[Yaichi's Mom]

My Brisby is now 3 years 9 months old.

Since she was about 2 1/2 years old we have been dealing with urinary leakage/incontinence. ( Apologies in advance for the lengthy post)

A brief history:

• leaked urine as a puppy when 10 - 12 weeks old; leakage resolved itself
• spayed at 7 months of age
• no urinary leakage noticed until about 2.5 years of age and mainly when she was asleep
• diagnosed initially as "spay incontinence"; was put on trial of Stilbestrol for 5 days where she remained dry
• leakage resurfaced 72 hours after initial dose of Stilbestrol; vet indicates that Stilbestrol would be required at too high a does to control incontinence and suggests Proin/PPA
• rejected dosage of Proin/PPA due to side effects ( hypertension ) and others - referred to holistic vet
• managed incontinence with product Leaks No More, Sang Piao Xiao San, acupuncture with moderate success
• leakage becomes more frequent and larger in volume, yet still not leaking all the time - referred to homeopathic veterinarian in conjunction and partnership with holistic veterinarian.
• after several varied homeopathic remedy doses we have still not hit on one that is resolving the incontinence ( realizing that each dog is different and it takes time to find the one that may work)
• vulvar area is inflamed due to leakage of urine
• ultrasound done to rule out any physical anomalies for incontinence
• ultrasound results show the following:

Clinical Impression:


The spleen was unremarkable.


The liver was normal in size and the parenchyma was isoechoic. Also. the gallbladder was not distended.


The kidneys were normal in size.



The adrenals were not enlarged.



The bladder was distended with urine and the mucosa was not thickened. No evidence of sediment, urolithiasis or neoplasia was
seen. However, what could have been a subtly dilated ureter was noted intramurally in the distal bladder and passed the
sphyncter measuring 0.3 cm in diameter.



The remainder of the abdominal ultrasound, was apparently normal.



Iliac or mesenteric lymphadenopathy was not seen.



No evidence of abdominal effusion was present.



Recommendation:

Consider further investigation of possible intramural ectopic ureteral disease via a diuretic-induced ultrasound flow study or
excretory urography and cystoscopy.


---------------------------------------------------


I have many questions. Here are just a few:


Have any of you had any experience with an incontinent spayed female GR?


If yes, what did you do and what were the results?


Have any of you dealt with an intramural ectopic ureter in a female dog?


If yes, what was your choice of diagnostics and treatment?


If you had it surgically corrected, what methodology was used? Was it successful?



-----------------------------


I am taking Brisby to an internal medicine specialist next week to discuss further diagnostics and a treatment plan.


I would appreciate any input you can give me from personal experience and what questions to ask.


From all that I have researched, it seems that correction ( should this be what we are dealing with) is completely successful in less than 50% of cases, a bit higher if treated via cystoscopy and laser ablation.


Any help or insight you all could share would be truly appreciated.


Many thanks in advance.

 

[Tahnee GR]

I used Proin successfully and with no side effects for years on my old girl, and I know of many others who have as well. I would try that before I would do surgery.

 

[Yaichi's Mom]

I used Proin successfully and with no side effects for years on my old girl, and I know of many others who have as well. I would try that before I would do surgery.

Thank you so much for your response, Linda.

Brisby has a predisposition to hypertension as documented by a veterinary specialist when she was having dental work done.

Although many have used Proin/PPA successfully and with no side effects, Brisby is not a good candidate for this drug. Many dogs have died after just one dose.

I am not ruling this out as a last resort, however I am hopefully looking for other approaches both to the incontinence and specifically if we are dealing with an intramural ectopic ureter (EU) or not.

USMI seems to have a good response rate to Proin/PPA, often with the addition of Stilbestrol or some other estrogen therapy, however since Proin/PPA acts on the sphincter, if the ureter bypasses the the sphincter, it likely will not have any effect.

Often times, EU & USMI are both present.

I don't know exactly what the affirmed diagnosis is with Brisby yet on either front: EU, USMI or both.

What I am hopefully seeking from all of you is advice, experience on what I should ask the internal medicine veterinarian, how do I make a decision and most specifically if any one of you have gone through this and what your advice may be.

