ISSN 2398-2977      

Ureter: rupture

pequis

Synonym(s): Ureter tears/defects


Introduction

  • Cause: uncommon presentation of uroabdomen due to a tear or defect in the ureter(s) usually proximally. Unknown cause but possibly congenital, occurring predominantly in foals.
  • Signs: neonatal or young foal which is depressed, off suck, progressively enlarging abdomen, diarrhea and signs of neuromuscular irritability.
  • Diagnosis: history, clinical signs, abdominal paracentesis, abdominal ultrasonography, contrast radiography, exploratory celiotomy.
  • Treatment: euthanasia or surgical repair after stabilization of patient.
  • Prognosis: good with successful surgical repair.

Pathogenesis

Etiology

  • Failure of normal organogenesis of the ureters can lead to ureteral defects of which the most common is ureteral ectopia. Other congenital defects include ureteral tears or rupture, as well as ureteral atresia, and ureteropelvic junctional injuries (UPJs).
  • Ureteropelvic junctional avulsion injuries occur after blunt trauma or accidental injury in humans, and in at least on case in a foal.
  • Uni- and bilateral ureteral defects have been described in at least 10 foals in the literature. Although they may be developmental in origin their actual cause is unknown. Some cases may have a blunt traumatic etiology, including complications of birth.
  • A single case has been described in an adult primiparous mare after a dystocia. The mare presented with uroperitoneum clinically and classical uroperitoneum serum biochemical changes. The right ureter was torn just above the trigone of the bladder and was repaired by stenting for 3 weeks; a full recovery was made.
  • A case of a presumed traumatic origin during slipping at exercise has been reported in a 14 year old Thoroughbred racehorse. The horse presented with acute abdominal pain post-exercise, frequent posturing to urinate, crouching and a stiff hindlimb gait. Uroperitoneum due to a tear in the lower part of the ureter was detected. The tear and the retroperitoneal urine was identified by transrectal ultrasonography. The horse made a full recovery with medical treatment.

Predisposing factors

General
  • Genetic predisposing factors not known.

Specific

  • Trauma reported in adult horses.

Pathophysiology

  • Urine leakage from the defect in the ureter can flow into the abdomen leading to uroperitoneum and abdominal distension, or retroperitoneally without evidence of urine in the abdominal space.

Timecourse

  • Unilateral cases may be slow to present with a delay of up to several weeks post-foaling or trauma.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Chaney K P (2007) Congenital anomalies of the equine urinary tractVet Clin North Am Equine Pract 23 (3), 691-696 PubMed.
  • Diaz O S et al (2004) Sonographic diagnosis of a presumed ureteral tear in a horseVet Radiol Ultrasound 45 (1), 73-77 PubMed.
  • Morisset S et al (2002) Surgicalmanagement of a ureteral defect with ureterorrhaphy and of ureteritis with ureteroneocystostomy in a foalJAVMA 220 (3), 354–358 PubMed.
  • Voss E D et al (1999) Use of a temporary indwelling ureteral stent catheter in a mare with a traumatic ureteral tearJAVMA 214 (10), 1523-1526 PubMed.
  • Hardy J (1998) Uroabdomen in foalsEquine Vet Educ 10 (1), 21-25 VetMedResource.
  • Jean D et al (1998) Case report: congenital bilateral distal defect of the ureters in a foalEquine Vet Educ 10 (1), 17–20 VetMedResource.
  • Cutler T J et al (1997) Bilateral ureteral tears in a foalAust Vet J 85 (6), 413–415 PubMed.
  • Divers T J et al (1988) Correction of bilateral ureteral defects in a foalJAVMA 192 (3), 384–386 PubMed.
  • Robertson J T et al (1983) Repair of ureteral defect in a foalJAVMA 183 (7), 799–800 PubMed.

Other sources of information

  • Schott H C II (2004) Disorders of the Urinary System. In: Equine Internal Medicine. Eds: Reed S M, Bayly W M & Sellon D C. 2nd edn. Saunders, USA. pp 1169-1183.

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