Medically reviewed by Dr. Scott Rizzo, DVM, MS, DACVIM, MBA, and Dr. Grace Clark, DVM, DACVIM
Some puppies and kittens leak urine no matter how carefully their families work on potty training. When we meet a young pet like that, an ectopic ureter is one of the first things we think about. Pets are born with it, and it can be treated. Here is what it is and how we find and treat it at VSP Louisville.
This post is part of our guide to USMI in dogs. USMI, a weak urethral sphincter, is the most common cause of leaking in adult dogs, and it often shows up alongside an ectopic ureter.
What is an ectopic ureter?
Each kidney drains urine into the bladder through a thin tube called a ureter. In a pet with an ectopic ureter, one or both of those tubes open in the wrong place. Instead of emptying into the bladder, the ureter empties farther down, beyond the muscle that normally holds urine in. Urine can then dribble out without the pet meaning to.
There are two forms. In the intramural form, which is the most common, the ureter does reach the bladder but tunnels inside the bladder or urethral wall before it opens in the wrong spot. In the extramural form, the ureter skips the bladder completely and attaches somewhere else. Some pets with ectopic ureters have other birth defects of the kidneys or urinary tract as well, so we always look at the whole system.
Signs to watch for
Most pets show signs as young puppies or kittens. A few aren’t diagnosed until they are young adults. Female dogs are about 20 times more likely to be diagnosed than males, and we see it more often in certain breeds, including Golden Retrievers, Labrador Retrievers and Skye Terriers.
Signs include:
- Constant leaking, or leaking that comes and goes
- Accidents and trouble with potty training
- Wet spots where your pet lies down or sleeps
- Dribbling urine
- Urinary tract infections that keep coming back
A bladder infection, bladder stones or a weak urethral sphincter can look very similar. That’s why we test rather than guess.
How we diagnose it
A full workup comes first so we can rule out other causes. That usually means bloodwork, including a complete blood count and chemistry panel, plus a urinalysis and urine culture to check for infection. Radiographs (x rays) help us look for stones and other problems in the abdomen, and an abdominal ultrasound gives us a look at the bladder. Sometimes the ectopic ureter itself shows up on ultrasound.
Cystoscopy is the gold standard for diagnosing ectopic ureters in most cases. We pass a small camera into the vagina, urethra and bladder and look right at the spot where each ureter opens. For many pets we can treat the problem during the same anesthesia. In rare cases a contrast CT scan is needed to track down an extramural ureter.
Treatment at VSP Louisville
The right treatment depends on which form your pet has.
Treating intramural ectopic ureters through a cystoscope
Cystoscopic laser ablation is the treatment of choice for intramural ectopic ureters. Your pet is under anesthesia and we work entirely through the cystoscope, so there is no abdominal incision. We open the wall of the abnormal tunnel so the ureter empties into the bladder where it belongs.
Dr. Scott Rizzo and Dr. Grace Clark perform these procedures with either our Storz MultiLASE thulium laser or a Storz resectoscope. The resectoscope is a slim scope with a fine electrocautery electrode that cuts and seals tissue while we watch on the monitor. We pick whichever tool suits your pet’s size and anatomy. These minimally invasive procedures are done only at our Louisville hospital.
When open surgery is needed
An extramural ureter bypasses the bladder, so it can’t be fixed from the inside. For these pets, board certified surgeon Dr. Joshua Bruce of Kentucky Veterinary Surgery performs open surgery at our Louisville hospital. He frees the ureter from its abnormal attachment, makes a new opening in the right place and reattaches the ureter to the bladder.
Recovery
Pets treated through the cystoscope usually get back to normal activity much faster, since there is no incision in the abdomen. After open abdominal surgery, plan on about two weeks of restricted activity and incision care. Whichever route your pet takes, we recommend repeating the urinalysis and urine culture over the following months so we can catch an infection early.
What results to expect, and where USMI fits in
Correcting the ureter often restores continence. Many of these pets have more than one problem, though. A weak urethral sphincter, called urethral sphincter mechanism incompetence or USMI, is common on top of the ectopic ureter, and some pets keep leaking after the ureter has been fixed. Our guide to USMI in dogs explains what it is and how we treat it.
When that leftover leaking happens, we can usually make things better. We follow the same steps we use for any dog with USMI. Medication such as Proin or Incurin can strengthen sphincter tone. Collagen injections, which Dr. Rizzo or Dr. Clark give through a cystoscope at VSP Louisville, bulk up the urethral tissue. For some dogs, Dr. Bruce places an adjustable artificial urethral sphincter called a hydraulic urethral occluder.
According to the American College of Veterinary Surgeons, male patients tend to do better, with success rates of 70 to 80 percent after surgery. In females, 25 to 70 percent may still have some leaking even with surgery and medication. That’s why we plan for the whole picture and not just the ureter.
Possible risks
The main risks after treatment are continued incontinence, urine leaking into the abdomen, narrowing (stricture) at the repair site and urinary tract infection. We’ll go over the risks that apply to your pet before any procedure.
Questions we hear often
Can cats have ectopic ureters?
Yes. Cats can be born with them too, though it’s much less common than in dogs. The signs, workup and treatment are similar.
Is an ectopic ureter painful for my pet?
The leaking itself usually doesn’t hurt. Urine sitting on the skin can cause irritation and scalding, and repeat urinary infections are uncomfortable, so it’s worth treating.
Does my pet need an abdominal incision to fix an ectopic ureter?
Usually not. The common intramural form is treated through a cystoscope with our Storz MultiLASE thulium laser or a Storz resectoscope. Dr. Scott Rizzo and Dr. Grace Clark perform these procedures, and only at VSP Louisville. Open surgery is needed only for extramural ureters, which bypass the bladder.
Will my pet be fully continent after treatment?
Many pets are. Some also have a weak urethral sphincter (USMI) and keep leaking afterward. Medication, collagen injections or a hydraulic occluder can usually help with that. Our USMI guide covers each option.
Do I need a referral?
No, you don’t need a referral. We still want your family vet included in your dog’s or cat’s care, so we’ll request their records and keep them up to date on your pet’s case.
Talk with us
If your young dog or cat is leaking urine, we can help you find out why. Call (502) 901-7990 or request an appointment. Referrals from your family vet are always welcome.
You may also want to read our guide to USMI in dogs, or learn about urinary surgery at VSP, our interventional radiology services and bladder and urinary stone management.
