What is an Ectopic Ureter?
An ectopic ureter is a congenital condition, meaning dogs are born with it, in which one or both ureters do not connect to the bladder in the normal location. The ureters are the tubes that carry urine from each kidney to the bladder, where urine is normally stored before being passed.
In affected dogs, the ureter opens in an abnormal location, most commonly within the urethra, which is the tube that carries urine out of the body. Because the urethra is not designed to store urine, this abnormal connection often results in urinary incontinence. The leakage is typically continuous, although in some cases it may appear intermittent.
Ectopic ureters may involve only one side, referred to as unilateral disease, or both sides, referred to as bilateral disease. In addition, there are two recognized anatomical forms. In the intramural form, the ureter travels within the wall of the bladder but ultimately opens in the wrong location. In the extramural form, the ureter bypasses the bladder entirely and connects elsewhere. This distinction is clinically important, as minimally invasive treatment options are generally only feasible in dogs with intramural ectopic ureters, whereas extramural cases typically require surgical correction.
Which dogs get ectopic ureters?
Ectopic ureters are most commonly diagnosed in young dogs, typically less than one year of age, with many cases identified between three and six months of age. Because this is a congenital condition—meaning dogs are born with it—the clinical signs are usually present from a very early stage.
Affected dogs often exhibit urinary incontinence at home from the time they are adopted, which may occur when they are resting, sleeping, or even walking around normally. Early on, this leakage is frequently mistaken for difficulty with house training, which can delay recognition of the underlying problem. As the issue persists despite appropriate training efforts, owners typically seek veterinary evaluation, leading to diagnosis.
Ectopic ureters can occur in a wide range of breeds but are most commonly reported in medium to large breed dogs, including breeds such as Golden Retriever, Labrador Retriever, and Bulldog. The condition is also seen more frequently in female dogs than in males.
What symptoms are seen with ectopic ureters?
Affected dogs often exhibit urinary incontinence at home from the time they are adopted, which may occur when they are resting, sleeping, or even walking around normally. Early on, this leakage is frequently mistaken for difficulty with house training, which can delay recognition of the underlying problem. As the issue persists despite appropriate training efforts, owners typically seek veterinary evaluation, leading to diagnosis.
How are ectopic ureters diagnosed?
Ectopic ureters are often suspected based on a dog’s history, particularly when urinary incontinence is present in a young dog. While this clinical presentation raises a strong index of suspicion, a definitive diagnosis requires advanced imaging to directly evaluate the urinary tract anatomy.
The diagnostic process typically begins with abdominal computed tomography (CT), which allows detailed visualization of the kidneys, ureters, bladder, and urethra. This imaging modality is particularly helpful in identifying the course and termination of the ureters and determining whether they are positioned abnormally.
Following CT imaging, cystoscopy is commonly performed. This minimally invasive procedure involves passing a small camera into the lower urinary tract to directly visualize the urethra and bladder. Cystoscopy not only confirms the diagnosis but also helps classify the type of ectopic ureter present.
Importantly, in dogs with the most common form—intramural ectopic ureters—cystoscopy offers both a diagnostic and therapeutic advantage. During the same procedure, the abnormal ureter can often be corrected using laser ablation, creating a normal opening into the bladder and restoring more typical urinary flow.
How are ectopic ureters treated?
In most dogs, ectopic ureters can be corrected using a minimally invasive procedure called cystoscopic-guided laser ablation. This is the preferred treatment in the majority of cases. During this procedure, a small camera (cystoscope) is used to visualize the abnormal ureter, and a fine laser is guided to precisely incise the tissue that is causing the abnormal tunnel. This allows the ureter to open into the bladder in a more normal location, restoring a more typical urinary pathway.
This approach is most effective in dogs with the intramural form of ectopic ureters, which is the most common type encountered clinically. One of the key advantages of this technique is that it is both minimally invasive and performed through natural openings, resulting in less discomfort and faster recovery compared to traditional surgery.
In a smaller proportion of cases—estimated at approximately 5 to 10%—dogs have the extramural form of ectopic ureters. In these cases, the ureter bypasses the bladder entirely and cannot be corrected using laser ablation. These patients require surgical correction through an abdominal procedure to reimplant the ureter into the bladder.
Because ectopic ureters are fundamentally an anatomic abnormality, effective treatment requires correction of this abnormal anatomy. Without addressing the underlying structural issue, medical management alone is not sufficient, and there are no medications that reliably resolve the incontinence associated with this condition.
What is the prognosis after treatment?
The prognosis for recovery of urinary continence following correction of ectopic ureters is generally good, but it is important to set appropriate expectations.
Regardless of the treatment method used—whether cystoscopic-guided laser ablation or surgical correction—approximately 50% of dogs will become completely continent after the procedure alone.
Among the remaining dogs that continue to have some degree of urinary incontinence, a proportion will improve with medical management.
However, not all dogs respond to medical therapy. Overall, a subset of patients—roughly half of those with persistent incontinence—may remain refractory to medications. In these cases, additional interventions may be considered, including urethral bulking (collagen) injections, placement of an artificial urethral sphincter, or other surgical procedures aimed at improving continence.
How long is recovery from the procedure?
Recovery depends on the type of procedure performed, but in most cases—particularly with minimally invasive treatment—the recovery period is straightforward and well tolerated.
Dogs that undergo cystoscopic-guided laser ablation typically recover very quickly. Because this procedure does not involve an abdominal incision, there is no need for strict exercise restriction, and most dogs can return to their normal activity levels shortly afterward. Mild lower urinary tract signs, such as a small amount of blood in the urine or mild straining to urinate, may be seen for one to two days following the procedure. These signs are generally transient and can be managed effectively with short-term use of anti-inflammatory medications.
In contrast, dogs that require surgical correction—most commonly for extramural ectopic ureters—will have undergone an abdominal procedure. As a result, these patients require a more traditional post-operative recovery, including exercise restriction for approximately two weeks to allow proper healing of the surgical site.
What can I expect from my visit?
During your visit, our service will begin by collecting a detailed history for your dog and performing a thorough physical examination. Based on this information, we will discuss whether ectopic ureters are a likely cause of your dog’s clinical signs and outline the recommended next steps in diagnosis and treatment.
If recent laboratory testing has not been completed, we will typically recommend baseline testing, including a urine culture. This is particularly important to ensure that there is no active urinary tract infection at the time of the procedure, which could cause complications. If a urine culture performed within the previous two weeks is negative, or if a urinary tract infection has been identified and your dog has been receiving appropriate antibiotics treatment for at least five days, we can generally proceed with the procedure. Otherwise, the procedure may need to be delayed until culture results are available and any infection is adequately addressed.
Because correction of ectopic ureters requires general anesthesia, the procedure is not performed on the same day as the initial consultation. Instead, it is typically scheduled for a later date, often within the following days or week, depending on availability and any required pre-procedural steps.
For dogs undergoing cystoscopic-guided laser ablation, the procedure is minimally invasive and most patients are able to return home the same day, without the need for overnight hospitalization. In contrast, dogs that require surgical correction will typically remain in the hospital for one to two days following the procedure to ensure appropriate recovery and monitoring.
Throughout the process, our goal is to provide clear communication and a tailored plan to ensure the safest and most effective care for your dog.
