Abstract: Objective: The aim of the study was to determine receiver operating characteristics (ROC) of computed tomographic excretory urography (CTEU) in predicting cystoscopic findings of ureteral anatomy.
Study Design: Retrospective cohort study.
Animals: Thirty-five client-owned dogs.
Methods: The medical records of dogs referred for suspected ectopic ureters were reviewed. Inclusion criteria included CTEU findings reported by board-certified radiologists, followed by rigid cystoscopy with or without ureteral cystoscopic laser ablation (CLA). Data included signalment, urinary incontinence degree, body condition score, weight, degree of colon distension, CTEU and cystoscopy findings. ROC analysis was used to compare CT-predicted ureteral orthotopia/ectopia to cystoscopy findings. Additionally, ROC of CT predicted ureteral orifice locations was analyzed. Regression covariate analysis was performed to identify factors that may have influenced accuracy of diagnosis.
Results: The ability of CT to identify a normal and intra-or extramural ectopic ureters conclusively and correctly was 13/26 (50%) and 32/41(78%), respectively. Sensitivity and specificity of identifying extramural versus intramural ureters was 2/7 versus 30/46 (29 vs. 65%) and 61/63 versus 17/24 (97 vs. 71%), respectively. Ectopic orifice determination sensitivity and specificity varied widely depending on location from 0% to 76% and 67% to 97%, respectively. Covariate analysis failed to identify interfering factors.
Conclusions: CT did not accurately predict anatomy of ureters; CT findings may need confirmation by cystoscopy and possibly intraoperative fluoroscopy prior to determining if CLA is indicated or not.
Clinical Significance: Our results may be of importance for surgeons interpreting the CTEU findings. CTEU prediction of the location of the ureteral orifice shows low sensitivity especially in or close to the urethral sphincter area.
(© 2024 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)
References: Owen RR. Canine ureteral ectopia ‐ a review. 2. Incidence, diagnosis and treatment. J Small Anim Pract. 1973;14(7):419‐427.
Davidson AP, Westropp JL. Diagnosis and management of urinary ectopia. Vet Clin North Am Small Anim Pract. 2014;44(2):343‐353.
Holt PE. Urinary incontinence in the bitch due to sphincter mechanism incompetence: prevalenece in referred dogs and retrospective analysis of sixty cases. J Small Anim Pract. 1985;24(4):181‐190.
Johnston SA, Tobias KM. Veterinary Surgery: Small Animal. Elsevier; 2018.
Owen LJ. Ureteral ectopia and urethral sphincter mechanism incompetence: an update on diagnosis and management options. J Small Anim Pract. 2019;60(1):3‐17.
NoÎl SM, Claeys S, Hamaide AJ. Surgical management of ectopic ureters in dogs: clinical outcome and prognostic factors for long‐term continence. Vet Surg. 2017;46(5):631‐641.
Holt PE, Moore AH. Canine ureteral ectopia: an analysis of 175 cases and comparison of surgical treatments. Vet Rec. 1995;136(14):345‐349.
Berent AC, Weisse C, Mayhew PD, Todd K, Wright M, Bagley D. Evaluation of cystoscopic‐guided laser ablation of intramural ectopic ureters in female dogs. J Am Vet Med Assoc. 2012;240(6):716‐725.
Hoey CSFK, Friend E, Meakin LB, Chanoit GP. Long‐term outcome of female dogs treated for intramural ectopic ureters with cystoscopic‐guided laser ablation. Vet Surg. 2021;50(7):1449‐1462.
Dekerle B, Maurice E, Decambron A, Viateau V, Maurey C, Manassero M. Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic‐guided laser ablation. Vet Surg. 2022;51(4):568‐575.
Hooi KS, Vachon C, Martel DV, Dunn M. Retrospective evaluation of cystoscopic‐guided laser ablation of intramural ectopic ureters in female dogs. J Vet Intern Med. 2022;36(1):156‐163.
Reichler IM, Eckrich Specker C, Hubler M, Boos A, Haessig M, Arnold S. Ectopic ureters in dogs: clinical features, surgical techniques and outcome. Vet Surg. 2012;41(4):515‐522.
Rogatko CP, Berent AC, Adams LG, Weisse CW, Bagley D. Endoscopic laser‐ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008‐2017). J Vet Intern Med. 2019;33(2):670‐679.
Fox AJ, Sharma A, Secrest SA. Computed tomographic excretory urography features of intramural ectopic ureters in 10 dogs. J Small Anim Pract. 2016;57(4):210‐213.
Samii VF, McLoughlin MA, Mattoon JS, et al. Digital fluoroscopic excretory urography, digital fluoroscopic urethrography, helical computed tomography, and cystoscopy in 24 dogs with suspected ureteral ectopia. J Vet Intern Med. 2004;18(3):271‐281.
Schwarz T, Bommer N, Parys M, et al. Four‐dimensional CT excretory urography is an accurate technique for diagnosis of canine ureteral ectopia. Vet Radiol Ultrasound. 2021;62(2):190‐198.
Taylor O, Knight R, Genain MA, Owen L. Ultrasonography as a sensitive and specific diagnostic modality for the detection of ectopic ureters in urinary incontinent dogs. Vet Radiol Ultrasound. 2022;63(3):328‐336.
Secrest S, Bugbee A, Waller K, JimÈnez DA. Comparison of transverse computed tomographic excretory urography images and maximum intensity projection images for diagnosing ectopic ureters in dogs. Vet Radiol Ultrasound. 2017;58(2):163‐168.
Hajian‐Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med. 2013;4(2):627‐635.
Cannizzo K, McLoughlin M, Mattoon J, Samii V, Chew D, DiBartola S. Evaluation of transurethral cystoscopy and excretory urography for diagnosis of ectopic ureters in female dogs: 25 cases (1992‐2000). J Am Vet Med Assoc. 2003;223:475‐481.
Messer J, Chew D, McLoughlin M. Cystoscopy: techniques and clinical applications. Clin Tech Small Anim Pract. 2005;20(1):52‐64.
Processing Request
No Comments.