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CASE DESCRIPTION 2 fillies, aged 3 months and 1 month, were examined because of urinary incontinence and urine scalding. CLINICAL FINDINGS In horse 1, ultrasonography did not reveal any structural abnormalities of the kidneys; however, unilateral ureteral ectopia was diagnosed cystoscopically. In horse 2, CT revealed bilateral nephropathy, bilateral distended ureters (up to 3.6 cm in diameter), and bilateral ureteral ectopia. Cystoscopy revealed intramural ureteral ectopia with abnormally caudally positioned ureteral ostia in both horses. TREATMENT AND OUTCOME Ureteral ostioplasty was performed under cystoscopic guidance. Laparoscopic scissors (horse 1) or a vessel-sealing device (horse 2) was introduced, and the tissue separating the intramural portion of the ureter from the urethra and bladder was cut longitudinally in a cranial direction toward the trigone. After surgery, both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 20 and 9 months for horse 1 and horse 2, respectively. CLINICAL RELEVANCE Cystoscopically guided ureteral ostioplasty provided an effective and minimally invasive surgical treatment option for correction of ureteral ectopia in 2 fillies.

Objective: To describe radical cystectomy followed by cutaneous ureterostomy as a treatment of invasive bladder neoplasia in dogs., Study Design: Retrospective study., Animals: Client-owned dogs with transitional cell carcinoma of the bladder trigone (n=4)., Methods: Perioperative complications and long-term outcomes of dogs that underwent cutaneous ureterostomy following radical cystectomy and lymphadenectomy for transitional cell carcinoma of the urinary bladder trigone were reviewed. Both ureters were transected and anastomosed to the ventral abdominal skin. Polyvinyl chloride catheters were placed in the ureteral stomas and maintained for 5 days. After catheter removal, dogs were managed with an absorbent diaper over the stomas. Long-term outcome and survival were documented by follow-up visits or phone contact., Results: Median age at the time of surgery was 10.3 years (range, 8-12). Average procedural time was ∼4.7 hours (range, 3.8-6.1). Minor complications occurred in all dogs, including bleeding and edema of the ureterostomy site during the first 2-3 days after surgery. One dog developed urine scald that resolved with improved stoma care and hygiene. Median survival time after surgery was 278.6 days (range, 47-498). Distant metastases were documented in 2 dogs at 47 days (bone) and 369 days (lung) after surgery., Conclusion: Radical cystectomy with cutaneous ureterostomy is a viable salvage procedure for urinary diversion after cystectomy in dogs with invasive bladder neoplasia. Postoperative management and quality of life were considered acceptable by most owners. Future studies are warranted to evaluate survival time in a larger number of animals., (© 2016 The American College of Veterinary Surgeons.)

OBJECTIVE To describe the signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy (PU) or corpus spongiotomy (CS). DESIGN Retrospective case series. ANIMALS 33 horses. PROCEDURES Medical records of male horses examined because of hematuria or hemospermia caused by urethral rents that underwent PU or CS at a referral hospital between 1989 and 2013 were reviewed. Data regarding signalment, clinical features, urethroscopic findings, surgical treatment, and outcome were recorded. Long-term follow-up information was obtained by telephone interviews. RESULTS Age of the study population ranged from 3 to 18 years. Nineteen geldings and 1 stallion were examined because of hematuria, of which 13 and 7 underwent PU and CS, respectively, at a mean of 56 days after onset of clinical signs. Thirteen stallions were examined because of hemospermia, of which 7 and 6 underwent PU and CS, respectively, at a mean of 193 days after onset of clinical signs. Hematuria resolved following 1 surgical procedure in all 17 horses for which long-term information was available. Of the 12 stallions for which long-term information was available, 7 had resolution of hemospermia after 1 PU or CS and 5 developed recurrent hemospermia that required additional PUs or CSs (n = 3) or primary closure of the urethral rent (2). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that PU and CS were reliable treatments for resolution of hematuria in male horses with urethral rents; stallions with urethral rents may require multiple PUs or CSs or primary closure of the rent for resolution of hemospermia.

