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A ureter is the fine tube connecting the kidney to the bladder. Cats have two ureters, from the left and right kidneys. An ectopic ureter refers to a developmental problem where one or both ureters implant in the wrong location. In cats, the most common location for ectopic ureters to be located is the urethra (the tube through which the bladder voids urine).
Symptoms include constant dribbling of urine (a true incontinence) along with urine scald around the vulva and repeated urinary infections. The condition is extremely rare in cats.
It is vital to have detailed imaging of the ectopic ureter prior to surgery so as to know their location. The procedure itself is extremely delicate and because of this, and the sophisticated imaging required, such cases are often referred to a specialist veterinary surgeon.
An MRI scan or contrast study radiographs help to locate the ectopic ureter and assist surgical planning. Since urinary infections are a common complication for cats with ectopic ureters, culture of the urine and antibiotic therapy is desirable prior to surgery.
The cat is given a general anesthetic, their belly clipped, and aseptically prepared. The surgeon makes a long incision in the area overlying the bladder. The ectopic ureter is traced and dissected free. The resulting hole in the urethra is sutured closed.
An incision is made in the bladder wall through which the newly freed ureter is passed. The end of the ureter is opened up to form a spatula shape, and then sutured into the bladder so that urine can drain freely into the bladder cavity. The bladder incision is then sutured closed.
The abdominal wall and skin are repaired and the cat woken.
A successful repair is curative and the patient can lead a normal, incontinence-free life. However, some repairs are only partially successful and a degree of urinary incontinence remains. Of these, some may further be helped by the addition of drugs which help tighten up the valve at the exit to the bladder.
To increase the chances of success, some surgeons undertake an additional procedure at the time of surgery, called a colposuspension. This means fixing the bladder in a slightly more cranial position in the belly, which aids bladder control.
Pain relief is essential after surgery, in order to reduce the risk of straining to pass urine. Most cats pass bloody urine for a few days after surgery. It is also important that the cat doesn't interfere with the skin incision, which necessitates wearing a cone.
Ectopic ureter repair is major surgery and as such the cat should be rested for 10 days postoperatively. The skin sutures are removed after 10 to 14 days, by which time internal healing should be complete.
Given the scans and the delicate nature of the procedure, this is expensive surgery. The cat guardian can expect to pay a minimum of $2,500, with costs reaching four times this (around $10,000) for the most complex cases.
Ectopic ureters are rare in cats, so it is difficult to assess the overall success rate. The equivalent procedure in dogs is said to have a 75% chance of success. However, complications do occur and include peritonitis, continued incontinence, anesthetic death, and inability to urinate due to postoperative swelling.
In some cases, if reimplantation of the ureter is not possible, then removal of the kidney is an option. Provided the cat's other kidney is healthy, they can go on to lead a normal life free from constant urine leakage.
Sadly, because an ectopic ureter is a physical problem due to incorrect location of the ureter, medical control is ineffective. Without surgery the cat is liable to suffer recurrent urinary tract infections and skin sores secondary to urinary scald.
Cats with ectopic ureters should not be bred from as the condition is hereditary and may be passed from parent to kitten.
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