Predicting long-term bladder control after ectopic ureter surgery

Abstract

BACKGROUND: Ectopic ureters (EU) are the main cause of urinary incontinence in juvenile dogs with a continence rate ranging from 22 to 72% reported after surgical correction. The objective of this retrospective preliminary study was to evaluate the usefulness of pre- and postoperative urethral pressure profiles (UPP) in predicting long-term continence in dogs with EU. RESULTS: UPP were performed in 16 female dogs prior to surgical correction of EU, as well as postoperatively, between 2012 and 2022. Urodynamic parameters included maximal urethral pressure (MUP), maximal urethral closure pressure (MUCP), anatomical profile length (APL), functional profile length (FPL) and integrated pressure (IP). A continence score (CS), defined as 1 = incontinent, 2 = continent with sporadic episodes of incontinence, 3 = continent, was given at the time of pre- and postoperative UPP. Neoureterostomy with dissection of the intramural portion (23 EU) or neoureterocystostomy (3 extramural EU) were performed. Seven dogs were neutered before or during surgical correction. Median preoperative CS was 1 (min 1, max 2). All dogs were continent with a CS of 3 in the immediate postoperative period. Long-term median follow-up time was 24 [8.5-42] months. Recurrence of incontinence occurred in 9 dogs (56.3%). Median time duration without recurrence was 5 months. In the 16 dogs, postoperative FPL values (median 70.5 [56-82.5] mm) were significantly increased compared to preoperative values (median 56.5 [41-72.3] mm) (P = 0.034). In the group of 7 dogs without recurrence of incontinence, IP increased significantly from a preoperative median value of 102 [19-171] cm.cmH2O to a postoperative median value of 132 [67-225] cm.cmH2O (P = 0.016). In dogs without recurrence, ranges of variation between pre- and postoperative MUP and IP values, as well as postoperative MUCP values (median 47.3 [24.5-52] cmH2O, P = 0.026) were significantly higher (P = 0.017 and P = 0.039 respectively). Recurrence hazard of incontinence was neither significantly associated with age, breed, preoperative urodynamic measurements, CS, neutering, or the type of EU. CONCLUSIONS: In our population, preoperative UPP could not be considered as a diagnostic procedure predictive for incontinence recurrence after surgical correction of EU. Our urodynamic findings support potential improvement in urethral tone in female dogs without recurrence of incontinence.