Objective: To evaluate and compare outcomes in cats following ureteral surgery or ureteral stent placement., Design: Retrospective case series., Animals: 117 cats., Procedures: Data regarding signalment, history, concurrent disease, clinical signs, clinicopathologic tests, surgical procedures, and perioperative complications (including death) were recorded. Follow-up data, including presence of signs of chronic lower urinary tract disease, chronic urinary tract infection, reobstruction, and death, if applicable, were obtained by records review or telephone contact with owners. Variables of interest were compared statistically between cats treated with and without stent placement. Kaplan-Meier analysis and Cox regression were performed to assess differences in survival time between cats with and without ureteral stents., Results: Perioperative complications referable to the urinary tract were identified in 6 of 43 (14%) cats that had ≥ 1 ureteral stent placed and 2 of 74 (3%) cats that underwent ureteral surgery without stenting. Perioperative mortality rates were similar between cats with (4/43 [9%]) and without (6/74 [8%]) stents. After surgery, signs of chronic lower urinary tract disease and chronic urinary tract infection were significantly more common among cats with than cats without stents. Nineteen of 87 (22%) cats with follow-up information available had recurrent obstruction; incidence of reobstruction did not differ between cats with and without stents. Median survival time did not differ between the 2 groups., Conclusions and Clinical Relevance: The potential for signs of chronic lower urinary tract disease and chronic infection, particularly among cats that receive ureteral stents, warrants appropriate client counseling. Judicious long-term follow-up for detection of reobstruction is recommended.

Objective: To report the procedure, postoperative outcome and complications of a new technique for ureteral implantation by means of a three-stitch ureteroneocystostomy in dogs., Materials and Methods: Clinical records of dogs requiring ureteral implantation between April 2007 and June 2013 were retrospectively reviewed. Data retrieved included signalment, preoperative biochemistry results, details of the surgical procedure, perioperative and postoperative complications, postoperative biochemistry results and outcome., Results: Nine dogs fulfilled the inclusion criteria. Follow-up times ranged from 10 to 79 months (median 30 months), with 8 of 9 dogs having an excellent long-term outcome and no major postoperative complications. One dog with follicular cystitis as a comorbidity developed obstruction from inflammatory granuloma and required revision surgery., Clinical Significance: The three-stitch technique for ureteral implantation compares favourably to previously documented techniques in terms of outcome and complication rates. Reduced tissue handling and a decreased volume of suture material may be beneficial for healing. The technique is also faster than previously described options, which may be of benefit in unstable patients requiring ureteral implantation due to traumatic injury or rupture., (© 2015 British Small Animal Veterinary Association.)

Objective: Retrospective study to determine postoperative continence when correcting intramural ureteral ectopia by transection of the ureter and neoureterostomy, leaving the distal ureter in situ. We hypothesised that the technique would achieve results comparable to previously described surgical techniques., Methods: Medical records for dogs that underwent surgery for correction of unilateral intramural ureteral ectopia were reviewed. Cases (n = 9) of a neoureterostomy where the distal ureter was left in situ were included. Postoperatively, owners were contacted by telephone or email and asked to complete a questionnaire, scoring their dog's urinary continence on a scale from 0 to 2 where 0 was completely continent, 1 was occasional incontinence during excitement or while recumbent and 2 was no improvement in postoperative urinary continence, with the dog having constantly wet perivulvar fur and constant dribbling of urine., Results: All dogs showed signs of severe urinary incontinence prior to surgery, including constantly wet perivulvar fur and constant dribbling of urine. Postoperatively, six dogs had a score of 0 and three dogs improved to a score of 1. Time to follow-up after surgery ranged from 1 to 62 months., Conclusion: The results of this study support our hypothesis. The technique was simple to perform and urinary continence achieved was comparable to that of other techniques. We suggest that this technique should be considered as an alternative for the correction of intramural ureteral ectopia., (© 2014 Australian Veterinary Association.)

Objective: To evaluate ureteral papilla implantation for neoureterocystostomy in cats., Study Design: Experimental study., Animals: Five domestic shorthair cats., Methods: The ureteral papilla was resected and the ureter isolated to the level of the renal hilus. The ureter was reimplanted into the apex of the bladder and the contralateral kidney was removed. Serum creatinine concentrations were measured daily for 7 days, then every other day from days 7-14, then every 3rd day until day 35. Ultrasound examination (once during the first 4 days, then again on day 35) and intravenous pyelography (day 35) were performed to assess ureteral patency. Histologic examination of the anastomosis was performed on day 35., Results: Serum creatinine concentration remained within reference range for all cats except for a transient (<24 hour) increase (2.2, 2.3, and 3.6 mg/dL respectively) in 3 cats. Ultrasound examination and intravenous pyelography revealed no evidence of ureteral obstruction. Histologic examination revealed complete mucosal epithelialization of the anastomosis, moderate inflammation localized to residual suture material, and no evidence of vascular compromise of the ureteral papilla., Conclusion: Implantation of the ureteral papilla is a viable technique for neoureterocystostomy in cats., Clinical Relevance: Advantages of ureteral papilla neoureterocystostomy include the technical ease of suturing the ureteral papilla, reduced risk of ureteral obstruction because sutures are not placed directly within the ureteral lumen and a more secure anastomosis because a complete 2-layer closure is performed.

