2013

An Evaluation of Post-operative Urinary Incontinence in Dogs with Intramural Ectopic Ureter Treated with Neoureterocystostomy [1]

Ektopik üreterin cerrahi tedavisinde ana motivasyon üriner inkontinensi ortadan kaldırmaktır. Özellikle intramural tipteki ektopik üreterin cerrahi tedavisi için farklı neoüreterostomi teknikleri geliştirilmesine rağmen, postoperatif üriner inkontinens skorlarının, eski teknikler kullanılarak elde edilenlere önemli bir üstünlüğü olmadığı tespit edilmiştir. Çalışmamızda, neoüreterosistostomi tekniğiyle tedavi edilen intramural ektopik üreter hastası köpeklerde postoperatif üriner inkontinens skorlarının, neoüreterostomi teknikleri kullanılarak elde edilen eski skorlarla karşılaştırılması amaçlanmıştır. Çalışmaya kliniğimize, doğduğundan veya sahiplenildiğinden beri sürekli damla damla idrar kaçırma şikayeti olan 7 dişi köpek dahil edildi. Radyolojik tanı için 4 hastada ekskretör ürografi, 2 hastada ekskretör ürografi ve retrograd vajinoüretrografi, bir hastada ise magnetik rezonans görüntülemeden (MRG) faydalanıldı. Kesin tanı sistotomi ile kondu. Hastaların tümünde ektopik üreter intramural karakterde idi. Hastalar neoüreterosistostomi tekniği kullanılarak sağaltıldı ve postoperatif 1. ve 2. ay inkontinens skorları kaydedildi. Postoperatif dönemde, üriner inkontinensin tamamen ortadan kaldırılması için, ek medikal tedavi olarak 4 hastada fenilpropalamin, bir hastada ise oksibutininden faydalanıldı. Çalışmanın sonunda, yedi hastanın 5 tanesinde (%71) üriner inkontinens tamamen ortadan kalktı. Elde ettiğimiz sonuçlar, farklı neoüreterostomi teknikleri kullanılarak elde edilenlerle benzer bulundu. Sonuçlar, intramural ektopik üreterin tedavisinde, üretrotomi içermeyen bir cerrahi yöntemin, üretra sfinkteri mekanizması yetersizliğinin cerrahi tedavisinde kullanılan bir yöntemle birlikte, eş zamanlı olarak uygulanması ve postoperatif dönemde alfa adrenerjik ilaçların kullanılmasını içeren bir kombine terapiyle en başarılı şekilde tedavi edilebileceğini düşündürdü.

The main motivation in the treatment of ectopic ureter (EU) is achieving complete urinary continence. Although, new neoureterostomy techniques were developed for the surgical treatment of intramural ectopic ureters, it was determined that postoperative incontinence scores achieved with the latest techniques have no distinct superiority over those achieved with older techniques. Therefore, we aim to determine the post-operative urinary incontinence scores in dogs with intramural EU that were treated with neoureterocystostomy and compared with older reports which neoureterostomy techniques were used. Seven female dogs which were brought to our clinic with a complaint of constant urine dribbling since they were born or adopted were included the study. The radiographic diagnosis was made by excretory urography in four dogs, excretory urography and retrograde vagino-urethrography in 2 dogs and MRI in 1 dog. Definitive diagnosis was made by cystotomy. Ectopic ureters were intramural character in all cases. Neoureterocystostomy technique was used for the surgical treatment and incontinence scores at post-operative 1st and 2nd months were recorded. For the purpose of complete elimination of the postoperative urinary incontinence, phenylpropalamine were used in 4 cases and oxybutynin were used in 1 case as additional medical therapy. Urinary incontinence was completely disappeared, 5 out of 7 patients (71%) at the end of the study. In conclusion, the results suggest that EU is most successfully treated with a surgical method that does not involve urethrotomy and it should be performed simultaneously with a surgical method used in the treatment of urethral sphincter mechanism incompetence and should be combined with a treatment involving the use of post-operative alpha adrenergic medications.

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