correct ectopic ureters is complicated and very delicate. Because the condition is rare and most veterinarians don't see many cases during their careers, often they refer patients to a soft tissue surgical specialist, which I think is a very good idea.
Other treatment goals are, of course, to relieve your pet's discomfort and reduce or eliminate urine dribbling. Unfortunately, even with surgery, about 50 percent of pets continue to have some degree of incontinence.
In those cases, I suggest trying acupuncture treatments as a non-toxic therapy to help alleviate any remaining incontinence. If your pet has suffered from recurrent UTIs because of this condition, I recommend using a blend of D-Mannose, marshmallow and cranberry extract, as well as the herb uva ursi to naturally build up bladder defenses.
Probiotics can also be very beneficial for these animals, especially if they've been on repeated rounds of antibiotics to treat infections. Managing external skin irritation is also very important for your pet's quality of life. I recommend gently disinfecting the perineal area with diluted betadine, followed by an application of either calendula oil or coconut oil to relieve urine-scalded or irritated skin.
You can do this several times a day, as it is very soothing. It's possible to reduce skin irritation by 90 percent by keeping the skin very clean and the lipid barrier maintained.