Objective: To compare 3 techniques for ureteroneocystostomy in cats., Study Design: Experimental surgical study., Animals: Fifteen adult cats., Methods: Cats (15) had ureteroneocystostomy with ureteronephrectomy of the contralateral kidney: 5 cats had an intravesical mucosal apposition technique (modified Leadbetter-Politano; intravesical-MA group), 5 cats had extravesical ureteroneocystostomy (modified Lich Gregoir) using a simple continuous suture pattern (extravesical-SC group) and 5 cats had an extravesical technique using a simple interrupted suture pattern (extravesical-SI group). Renal function was evaluated by measuring serum creatinine concentration. Ultrasonographic assessment of the kidney and ureteroneocystostomy site was performed the day after surgery, twice weekly for 3 weeks and once weekly for the remainder of the study. Cats were euthanatized 50 days after surgery. The kidney and ureter removed at surgery, the remaining kidney, ureter, ureteroneocystostomy site, and bladder were examined histologically., Results: Two extravesical-SC cats were euthanatized because of azotemia and uroabdomen, and 1 died acutely at day 4 for unknown reasons. In the intravesical-MA and extravesical-SI cats, the serum creatinine concentration increased after surgery, peaking at a mean (+/-SD) of 9.4+/-2.4 mg/dL and 4.9+/-3.3 mg/dL on day 3, and decreasing to 3.4+/-5.7 mg/dL and 1.5+/-0.4 mg/dL on day 7, respectively. The extravesical-SI technique was associated with consistently lower serum creatinine concentrations for the first week after surgery compared with the other techniques. The mean serum creatinine concentration was within the reference range in cats in the intravesical-MA and extravesical-SI groups by days 10 and 5, respectively. Renal pelvic dilatation occurred in all cats but resolved more rapidly in cats after extravesical techniques. There was no significant difference in serum creatinine concentrations or renal pelvic dilation between the intravesical-MA and extravesical-SI techniques. Bladder mass height at the anastomosis site was significantly larger and persisted for longer with intravesical-MA technique., Conclusion: An extravesical-SI technique is seemingly the choice for ureteroneocystostomy in cats with undilated ureters. Renal pelvic dilation on ultrasound examination should be expected after ureteroneocystostomy in cats., Clinical Relevance: An extravesical ureteroneocystostomy technique using a simple interrupted pattern for anastomosis should be considered in cats undergoing renal transplantation.

A 6-year-old, castrated male, mixed-breed dog was diagnosed with partial unilateral ureteral obstruction secondary to a ureteral mass. The ureteral mass was surgically resected, and an ureteroneocystostomy was performed. Histopathology of the ureteral mass was consistent with a poorly differentiated mast cell tumor (MCT). The patient recovered well but was euthanized 5 months postoperatively for central nervous system signs. A choroid plexus tumor was diagnosed during necropsy examination. There was no evidence of recurrence or dissemination of the ureteral MCT. Extracutaneous MCTs are rare in dogs, and primary MCT associated with the urinary tract has not previously been reported in the veterinary literature.

A 2-day-old male foal developed uroperitoneum. Initial exploration of the abdomen via ventral midline celiotomy failed to localize the source of uroperitoneum. Bilateral nephropyelocentesis and antegrade urography were performed, and a defect in the right ureter and stenosis of the left ureter were identified. With the foal in dorsal recumbency in the Trendelenburg position, ureterorrhaphy was performed on the right ureter. After ureterorrhaphy, a ureteral catheter was maintained as a stent. The stenotic left ureter was transected, and ureteroneocystostomy was performed using a drop-in mucosal apposition technique. The ureteral catheter was removed 26 days after surgery. Histopathologic findings suggested that ureteritis of unknown origin was a possible initiating factor for stenosis of the left ureter. The drop-in technique for ureteroneocystostomy may be used successfully for ureteral transposition in horses. Ureterorrhaphy combined with the use of a ureteral stent may be used to repair ureteral defects in foals.

