Puddles (not her real name) is a 5-month-old female Rottweiler puppy. She idles at happy, and loves everything and everyone around her.
In addition to her lovely behavioral traits, she is also physically impressive. She is well proportioned and athletic, with beautiful brown eyes, and a classic Rottie head, which still has the rounded features of puppy-hood.
From all external appearances, she seems flawless. But her owners quickly noticed that something was very wrong with her.
They immediately observed that her backside was always wet. Despite being taken outside frequently, she could not seem to control her urine. She would posture to urinate, and a little would come out, but the dripping was incessant.
Her veterinarian could see that she was essentially incontinent. The urine was tested to see if there was an infection, which there was not. Abdominal X-rays indicated that she had only one kidney. The next step was to see where the urine was going after leaving the kidney. To determine this, an intravenous dye was administered, which would would be filtered from the blood by the kidney, and then passed into the urine. This contrast would show up on an X-ray, tracing the path of the urine flow as it left the kidney.
The kidney lit up on X-rays, as the dye concentrated within it. The dye then flowed into the ureter, which is the tube connecting the bladder and the kidney, but it did not follow a normal course. Rather than emptying into the bladder, the dye could be seen immediately in the urethra, and actually flowing out of Pebbles. The diagnosis was confirmed.
The condition is a congenital disorder known as ureteral ectopia (Ectopic ureters). Instead of flowing into the bladder, to be stored, and eliminated later, the urine bypasses the bladder and flows from the dog, essentially, as it is produced. This condition makes it nearly impossible to keep affected dogs as pets. Even if you only kept them outside, the constant wetness and acidity would create ulcerations and infections that would be difficult to manage.
Surgical correction is the primary management tool for this condition, but it requires a skilled surgeon, and can be expensive. Furthermore, even with surgery, up to 50 percent of cases will continue to be incontinent. Given the expense, and the fact that the odds of a good outcome may be no better than a coin toss, many of these dogs are put to sleep before they ever see the inside of a surgical suite.
Although funds were limited, Puddles’ owners were determined to give her a chance. They, and their veterinarian, reached out to us, and after consulting on the case, we agreed with the diagnosis and pledged to help.
Puddles’ case was unusual because she had only one kidney, and her ureter completely bypassed the bladder. Surgical repair required transecting the ureter at its attachment to the urethra, and re-implanting it into the bladder. The surgery went very well, and post surgical X-rays confirmed that the bladder was now filling with urine. Of course, this was only the first step, and statistics tell us that her incontinence may persist in spite of surgery.
Regardless of the medical outcome, I (Henri Bianucci) see this case, and others like it, as a success. As small animal veterinarians, our function is to serve and preserve the human-animal bond. This family understood that the odds of resolving this condition were, possibly, no greater than those of failure.
Though they were of limited means, they reasoned that they could live with a failed effort but never with having denied her the chance. They were determined to put all they could into the effort and, together, we made it happen. As of this writing, it is too early to call the outcome of Puddles’ case, but win, lose or draw, everyone involved can say they did their best, and made the most of the chances available to this little patient.
In medicine and surgery, the rate of positive outcomes is certainly a valid metric to use when evaluating the quality of a practice. However, a large part of what we provide is hope and peace of mind. The hope is always for the best possible result, and peace of mind comes from knowing we have done all that we could to provide an opportunity to achieve it.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org.