Bilateral ureterocystostomy in a 450-kg horse with ectopic ureters.

A 450-kg yearling Clydesdale filly was determined to have bilateral ectopic ureters. The resulting incontinence caused severe malodorous perineal dermatitis. Bladder capacity was measured at 800 ml. The urethral sphincter lacked tone, and the horse was seen to urinate in a normal manner only 2 or 3 times a week. A midline celiotomy was performed, and the ureters were identified by cannulation from the ectopic openings. The ureters were ligated, and the cut ends were anastomosed to the dorsal bladder surface by an extravesicular end-to-side technique. A partial thickness seromuscular layer of the bladder was sutured over the ureters in a cranial direction from the anastomosis site for 15 mm. This fixed the ureters to the dorsal surface of the bladder and protected the anastomosis site from tension. After surgery, the horse urinated n a normal manner many times a day. Urinary incontinence continued, but gradually improved. Bladder capacity increased over 13 months to 4.3 L. Surgical (urethral extension) and medical (phenylpropanolamine and estrogen) treatments were instigated to increase urethral sphincter tone. Urinary incontinence continued to improve and, at 11 months after surgery, incontinence was negligible, and the perineal dermatitis had healed.