Objective: To use technetium Tc 99m diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scintigraphy to monitor ureteral obstruction after ureteroneocystostomy in a canine model of partial ureteral obstruction., Study Design: Experimental study., Animals: Eight normal adult dogs., Methods: Partial ureteral obstruction was created in 8 dogs by incomplete ligation of the terminal right ureter. Two weeks later, ureteroneocystostomy was performed in 7 dogs with unilateral partial ureteral obstruction and in 1 dog that had developed bilateral partial ureteral obstruction. 99mTc-DTPA scintigraphy was performed intermittently for 2 weeks after ureteroneocystostomy. Renal transit time of each kidney, as assessed by the time to maximal uptake (time of peak), and glomerular filtration rate, as assessed by percentage of kidney uptake of the radiopharmaceutical between 1 and 3 minutes, were estimated. Comparison between affected and nonaffected kidneys was performed with the Wilcoxon rank sum test., Results: Unilateral partial ureteral obstruction was induced successfully in 7 dogs. In 1 dog, bilateral partial obstruction was induced inadvertently. After ureteroneocystostomy, percentage of kidney uptake of 99mTc-DTPA was low in 4 affected kidneys. The uptake returned to within normal limits in 2 of the kidneys during the observation period. The time activity curve had a more rounded appearance or was increasing continuously for all affected kidneys. A significant increase in renal transit time was observed 2 and 4 days after ureteroneocystostomy. Transit time progressively returned to normal by 4 to 11 days for all affected kidneys except 1., Conclusion: Ureteroneocystostomy resulted in persistent partial ureteral obstruction for 4 to 11 days as determined by 99mTc-DTPA scintigraphy., Clinical Relevance: 99mTc-DTPA scintigraphy may be a useful procedure for monitoring renal function and ureteral obstruction after ureteroneocystostomy. Persistent partial ureteral obstruction may be seen 1 to 2 weeks after ureteral reimplantation in dogs with previously existing dilated ureters.

Renal transplantation is a successful treatment for terminal renal failure in cats. However, in the initial clinical study, there was a frequent occurrence of obstruction of the implanted ureter at the bladder wall or stoma. This resulted in the use of a modified "drop-in" technique that had proved effective in the prevention of obstruction in five normal cats. When applied to renal transplant recipients, ureteral obstruction was reduced, but continued to occur. The modified "drop-in" technique was abandoned and replaced with a technique that apposed the cut edge of the ureteral mucosa to the torn edge of the bladder mucosa. This technique is recommended as it has prevented ureteral obstruction in six successive cases. Prevention of ureteral obstruction, and the required corrective surgery, markedly reduces patient morbidity and mortality, length of hospitalization, and expense to the client.

Cytometrographic studies and urethral pressure profiles were performed to objectively assess the functional status of the urinary bladder and urethra in 9 dogs with congenital ectopic ureters. Functional abnormalities of the urinary bladder or urethra were detected in 8 of 9 (89%) dogs. Cystometrographic evidence of reduced bladder capacity was detected in 4 (44%) dogs, and abnormalities in urethral pressure profiles were consistent with urethral incompetence in 6 (67%) dogs. Dogs with urethral pressure profile abnormalities were treated with phenylpropanolamine hydrochloride, and the urethral pressure profile was reevaluated. Urethral pressure measurements obtained before surgery (3 dogs) and after phenylpropanolamine (6 dogs) were used to predict the likelihood of continence after surgery. Predicted outcomes included continence maintained without medication (3 dogs), continence maintained with phenylpropanolamine (2 dogs), and persistent incontinence despite phenylpropanolamine administration (4 dogs). After surgical repair of ectopic ureters, 2 of 9 (22%) dogs were continent without medication, and 2 (22%) maintained continence with phenylpropanolamine treatment. Various degrees of incontinence persisted in 5 of 9 (56%) dogs, 4 of which had urethral incompetence that had been documented as poorly responsive to phenylpropanolamine administration prior to surgery. Predicted outcomes were consistent with actual outcomes in 8 of 9 (89%) dogs, with predictions of incontinence proving accurate in 4 of 4 (100%) dogs and predictions of continence proving accurate in 4 of 5 (80%) dogs. Urodynamic assessment of dogs with ectopic ureters appears to be valuable for identifying concurrent functional abnormalities of the urinary bladder and urethra and for predicting postoperative outcome.

