Page 207 - Problem-Based Feline Medicine

12 – THE INCONTINENT CAT 199

Diagnosis Ureteronephrectomy may be considered when the
affected kidney is diseased and the contralateral kidney
A history of urinary incontinence since birth or
is normal.
when acquired as a kitten indicates congenital
ureteral ectopia. Onset of signs following recent Renal infarction by ligation of the renal blood vessel
abdominal surgery at any age would suggest acquired may be considered in azotemic cats with unilateral
ureteral ectopia. ureteral ectopia.
Clinical signs which are suggestive are: Continued incontinence after surgery may be due to
● Urinary incontinence without urinary bladder concomitant urethral incompetence or reduced bladder
distention. capacity due to disuse. If the latter, bladder capacity
● Incontinence despite normal urination (unilateral usually improves with time.
ectopic ureter).
Secondary bacterial infections are not uncommon and
Radiographic techniques such as excretory urogra- antimicrobials based on culture and sensitivity tests
phy/pneumocystography and retrograde urethrography should be administered.
or vaginourethrography provide information on the site
of ureteral termination, renal size and ureteral shape.
Prognosis
● One or both ureters fail to terminate normally in the
urinary bladder. Following surgical correction, prognosis is generally
● Other anomalies, such as cystic and renal hypopla- good with immediate cessation of urinary incontinence.
sia, hydronephrosis and megaureter may be seen.
Cats with ectopic ureters that terminate in the vagina
Vaginoscopy may reveal the ectopic ureteral orifice if are more likely to be continent after surgery.
the ureter enters the vagina.
Reimplantation of dilated ureters into the bladder may
Ultrasonography may help to demonstrate the abnor- result in increased vesicoureteral reflux that can predis-
mal termination of the urethra or vagina. pose to ascending pyelonephritis.
Biochemistry
● Serum urea and creatinine estimations can be used URETHRAL STRICTURE*
to evaluate renal function.
● Urea and creatinine are more likely to be elevated Classical signs
with bilateral ureteral ectopia, especially if chronic.
● Dribbling urine.
● Elevations indicate both kidneys are diseased from
● Distended bladder.
ascending pyelonephritis or an associated congeni-
● Dysuria.
tal renal anomaly.
Urinalysis and bacterial culture can identify the pres-
Pathogenesis
ence of secondary infection.
Congenital urethral strictures are occasionally seen in
Differential diagnosis young cats.
Urinary retention with overflow (overflow inconti- Acquired strictures are more common and occur sec-
nence) is differentiated from ectopic ureter by finding a ondary to trauma, inflammation or iatrogenic causes
distended bladder on palpation. following catheterization or surgery.

Treatment Clinical signs
Vesico-ureteral transplantation is the treatment of Typical signs are incontinence associated with a dis-
choice when the kidney function is normal and the tended bladder (overflow incontinence) and dysuria
ureter is not markedly abnormal. (difficulty urinating) with a narrow urine stream.