Ectopic Ureter in a 4-Month-Old Intact Male Mixed Breed Canine: Our Case Of the Month January 2021

Patient Information

Age

4 Months

Gender

Male, Intact

Species

Canine

Images

Ectopic ureter dilated and hyperperistaltic as it bypasses the ureter papilla, note color flow negative so as not be confused with iliac vasculature.

Left kidney severe hydronephrosis owing to obstructive left ureter.

Right kidney showing normal kidney size, contour, and structure.

Enlarged left kidney bulging under the skin.

Surgical approach demonstrating ectopic ureter.

Severe hydronephrotic left kidney at surgery.

Ureter demonstrating erroneous entrance into the urinary bladder.

Enlarged, irregular left kidney with hydroureter after surgical removal.

Left kidney dissected in half showing the renal pelvis.

A 4-month old mixed breed puppy was surrendered to a rescue after being "rejected by breeder" for leaking urine.

An ultrasonographic examination of the abdomen identified an enlarged kidney and left ectopic ureter with suspect concurrent ureterocele.

This ectopic ureter was one of the largest our team of specialists has ever seen and wanted to share!

Special thanks to:

Rebekah Jakum, CVT/ARDMS/RVT, owner of Pennsylvania Mobile Veterinary Ultrasound (servicing Northeast to South Central PA) for providing the beautiful ultrasound images on this critical case.
SonoPath Specialist, R.McKenzie “Mac” Daniel, DVM, DABVP (Canine and Feline) for his comprehensive interpretation of this case.
Dr. Anjali Bandekar, DVM, BVSc & AH practice owner of New Britain Veterinary Clinic and her compassionate staff for providing excellent care for this sick patient.
Anjilla J. Cooley, DVM, MS of Cool Vet LLP, for her surgical skills and remarkable intra-op photos.

History

Patient was presented after being "rejected by breeder" due to leaking urine.

Image Interpretation

The urinary bladder was normal in overall size and tone with anechoic urine. A thinly walled cystic outpouching of the caudodorsal urinary bladder wall in the area of the ureteral papilla was present, potentially measuring up to 3.5 cm in diameter and containing anechoic fluid. A fluid distended tubular structure was also noted dorsal to the urinary bladder, extending past the area of the ureteral papilla and appearing to enter the area of the cystourethral junction or proximal urethra. This tubular structure extended cranially to the level of the left kidney. The tubular structure measured up to 2.8 cm diameter approaching the left kidney. The left kidney was enlarged in size, measuring approximately 9.0 cm in length, but potentially larger. The left kidney parenchyma was almost completely replaced by anechoic fluid with only a small amount of cortical tissue and intermittent interdiverticular septum. Normal size and margination were present in the right kidney which measured 7.3 cm.

DX

Left ectopic ureter with suspect concurrent ureterocele. Severe diffuse left hydroureter and end stage left kidney hydronephrosis.

Outcome

Excretory urography or ideally CT for further assessment of the left ureter and urinary bladder as well as for surgical planning is recommended if possible. Surgical consultation recommended. Appropriate antibiotic therapy is likely indicated pending and based on urine culture and sensitivity results. The patient underwent surgery for removal of the hydronephrotic left kidney and hydronephrotic left ureter. A recheck of the patient a few weeks following the procedure found him recovered well and doing great.