A urethral defect, presumed to communicate with the corpus spongiosum penis, caused hematuria in seven geldings and hemospermia in three stallions. Hematuria in geldings occurred at the end of urination. Hematuria was not observed in stallions with hemospermia. A linear urethral defect was identified, by endoscopic examination, on the convex surface the urethra at the level of the ischial arch of each horse. Cause of the defect was not determined. Two stallions were successfully treated for hemospermia, one by temporary subischial urethrostomy combined with sexual rest for 10 weeks, and the other by sexual rest alone for 6 months. The third stallion had hemospermia 6 weeks after urethrostomy. The geldings were successfully treated for hematuria, six by temporary subischial urethrostomy, and one by a subischial incision that extended into the corpus spongiosum penis but did not enter the lumen of the urethra. Efficacy of subischial urethrostomy for treatment of hemospermia was difficult to assess because of the small number of surgically treated stallions. In geldings, surgery eliminated hematuria, presumably by reducing vascular pressure in the corpus spongiosum penis during urination, thus allowing the urethral defect to heal.

Renal transplantation is a successful treatment for terminal renal failure in cats. Ureteral obstruction at the bladder wall or stoma has been a technical complication encountered in approximately 50% of clinical transplants. The small (0.4 mm) diameter of the feline ureter makes standard techniques described for ureteroneocystostomy unsatisfactory for cats. In this study, we used microsurgical techniques to oppose ureteral mucosa to intact bladder mucosa in an attempt to form a stricture-free stoma. In each of 5 anatomically normal cats, 1 ureter was microsurgically implanted in the bladder. Ultrasonographic examination of the kidneys, ureters, and bladder was performed twice weekly for 8 weeks. Excretory urography was performed at postoperative weeks 1, 2, 4, 8, and 12. Biopsy specimens were taken from the kidney on the surgically treated side 4 weeks after surgery. At 12 weeks, the kidney, ureter, and ureterovesical junction from the treated side were removed and submitted for histologic evaluation. At 1 week, all cats had enlargement of the kidney, renal pelvis, and ureteral lumen on the treated side. This enlargement gradually decreased, and by week 8, there was no difference in comparison with the control side. Ureteroneocystostomy that requires tunneling of the ureter through the bladder wall may result in hydroureter and hydronephrosis, which may resolve. Recognition of these changes may prevent unwarranted surgical intervention in cases of suspected obstruction. The technique described in this study has been used in 15 cats receiving renal allografts. None required surgical correction of ureteral obstruction.

A 450-kg yearling Clydesdale filly was determined to have bilateral ectopic ureters. The resulting incontinence caused severe malodorous perineal dermatitis. Bladder capacity was measured at 800 ml. The urethral sphincter lacked tone, and the horse was seen to urinate in a normal manner only 2 or 3 times a week. A midline celiotomy was performed, and the ureters were identified by cannulation from the ectopic openings. The ureters were ligated, and the cut ends were anastomosed to the dorsal bladder surface by an extravesicular end-to-side technique. A partial thickness seromuscular layer of the bladder was sutured over the ureters in a cranial direction from the anastomosis site for 15 mm. This fixed the ureters to the dorsal surface of the bladder and protected the anastomosis site from tension. After surgery, the horse urinated n a normal manner many times a day. Urinary incontinence continued, but gradually improved. Bladder capacity increased over 13 months to 4.3 L. Surgical (urethral extension) and medical (phenylpropanolamine and estrogen) treatments were instigated to increase urethral sphincter tone. Urinary incontinence continued to improve and, at 11 months after surgery, incontinence was negligible, and the perineal dermatitis had healed.

Eleven of 20 dogs (55%) were incontinent after surgical treatment of ureteral ectopia. Ureterocystostomy was performed in 15 dogs, ureteral transection and bladder reimplantation in four dogs, and ureteronephrectomy in one dog. Siberian huskies had a significantly higher rate of persistent postoperative incontinence than other breeds. There was no difference in postoperative incontinence between dogs with unilateral and bilateral ectopia. Concurrent bacterial cystitis was not associated with persistent postoperative incontinence. Age at the time of surgical correction had no effect on the rate of postoperative incontinence. Eight incontinent dogs were treated medically; three are continent with medication, three are improved but still incontinent, and two did not improve.