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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: 

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.

Videos

Severe dilation of the left ectopic ureter dorsal to the urinary bladder.
Further imaging demonstrating the deep pelvic urethra and ectopic ureter in the far field.
Severe hydronephrotic left kidney owing to ectopic ureter and obstruction.
Severe hydronephrosis of the left kidney with hydroureter on the right.
Normal right kidney with no evidence of ureteral dilation.