Page 1055 - Small Animal Internal Medicine, 6th Edition

CHAPTER 57 Neonatology and Pediatrics 1027

damage to the urinary tract. Traditionally, treatment for or not. The age of onset ranges from 6 weeks to puberty,
dogs with ureteral ectopia is surgical correction (revision), the duration runs days to months, and the disorder is often
VetBooks.ir and postoperative success rates vary between 50% to 75%. intermittent. Cytologic examination of the discharge is sup-
purative. Vaginal cultures (aerobic) generally fail to grow
It has been reported that dogs weighing <20 kg have a
better outcome postoperatively. Minimally invasive therapies
organisms could be cultured from a littermate without
have also been utilized in dogs with ectopic ureters such as anything but normal flora in small mixed numbers. Similar
cystoscopic-guided laser ablation for the ectopic ureter (Fig. signs. A urinalysis, acquired by cystocentesis, is character-
57.29, Video 57.4). Nephrectomy is reserved for advanced istically normal (a decreased urine specific gravity is typical
cases with irreversible renal damage ipsilaterally and normal for young dogs lacking adult concentrating abilities), and
function contralaterally, or cases with severe financial con- urine culture, if performed, is negative. The clinician needs
straints. Removal of affected individuals from breeding pro- to perform enough diagnostics to rule out more significant
grams and avoidance of similar pedigrees in breeding should causes of vulvar discharge and feel comfortable with the
always be discussed with the owners. Ongoing studies exist diagnosis of benign puppy vaginitis. Important rule-outs
evaluating the mode of inheritance. Postoperative persistent (some of which are associated with inflammation) include
incontinence can be managed in many cases pharmacologi- urinary tract infection, urine scalding, perivulvar dermatitis,
cally with the α-adrenergic stimulant phenylpropanolamine redundant dorsal vulvar folds, the onset of the initial estrous
(1.0-1.5 mg/kg PO q8-12h), or estrogen compounds that cycle, vaginal foreign bodies (i.e., foxtails), and urogenital
increase sensitivity of α-adrenergic receptors in the urethra anatomic anomalies (ectopia, disorders of sexual differentia-
(compounded diethylstilbestrol, DES, at 0.02 mg/kg PO tion, significant strictures distal to the urethral papilla). The
tapered to 1-3 times weekly or estriol (Incurin [Merck] 2 mg specific etiology of puppy vaginitis is unknown. An imbal-
PO daily for 14d then tapered). Time-released phenylpropa- ance of juvenile vaginal glandular epithelium is postulated.
nolamine is more effective than short-acting phenylpropa- The condition is reported in the literature to resolve both
nolamine in refractory cases of incontinence. Combination with puberty and with ovariohysterectomy, two very dif-
therapy with phenylpropanolamine and an estrogen com- ferent events endocrinologically, therefore neither is likely
pound can be superior if either fails when used as a single to truly cause resolution. Puppy vaginitis diminishes with
agent. Gonadotropin-releasing hormone (GnRH) analogues maturity. Cleansing the perivulvar area with gentle antisep-
recently have been shown to improve continence in ovari- tic wipes is advised. There is no association between puppy
ectomized female dogs, most likely through interaction with vaginitis and adult chronic vaginitis or urinary incontinence
GnRH, FSH, and LH receptors in the lower genitourinary postovariohysterectomy.
tract (Reichler et al., 2003). A postoperative urine culture
should always be determined before assuming that persistent Gastrointestinal Disorders
incontinence is due to residual anatomic abnormalities. Pediatric patients should be presumptively dewormed at 2,
Female puppies presented with mucopurulent vulvar dis- 4, and 6 weeks of age for parasites (roundworms) acquired
charge should be evaluated for the benign condition called via transplacental transmission. In endemic regions, Neos-
“puppy vaginitis”, a misnomer as it is not an inflammatory pora caninum, Babesiosis, Leishmaniasis, and Dirofilarial
condition. The discharge can be accompanied by mild periv- microfilariae can also be transmitted transplacentally. Trans-
ulvar dermatitis. The puppy is not typically attentive to the mammary transmission and environmental contamination
discharge, and there is not any associated change in urinary with parasites can continue postpartum. Repeated deworm-
behavior (dysuria or polakiura). Clients often have a dif- ing (every 2 weeks) is required because of this and because
ficult time deciding if a puppy has normal urinary behavior of the parasites’ life cycles. Fecal evaluation should follow
completion of routine anthelmintics at 7 to 8 weeks of age,
usually when the puppy has been transferred to its new
owner and veterinarian. Abnormal stools at any age should
prompt a fecal parasite evaluation. Clinically significant
endoparasitisms of young dogs and cats include round-
worms (Toxocara canis, Toxocara cati, Toxascaris leonina),
hookworms (Ancylostoma caninum, Ancylostoma tubeforme,
Uncinaria stenocephala), tapeworms (Dipylidium caninum,
Echinococcus granulosus, Taenia spp.), Strongyloides stercora-
lis, and protozoal organisms such as coccidia (Isospora spp.),
Cryptosporidium parvum, and Giardia sp. Clinical signs are
variable and range from asymptomatic to life-threatening;
most common clinical signs include diarrhea, weight loss, or
failure to gain. Ancylostoma caninum can be associated with
FIG 57.29 severe hemorrhagic enteritis and anemia in puppies. Diag-
Laser ablation (arrow) of the bladder mucosa creating an nosis of endoparasitic infestations is most commonly made
opening for an intramural ectopic ureter. by fecal flotation, and centrifugation techniques may improve