Medical mystery: Why did the dog ruin the couch?

Adrienne Ruggieri's puppy was peeing uncontrollably. Outdoors, indoors, day and night.

"When they're puppies, it's hard to tell if it's a problem because they're always going to the bathroom," she said. At six months, the Norwegian elkhound had it under control, but that only meant she would bark to go out several times a night.

Ruggieri and her husband took Kayley to the veterinarian near their home in Delran.Antibiotics prescribed for a culture found to be a urinary tract infection seemed to do the trick. But the faucet was back on within weeks.

For two years, Kayley's bladder seemed to be on autopilot: incontenence-culture-antibiotics-repeat. During these episodes, four or five times a year, the otherwise spry, gregarious dog would become lethargic and dribble urine as she walked. Eventually, the Ruggieris had to toss their beloved tan microfiber couch.

Kayley's vet suspected that Kayley's chronic infections were caused by a recessed vulva, a common birth defect in dogs that can cause urine to pool around the genitals. Her double coat,extending down to her inner thighs, also provided an ideal environment for bacteria.

But she began having seizures shortly after turning three. The phenobarbital prescribed to control them increased drinking and urination.

The vet referred Kayley to the University of Pennsylvania's Matthew J. Ryan Veterinary Hospital for a procedure that would remove the excess skin folds in the vulva, hopefully ending the rounds of urinary tract infections.

Penn surgeon Dana Clarke did an ultrasound first. It showed that Kayley's ureters - two slender tubes that carry urine from the kidneys to the bladder - were distended with fluid, and her left kidney was bloated.

Why would that be? Clarke scoped the urinary tract to get a closer view.

Peering through the scope, the surgeon could see that Kayley's problems went beyond a misformed vulva.

Rather than emptying into the bladder, Kayley's ureters passed through the balloon-like organ and terminated in the urethra, the passage to the outside. The condition is known as ectopic ureter. Without the bladder's pressure and muscle control, urine trickled out.

Kayley's frequent infections, likely the result of urine buildup in several spots, intensified the incontinence. Plus, the opening at the end of the left ureter was minuscule. Urine was backed all the way up into the kidney.

"We knew if we didn't do something fast, we were going to get resistant bugs and risk kidney failure," Penn surgeon Dana Clarke said.

Still looking through the scope, Clarke used a laser to destroy the portion of each ureter that extended beyond the bladder, so both now emptied where they should.

The leakage stopped immediately.

Ectopic ureter - urine flow bypassing the bladder, sometimes going directly to the vagina - is a congenital defect. The condition occurs in about one in 50 dogs, and is diagnosed eight times more often in females than in males. Most commonly affected are Labrador and golden retrievers, West Highland white and fox terriers, English bulldogs and Newfoundlands.

Ectopic ureter also is found, though rarely, in cats and horses (and cattle, sheep, and pigs). About one in 500 human babies is born with it, too.

In dogs, it often is initially mistaken for chronic urinary tract infections.

Kayley, now 41/2 years old, is off antibiotics and has complete control of her urine: She can hold it for up to eight hours, though the Ruggieris try to get her outside for a walk every four.

Joan Capuzzi is a small-animal veterinarian at Dutton Road Veterinary Clinic in Philadelphia. jpcapuzzi@outlook.com

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