Ectopic ureter laser ablation
Ectopic ureter occurs when the ureter (tube that connects the kidney to the bladder) tunnels through the bladder and opens in the urethra (tube that connects bladder to the outside). Urine leakage occurs because the opening is beyond the urethral sphincter. The most concerning aspect of this condition is the fact that there is a direct connection between the outside and the kidney, which would predispose the patient to a kidney infection. Besides urine leakage, pet would always be predisposed to urinary tract infections as well as kidney infections. Recurrent infections may lead to bacterial resistance, which may end up being life threatening.
Currently, ectopic ureter laser ablation is considered the treatment of choice for intramural ectopic ureters. The laser allows the destruction of the urethral/ureteral wall connection. This prevents the ureter from tunneling through the urethra, and allows the ureter to directly open into the bladder, creating a somewhat more normal anatomy. Approximately 50% of dogs who undergo this procedure will be continent (no longer leak urine) after surgery with no further treatment, and many will no longer experience issues with recurrent urinary tract/kidney infections. However, the excess tissue and other urethral sphincter abnormalities may still predispose to urine leakage. With additional treatment (medical or surgical), approximately 75% of dogs will be fully continent. The least invasive and most successful way of correcting a possible continued urinary incontinence is by placing a urethral occluder. Collagen injection can also be performed in addition to medical management (i.e. use of phenylpropanolamine and DES). However, collagen implants only last 6-24 months before they need to be re-done. Urethral occluder does not need to be replaced and will likely last her whole life. Urethral occluder is a new device in veterinary medicine. Therefore, there is limited long-term follow-up despite its high success rate. We are only now starting to follow older dogs that have had urethral occluders for many years. Possible complications include formation of urethral stricture, scar tissue formation, urinary obstruction, and implant rejection. Fortunately, these side-effects rarely occur and a small number of dogs with ectopic ureters that underwent laser ablation require the placement of a urethral occluder. Medical treatment (medications that tighten the urethral sphincter) is recommended prior to considering placement of a urethral occluder.