Brisby is not completely incontinent. She holds her urine for the most part during waking hours and dribbles while napping and has much larger leaks when she is asleep. Sometimes when she wakes up, she will leave a urine trail of drops when she gets up as she has a slightly inverted vulva and the urine seems to collect there, which is also causing irritation and rawness in that area.

I put white towels and comforters everywhere, to absorb the urine, to monitor how much she is actually leaking etc., do a lot of laundry and shampoo my carpets once a week. I need to replace my floors to something non absorbent, easy to clean, however with all the vet bills this is not financially possible at this time. Often times I can't monitor true urine output if she is not leaking on the places I have set up and sleeps elsewhere.

If there is anyone here on the forum who can share their experience with me if you have gone through this with a young dog, know of someone who has or are a veterinarian who can chime in, I would be most grateful.

My girl is only 3 years 9 months old and hopefully has many years ahead of her.

I am trying to gather all the information I can before we go to see the internal medicine specialist next week for a consult for a further diagnostic/treatment plan.

I need all of your help to guide us...please....

Ingrid & Brisby

ps. mods, if you could please correct the title to this thread...I have Bris at the very end of the title which is a typo. Could you please remove...no biggie if you can't.
I am also hoping this thread will be an information source for others who are going through this with their dogs: GR's or any other breed. Many thanks. The title should read: Possible Intramural Ectopic Ureter/Incontinence - Advice Please

 

[Tennyson]

You've certainly have done your research and are very organized with your research process. With some outside help Brisby is in very good hands going forward. Nothing with IEU's is black or white.
Hope your next vet visit goes well and you get more direction in whatever you decide to do.
Keep us ALL posted on Brisby. She's lucky to have you!

 

[Jessie'sGirl]

Yes, you are certainly doing your homework and looking at all the options. Hope you get some good advice and can find a solution to Brisby's urinary issues.

 

[Tennyson]

Hey Ingrid,
How did you make out with Brisby's appointment? Hoping you got some answers.

 

[Yaichi's Mom]

Hey Ingrid,
How did you make out with Brisby's appointment? Hoping you got some answers.

Hi M! ...thanks for checking in on us

Apologies that I didn't see your post until this morning.

I am glad that we went to see the internal medicine specialist here at TVEH as he was able to confirm much of what I had researched and also was able to answer some of the questions I had.

Bottom line is that EU's ( ectopic ureters either unilateral and bilateral):

• can be corrected by either conventional surgery or cystoscopy with laser ablation, however this results complete continence is 50% or less of the cases, which still require to be managed with other intervention/modalities of treatment: ie hormones ( DES, Incurin, etc.), PPA, acupuncture, chiropractic, herbal remedies, homeopathy, collagen injections, sphincter ring etc.
• USMI ( Urinary Sphincter Mechanism Incompetence) is usually present in the majority of cases, therefore correcting an EU will not solve incontinence
• there is no risk to leave an EU unresolved, which was my major concern: no risk of damage to kidneys/kidney function, bladder, overall health, longevity etc. The only risks are frequent UTI's, perivulvar dermatitis/irritation, other than the risk of pyelonephritis as a result of untreated UTI ( these were already knowns )
• the next diagnostic step would be to conduct a CT excretory ureterogram, to confirm the flow of urine from the kidneys, through the ureters to the bladder etc., at a cost of app. $2000
• cystoscopy/laser ablation would be a one step diagnostic and correctional procedure however it is not available at TVEH. The closest clinic here would be AMC in New York. Unknown if Guelph performs this procedure. Cost unknown however could be in the ball park of $5-6K.

Considering the success rate of correcting an EU ( if one exists in Brisby's case which is not confirmed) I see little value in conducting further testing if the confirmed results are not actionable in resolving her leakage.

In other words, if USMI is the root cause of leakage, then putting her through additional procedures will not resolve the issue and we will have to manage this in the same manner than we would without correcting an EU should it be present.

The end result is that we will continue to try to manage Brisby's leakage with more natural modalities ( herbs, acupuncture, chiropractic, homeopathy etc.) hoping for success before moving to a trial of PPA/DES.

