Colt with Ectopic Ureter

History

O.T. was a one month old colt with a history of dribbling urine from his penis since he was born.  He was evaluated at the University of Florida’s Veterinary Medical Center where an ultrasound and double contrast Computed Topography (CT) were performed.  The ultrasound revealed a large right ureter and kidney with hydronephrosis (an excessive amount of fluid within the kidney due to backward pressure caused by an obstruction of outflow).  The CT showed that Oliver had a right ectopic ureter.  He was moved from Florida to Arizona, and was brought to Southwest Equine for surgical correction of his ectopic ureter.

Definition of an Ectopic Ureter

Urine is produced in the kidney and flows down the ureters and into the bladder.  The urine is then stored in the bladder until the bladder becomes full.  Once the bladder starts to stretch, the horse will urinate which causes the urine to move from the bladder through the urethra and out of the body.

In normal anatomy, there are two ureters (one from each kidney) which insert onto the bladder during fetal development.  An ectopic ureter is a term used to describe when a ureter inserts at an abnormal location, ie it does not insert on to the bladder normally. This condition occurs more commonly in dogs with the ureter inserting on the urethra, vagina, or the uterus.  Ectopic ureters are extremely uncommon in horses and is seen in foals with clinical signs that include urinary incontinence (inability to control urination), dribbling urine, or frequent urination.

Surgery

Before surgery, O.T. was started on Phenazopyridine to darken his urine and allow for easy identification of the ureter during surgery.  This drug also helps to relieve irritation or spasms of the bladder mucosa.  A urinary catheter was also placed to help empty the bladder.  He was started on pre-operative antibiotics.

At surgery a dilated ureter was found on the right side of the abdomen.  The ureter was traced back to determine it’s insertion on the urethra.  The ureter’s insertion point was located too far caudally in the pelvic canal to correct at it’s insertion.  The ureter was transected (cut); the caudal portion was ligated (sutured closed) and 3cc of Oxytetracyline was injected into it to help regress the remaining tissue.  The cranial portion of the ureter was then attached to the dorsal aspect of the bladder.  In order to accomplish this, a cystotomy (incision in the bladder) was performed and the ureter sutured into the bladder.  O.T. recovered well from anesthesia.

Surgical Pictures:

Post-Operative Hospitalization and Treatments

The colt did well after his surgery.  The urinary catheter was kept in place to ensure his bladder would not become too full until he was able to comfortably urinate.  He was given injectable pain medications that included Banamine as well as antibiotics to prevent post-operative infection. He was also kept on the Phenazopyridine for its analgesic properties to the bladder mucosa.  Since foals are prone to gastric ulcers during periods of stress and with the use of a NSAID (ie Banamine), he was placed on Gastrogard (Omeprazole) to help prevent gastric ulcers.

O.T. did well post-operatively. He was comfortable, nursed well and seemed like a happy foal after surgery. The third day after surgery, the urinary catheter was removed and his pain medication decreased to just the oral Banamine.  Oliver Twist continued to do well and urinate normally without the urinary catheter.  He was not dribbling urine post-operatively and had no excessive fluid in the abdomen, indicating that the relocated ureter was successfully draining into his bladder.

O.T. did great at home and was able to be a normal, happy foal post-operatively.

Take away note: please call your veterinarian immediately if your foal is dribbling urine or straining to urinate. Ectopic ureters are uncommon, but ruptured bladders or umbilical infections are very common and are an emergency in young foals (typically 1-4 days of age).