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The ureter is the duct that carries urine from the kidney to the bladder. The urethra carries urine from the bladder and voids it outside the body. Occasionally, the ureter becomes displaced, either through trauma or due to disease or ureteral ectopia occurs, where the ureter joins up directly with the urethra in the bladder instead of emptying its contents into the bladder, where it is later voided via the urethra. A ureteroneocystostomy can be performed surgically by your veterinarian to transect and reimplant the ureter correctly into the bladder when it has become displaced or joined directly to the urethra, bypassing the bladder. This is a delicate surgical procedure and expertise in the urological system by a qualified, specialized veterinary surgeon is recommended for the best outcome to be achieved.
Prior to surgery your dog will be required to fast from food for 12 hours. General anaesthetic by intubation and gas will be administered after your dog has been sedated and administered intravenous anesthetic to put them into a deep sleep. The pelvic area will be shaved and prepared antiseptically. Urinary catheters will be placed to drain urine.
An incision is made in the pelvic area using a ventral midline celiotomy extending to the pubis and subcutaneous tissues incised to expose urinary tract organs, the ureter, and bladder. Stay sutures may be placed in the bladder and urethra to prevent movement during the procedure. For ectopic ureter, an incision is made into the bladder, and the first part of the urethra and the ectopic ureter is dissected out of the urethra and sutured appropriately into the bladder.
For other ureter displacements, necessary repairs to the ureter, kidneys and bladder are affected and then the displaced ureter is connected by creating an anastomosis to the appropriate place on the bladder to allow urine carried from the kidneys to drain into the bladder correctly. Repairs are created with specialized sutures using absorbable suture materials. Care not to interfere with vessels and other delicate urinary tract structures is taken. Once the displaced ureter has been connected appropriately to the bladder, incisions are closed and the dog is monitored in recovery.
Ureteroneocystostomy is the standard procedure to reintroduce the ureter into the bladder and allow appropriate voiding of ureteral contents. Prognosis is mixed depending on the condition and the ability to achieve ureter repair and reimplantation successfully. Urinary incontinence may persist in approximately half of cases. In addition, the reimplantation site can be prone to narrowing and subject to blockages and this will have to be addressed if it occurs in the future.
Urinary incontinence can be expected during recovery, and should resolve in many cases. Your dog will need to have activity restricted for several days post-surgery. The surgical incision should be monitored to ensure there is no redness, discharge, excessive swelling or bleeding at the site. If this occurs, veterinary advice should be obtained. You will need to prevent your dog from interfering with the incision and an e-collar will usually be used. Analgesics and antibiotics will be prescribed for a few days and should be administered as directed. It will be important to monitor fluid intake and output. Your veterinarian will provide information on what to expect and if urinary output is inadequate or indicates signs of renal disorder, your veterinarian should be notified immediately. A specialized diet may be recommended to support urinary tract function in your dog.
The cost or ureteroneocystostomy can be expensive and ranges from $2,000 to $10,000 depending on the cost of living in your area, the availability of a specialist and the condition for which the procedure is being performed.
Renal complications are a risk and stricture subjecting the ureter to blockages in future may occur. Urinary incontinence may continue in many cases and pet owners should be aware of this possibility.
Ensuring your dog has access to adequate water at all times and a healthy diet may reduce the likelihood of blockages forming in the ureter of your dog. Injury from accidental trauma can be avoided by restricting your dog's outdoor activity to a leash or enclosed area to avoid motor vehicle accidents that may cause this type of trauma.
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