For those interested and for future reference for anyone going through this with a female Golden or any other breed, here are some studies on EU's, correction etc., as a reference.

VARIATIONS OF URETERAL ECTOPIA IN DOGS – LESSONS LEARNED

Ectopic Ureters and Ureteroceles in Dogs: Presentation, Cause, and Diagnosis

Study on EU in Golden Retrievers

DIAGNOSING AND MANAGING URINARY INCONTINENCE IN DOGS

Urinary Incontinence in the Dog

Evaluation of cystoscopic-guided laser ablation of intramural ectopic ureters in female dogs.

Any comments, suggestions and success stories are more than welcome.

Hopefully the information above will help others on a similar journey.

 

[ZeppGold]

Thanks for the info.
Just wanted to give you info on our rescue Honey.
She was given up to a rescue when she was 5 months old because she had a ectopic ureter. The rescue did the operation on her when she was 5 months old.
They had to remove one kidney in the surgery. Don't remember or know all of the other details.

We adopted her when she was 7 months old.
She had a little bit of problems with UTI and leakage for the first year.
Since then, (she is now 11 years old) she has been leak free.
Because she only has 1 kidney, we have her urine tested every 6 months.
She has only had a few infections in the last 10 years.

Just wanted to share a success story with you.

 

[Yaichi's Mom]

Thanks for the info.
Just wanted to give you info on our rescue Honey.
She was given up to a rescue when she was 5 months old because she had a ectopic ureter. The rescue did the operation on her when she was 5 months old.
They had to remove one kidney in the surgery. Don't remember or know all of the other details.

We adopted her when she was 7 months old.
She had a little bit of problems with UTI and leakage for the first year.
Since then, (she is now 11 years old) she has been leak free.
Because she only has 1 kidney, we have her urine tested every 6 months.
She has only had a few infections in the last 10 years.

Just wanted to share a success story with you.

Thank you so much for your response and success story with your Honey.

You are indeed an angel for rescuing an incontinent dog. Sadly most of these pups who manifest incontinence are euthanized before they ever have an opportunity to find a home and many/most are given up due to incontinence if they live long enough.

I realize that you don't know exactly what was done for your Honey, however I am assuming that since she had a kidney removed that she had a full abdominal surgery to remove the kidney and repair the ureter.

Did your Honey need to take any further medication/treatment to manage her incontinence in the first year?

Wishing you many happy days ahead for you both.

Thank you so much for sharing your experience!! :kiss:

 

[ZeppGold]

She has not had to take any medications except for the couple of times that she needed an antibiotic for a UTI. I looked up what it said was done on the papers that we received when we adopted her - "a right nephrectomy and ureterectomy were performed, extending he incision into the urethra to dissect out the ureter." I don't remember all of the details. We just remember to check her often for infections and watch potential meds since she only has one kidney. She was had numerous other problems - lumps, mast cell tumors, ear infections, broken toe nails. But we don't care. She is definitely our "Honey."

I wish you good luck with Brisbee. Honey's surgery was 11 years ago and maybe they have better options for control, etc. May you have many more years together.

 

[Yaichi's Mom]

She has not had to take any medications except for the couple of times that she needed an antibiotic for a UTI. I looked up what it said was done on the papers that we received when we adopted her - "a right nephrectomy and ureterectomy were performed, extending he incision into the urethra to dissect out the ureter." I don't remember all of the details. We just remember to check her often for infections and watch potential meds since she only has one kidney. She was had numerous other problems - lumps, mast cell tumors, ear infections, broken toe nails. But we don't care. She is definitely our "Honey."

I wish you good luck with Brisbee. Honey's surgery was 11 years ago and maybe they have better options for control, etc. May you have many more years together.

She is blessed to have you for a Mom as well as I'm sure from what you write you are blessed to have her, especially with all you both have gone through together!

It sounds like your Honey fell into the app. 50% of successful ureter corrections that result in complete continence.

Thank you for your good wishes. We are in it through thick and thin, no matter where it takes and and what we may need to do.

Wishing you and your Honey many more years of happy times together.

 

[T&T]

Dr Dobias product seems to be getting great reviews
https://peterdobias.com/collections/all-products/products/canine-health-pack-incontia