Neoureterostomy in Dogs

Neoureterostomy is a surgical procedure which corrects select cases of ectopic ureters in dogs. The ureters are tubes that transport urine from the kidneys to the bladder. Ectopic ureters may or may not lead to the bladder, and may transport the urine elsewhere. This is a congenital defect that can occur in one or both ureters. Neoureterostomy treats ectopic ureters that do lead to the bladder, but do not penetrate it. This procedure may not be the first line of treatment due to less invasive alternatives, particularly laser ablation. However, it is the most common surgical procedure used to treat ectopic ureters.

There are two approaches to this surgery: resective and ligation. Resective neoureterostomy is the most common approach. Ligation neoureterostomy is indicated when the ureters have formed along the bladder wall, but connect into another area, usually the urethra or vagina. This approach involves redirecting the ureters back into the bladder. While it is a simpler technique, it presents a higher risk of postoperative complications and is reserved for select cases. The procedure steps for resective neoureterostomy are as follows:

1. CT scan, cystoscopy, intravenous pyelogram, or ultrasound may be used to confirm a diagnosis of ectopic ureters prior to surgery.
2. A blood sample will be taken and analyzed to ensure it is safe for the puppy to undergo general anesthesia. 
3. General anesthesia and analgesics will be administered via IV throughout surgery.
4. The surgeon will shave and clean the operative area.
5. The skin is incised. Another incision will be made into the abdomen.
6. The surgeon will examine the ureters carefully.
7. An incision is made into the bladder, and then into the urethra. The surgeon will apply stay sutures on the sides of the bladder and urethra.
8. The trigone of the bladder, which is where the ureters would normally lead, is examined for normal openings.
9. A catheter is placed into the opening of the ectopic ureter. 
10. The ectopic ureter is then incised and dissected from the submucosal tissue.
11. The ureter is removed from its abnormal position and lifted to the level of the trigone. The excess length of the ureter is removed.
12. Sutures are used to affix the mucosa of the ectopic ureter to the mucosa of the bladder.
13. The abdominal incision is then sutured.
14. The puppy is hospitalized for a few days according to surgeon instructions.

The efficacy of this procedure will vary on a case-by-case basis. Urinary incontinence resolves in about 55% of dogs that undergo neoureterostomy. In some cases, an additional procedure known as colposuspension is required to fully treat the condition. Neoureterostomy, when combined with colposuspension, has a 71% success rate. Alternative treatment methods, particularly laser ablation, are less invasive and generally more effective in treating ectopic ureters. Dogs are also allowed to go home the same day, which eliminates hospitalization costs. However, because the equipment to perform laser ablation is expensive, it is only available at some veterinary hospitals.

During the hospitalization, a urinary catheter and collection system will remain in place for up to three days after surgery. Antibiotics and analgesics will be prescribed postoperatively. Additional medications to correct urinary incontinence may also be prescribed. These medications are much more effective in dogs that have been surgically treated for ectopic ureters.

Owners should follow the veterinary surgeon’s recovery instructions carefully. Urine should be monitored for signs of incontinence and infection. Discomfort and straining to urinate are normal for the first few days after surgery. However, if these symptoms persist, owners should contact their veterinarian immediately. The sutures will be removed ten to fourteen days after surgery. If urinary incontinence is still present within three months of surgery, another intravenous pyelogram will be conducted to assess the efficacy of the surgery.

The cost of neoureterostomy in dogs will vary based on standards of living and additional treatment costs incurred. The average price of neoureterostomy is approximately $5,000.

Neoureterostomy has an increased risk of postoperative complication compared to less invasive methods. Typically, the main complication is persistent urinary incontinence. This may improve with additional treatments, medications, or procedures. The rate of postoperative complication is roughly 26%. The veterinary surgeon will discuss all possible complications with the owner prior to surgery.

Congenital defects are impossible to prevent. Dogs that are treated for ectopic ureters should not be bred, and ideally should be spayed or neutered.