Sophie MessineoA 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

Ectopic ureter

Urethral sphincter mechanism incompetence (USMI)

Neurologic dysfunction

Anatomical abnormalities

UTI

Behavioral?

Differentials

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…

SurgeryThe 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-UpThe last client communication entered on 9-6-06 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.