Apollo is an amazing 1-year-old male neutered British Shorthair that presented to his regular veterinarian for urinary incontinence (inability to hold his urinations). Poor Apollo was getting quite uncomfortable with his constant dripping of urine and soggy bottom (cats are obsessed with being clean and tidy!). After a course of antibiotics to treat the associated urinary tract infection, Apollo was referred to our team of specialists in central London to get to identify the cause his incontinence. Our internal medicine specialist, Dr. Hannah Darcy, ordered a series of imaging tests to try and visualize his internal urinary anatomy. Diagnostic Imaging Specialist, Dr. Ian Jones, performed an abdominal ultrasound and then a high-tech CT scan to provide the images of his urinary system. He found an exceedingly rare abnormality! A left intramural ectopic ureter. The ureters are the two tubular structures that run from the kidney to the bladder transporting the urine. In Apollo’s case his left ureter terminated about 2 cm beyond the bladder and into his urethra (the tube that carries urine from the bladder, through the penis and to the outside world). With this abnormal anatomy, the bladder sphincter was bypassed causing the constant dripping of urine.
Dr. Janet McClaran, head of Soft Tissue surgery, discussed in detail the delicate surgery that would be required to re-locate the ureter back to its appropriate place inside the urinary bladder. Upon examination an additional abnormality was detected- poor Apollo also had a heart murmur. His condition was investigated by our Cardiology team, and Dr Joao Neves diagnosed hypertrophic cardiomyopathy, one of the most commonly encountered heart diseases in cats. This is characterized by an abnormal thickening (hypertrophy) of one or several areas of the walls of the heart. At this stage only monitoring was required, but this abnormality could make the anaesthesia required for surgery more complicated and riskier. Fortunately, London Vet Specialists has the expertise of Dr. David Neilson, specialist in Anaesthesia to monitor and care for Apollo during his surgery. The pictures below show intra operative images before and after the ureter repair: The image on the left demonstrates two wires marking the entrance of the ureters. The red arrow showing the correctly located right ureter and the green arrow pointing to the left ureter entering the urethra 2 cm below the other when they should be at the same level. The second picture (on the right) we can see after the procedure how both of the ureters are now entering the evenly bladder at the correct level (marked again with the wires).
Apollo required close monitoring during his recovery to make sure he was comfortable and able to urinate. Lucky for Apollo our surgical intern Dr Maite Pardo and our surgical nurse Fran Owen were involved along every step of his recovery making sure he was safe and sound. He recovered in the hospital for a few days of care to manage some mild swelling, but at his final recheck, he was super happy. His urinations were back to normal and he had a totally dry bottom. After a lifetime of dribbling and leaking urine, within 2 weeks of surgery, he was a normal kitty!
Apollo´s condition is quite rare in male cats but thanks to our amazing team at London Vet Specialists he can live his life with his pipes back in working order!