Case Study

CT – Ectopic ureter with pelvic bladder and sphincter incompetence in a 5 month old Bulldog mix with incontinence

This 18 week old F bulldog mix is dribbling urine

DX

The patient has a pelvic bladder which may be the underlying cause of the urinary incontinence here

Image Interpretation

CT of the abdomen – The contrast resolution and the deep intrapelvic position of an essentially empty urinary bladder do not allow for the visualization oft he ureteral orifices. However there is no pyelectasia and no hydroreter. Both ureters present with normal diameter and peristalsis and can be traced into the pelvic canal where they are border effacing with the hypogastric organs. The caudal position of the urinary bladder is remarkable here.

Outcome

However, the assessment of the urinogenital system is limited here. The scan does not reveal indirect evidence of a ureteral ectopia. Direct assessment of the ureteral orifices was not possible though.
Consider vaginoscopy and retrograde vaginourethrocystoscopy for further workup and to rule out presence of mutiple malformations.

Repeat CT 3 weeks later, pre and post contrast – A deep intrapelvic position of a moderatley distended urinary bladder is noted. There is no pyelectasia and no hydroreter. Both ureters bypass the cysturethral junction with an intramural bypass and open into the vagina at the urethrovaginal junction.
The tone of the cysturethral junction appears to be decreased. There is pooling of contrast within the vagina and vaginal vestibule as well as leakage out of the vulva. Mild reflux of contrast into the uterine body is noted.

Overall assessment:
• Bilateral congenital ureteral ectopia
• Pelvic bladder with possible sphincter incompetence