Cystoscopic-guided laser ablation of an intramural ectopic ureter in a dog: clinical case
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2016-04-01
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A ectopia ureteral é uma anomalia congénita na qual um ou ambos os ureteres terminam distalmente ao trígono vesical resultando em incontinência urinária. Os ureteres ectópicos dividem-se em duas grandes classes: os extramurais, que tem um percurso extravesical e terminam na uretra na maioria dos casos; e os intramurais, que geralmente entram na bexiga ao nível anatomicamente correto, mas tunelizam na submucosa da parede da bexiga, terminando também maioritariamente na uretra. A ectopia ureteral é a causa mais comum de incontinência urinária em cães, embora seja uma doença de ocorrência rara. É tipicamente diagnosticada em animais jovens e é mais frequente em fêmeas que em machos. Existem algumas raças predispostas para esta doença, incluindo o Husky Siberiano, Caniche, West Highland White Terrier, Golden Retriever, Bulldog Inglês, Newfoundland, Skye Terrier e Fox Terrier.
O diagnóstico definitivo é alcançado através de métodos imagiológicos, em integração com os dados recolhidos na apresentação clínica e história pregressa do animal. O tratamento de eleição desta doença é cirúrgico, havendo várias técnicas passiveis de serem realizadas: neoureterostomia, reimplantação ureteral, nefroureterectomia ou cistoscopia e ablação por laser. A cistoscopia e ablação por laser é uma técnica recente, realizada pela primeira vez em cães em 2006, que se destaca por ser minimamente invasiva e de rápida execução. As taxas de sucesso obtidas até ao presente não variam significativamente consoante a técnica utilizada. Frequentemente, os animais com ectopia ureteral necessitam de terapia médica pós-operatória que muitas vezes não é suficiente para alcançar a continência urinária, havendo necessidade de recorrer a outras técnicas ainda em desenvolvimento.
O caso clínico apresentado nesta dissertação foi recebido no Hospital Veterinário da Universidade do Tennessee onde foi diagnosticada uma ectopia ureteral a um Golden Retriever de quatro meses de idade através de tomografia computorizada e instituída a resolução cirúrgica através de cistoscopia e ablação por laser. O animal permanecia com episódios de incontinência urinária, seis meses após a cirurgia e sob tratamento médico com fenilpropanolamina, pelo que foi aconselhada a colocação de um constritor uretral. Os resultados obtidos neste caso clínico estão em conformidade com a bibliografia atual.
Ureteral ectopia is a congenital anomaly in which one or both ureters end past the bladder trigone, leading to urinary incontinence. Ectopic ureters can be divided in two categories: extramural that totally bypasses the bladder, entering the urethra most of the times; and intramural that usually enter the bladder in the right anatomical position, but then tunnel through the bladder wall and terminate also most frequently in the urethra. Ureteral ectopia is the most common cause of urinary incontinence in dogs, even though it is a rare condition. It is typically diagnosed in young animals and more frequently in female than male dogs. There are some breeds considered predisposed to this condition such as Siberian Husky, Toy Poodle, West Highland White Terrier, Golden Retriever, English Bulldogs, Newfoundland, Skye Terrier and Fox Terrier. The definitive diagnosis is achieved associating imaging techniques to information gathered through the clinical presentation and past history of the patient. The treatment of choice for this condition is surgical and different techniques can be performed: neoureterostomy, ureteral re-implantation, nephroureterectomy and cystoscopic-guided laser ablation. Cystoscopic-guided laser ablation is a recent technique, firstly performed in dogs in 2006 that stands out for being minimally invasive and of rapid execution. Success rates obtained until today, do not vary significantly depending on the chosen technique. Patients with ureteral ectopia often need post-surgical medical therapy which sometimes is not enough to achieve urinary continence, hence the need to perform other developing techniques. The clinical case presented in this dissertation was received at University of Tennessee Veterinary Teaching Hospital, in which a four-month-old Golden Retriever was diagnosed with ureteral ectopia using computed tomography. Further surgical resolution with cystoscopic-guided laser ablation was established. Six months after surgery, the patient still had episodes of urinary incontinence and whereby an urethral artificial occluder placement was advised. The results obtained in this clinical case match what is shown in the current literature.
Ureteral ectopia is a congenital anomaly in which one or both ureters end past the bladder trigone, leading to urinary incontinence. Ectopic ureters can be divided in two categories: extramural that totally bypasses the bladder, entering the urethra most of the times; and intramural that usually enter the bladder in the right anatomical position, but then tunnel through the bladder wall and terminate also most frequently in the urethra. Ureteral ectopia is the most common cause of urinary incontinence in dogs, even though it is a rare condition. It is typically diagnosed in young animals and more frequently in female than male dogs. There are some breeds considered predisposed to this condition such as Siberian Husky, Toy Poodle, West Highland White Terrier, Golden Retriever, English Bulldogs, Newfoundland, Skye Terrier and Fox Terrier. The definitive diagnosis is achieved associating imaging techniques to information gathered through the clinical presentation and past history of the patient. The treatment of choice for this condition is surgical and different techniques can be performed: neoureterostomy, ureteral re-implantation, nephroureterectomy and cystoscopic-guided laser ablation. Cystoscopic-guided laser ablation is a recent technique, firstly performed in dogs in 2006 that stands out for being minimally invasive and of rapid execution. Success rates obtained until today, do not vary significantly depending on the chosen technique. Patients with ureteral ectopia often need post-surgical medical therapy which sometimes is not enough to achieve urinary continence, hence the need to perform other developing techniques. The clinical case presented in this dissertation was received at University of Tennessee Veterinary Teaching Hospital, in which a four-month-old Golden Retriever was diagnosed with ureteral ectopia using computed tomography. Further surgical resolution with cystoscopic-guided laser ablation was established. Six months after surgery, the patient still had episodes of urinary incontinence and whereby an urethral artificial occluder placement was advised. The results obtained in this clinical case match what is shown in the current literature.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Cães , Incontinência urinária , Doenças urológicas , Ectopia ureteral , Cistoscopia e ablação por laser