Transcript The story of a dog called “So-pee-a”

Sophie Messineo
A case study
Amelie Hatfield
Sophie Messineo’s History
Golden Retriever
9 months old at presentation
Spayed at 7 months
Owners thought they were having
problems housebreaking her
Sophie often voids large amounts of
urine when she sleeps
Everything else is normal
On Feb 9th, at 12 weeks of age,
Sophie went to the vet for a complaint
of “no bladder control.”
A U/A revealed: USG 1.018 and 4+
bacteria
Record does not indicate whether
antibiotics were prescribed, but I believe
they were, according to info gained from
the owners.
On February 17, a recheck urinalysis
was performed:
pH 8.5
USG 1.023
No bacteria
But Sophie was still periodically leaking
urine during sleep.
Owners began taking the water up at 7pm.
Two weeks later
Sophie had a 104F temperature
On 4/6, a urine culture revealed
Methicillin-resistant staph
Sophie still voided urine in her sleep
There is no record of what antibiotics
were given for the MRS, but I believe
it was treated.
Sophie was spayed on June 6th, and had another U/A and
culture performed at that time (no growth)
Sophie took a four day course of DES but she was still
incontinent
After that, Sophie began taking phenylpropanolamine twice a
day, which corrected her incontinence…
But the owners thought she was too hyperactive, so they
reduced her to one capsule in the mornings
She received 1000mg Vitamin C BID to acidify her urine
She still had occasional incontinence, which is why she
came to the VTH
Diagnostics at VTH
CBC: Everything WNL
Chem: Na 145 (L), K 3.4 (L), all else
WNL
U/A: pH 8, USG 1.025, all else WNL
Culture: No growth
Differentials
Ectopic ureter
Urethral sphincter mechanism
incompetence (USMI)
Neurologic dysfunction
Anatomical abnormalities
UTI
Behavioral?
We performed an
abdominal ultrasound
and this is what we found…
Urinary Bladder (left side)
Left Kidney
LASIX STUDY
Ultrasound Findings
Left ureterocele
Possible more caudal location of left
ureter
Dilated urethra, possible membrane
Mild renal pelvic dilation bilaterally
Enlarged jejunal lymph nodes
This is what was found on
cystoscopy…
Paramesonephric
Septal Remnant
Additional Diagnostics
An CT was performed:
Intramural left ureter with a dilation
consistent with ureteroceole.
The intramural ureter is narrowed and
appears to exit caudal to the level of the
right ureteral papilla but still cranial to
the trigone.
Sophie’s
paramesonephric septal
remnant was broken
down using a harmonic
scalpel…
Surgery
The left ureteroceole was debrided.
The left ureter entered the bladder
much more ventrally and laterally than
is normal. The ureter followed an
intramural path and opened caudally,
near the neck of the bladder.
The ureter was resected and
anastamosed to a more promixal
location in the bladder.
Follow-Up
The last client
communication entered on 96-06 indicates Sophie is
doing well. She has had one
“accident” in her sleep.
She has discontinued the
PPA.
If Sophie continues to have
noctiuria, options are DES +
PPA and collagen injections
in her urethral sphincter.