1. Sophie Messineo A case study Amelie Hatfield

2. 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

3. On Feb 9 th, 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.

4. 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.

5. 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.

6. Sophie was spayed on June 6 th, 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

7. 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

8. Ectopic ureter Urethral sphincter mechanism incompetence (USMI) Neurologic dysfunction Anatomical abnormalities UTI Behavioral? Differentials

9. We performed an abdominal ultrasound and this is what we found…

10. Urinary Bladder (left side)

11. Left Kidney

12. LASIX STUDY

14. Ultrasound Findings Left ureterocele Possible more caudal location of left ureter Dilated urethra, possible membrane Mild renal pelvic dilation bilaterally Enlarged jejunal lymph nodes

15. This is what was found on cystoscopy…

16. Paramesonephric Septal Remnant

17. 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.

18. Sophie’s paramesonephric septal remnant was broken down using a harmonic scalpel…

19. 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.

20. Follow-Up The 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.