Equine JAVMA | DEC 1, 2018 | VOL 253 | NO. 11 1467 A 3-month-old 157-kg (345-lb) Quarter Horse filly (horse 1) was referred to the Washington State University Veterinary Teaching Hospital because of a 2-month history of urinary incontinence, first noticed when horse 1 was 3 weeks old and lying down in the paddock. Horse 1 had been evaluated and referred by the owner’s veterinarian. On examination at the veterinary teaching hospital, horse 1 was bright, alert, and responsive and had a rectal temperature of 38.5°C (101.3°F; reference range, 37.7° to 38.8°C [100.0° to 102.0°F]), heart rate of 72 beats/min (refer- ence range, 60 to 80 beats/min), and respiratory rate of 24 breaths/min (reference range, 20 to 40 breaths/ min). In addition, urine scalding was evident on the hind limbs and perineal area. Standing sedation of horse 1 was achieved with IV administration of xylazine hydrochloride (1.0 mg/ kg [0.45 mg/lb]) and butorphanol tartrate (0.03 mg/ kg [0.014 mg/lb]). A flexible endoscope a was used to examine the horse’s vagina, urethra, and urinary bladder. The right ureteral ostium was in a normal location, whereas the left ostium was located at the level of the urethral sphincter, and a distended left ureter (approx 1.5 cm in diameter) was evident bulg- ing against the urinary bladder wall as the ureter coursed along the bladder (Figure 1). Abnormal results of hematologic analyses includ- ed leukocytosis (16.9 X 10 3 WBCs/μL; reference range, 5.5 X 10 3 WBCs/μL to 10.5 X 10 3 WBCs/μL) and hyper- A minimally invasive surgical technique for ureteral ostioplasty in two fillies with ureteral ectopia Andrew R. E. Jones BVetMed, MS Claude A. Ragle DVM From the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164. Dr. Jones’ present ad- dress is San Luis Rey Equine Hospital, 4211 Holly Ln, Bonsall, CA 92003. Address correspondence to Dr. Ragle (ragle@wsu. edu). CASE DESCRIPTION 2 fillies, aged 3 months and 1 month, were examined because of urinary incontinence and urine scalding. CLINICAL FINDINGS In horse 1, ultrasonography did not reveal any structural abnormalities of the kidneys; however, unilateral ureteral ectopia was diagnosed cystoscopi- cally. In horse 2, CT revealed bilateral nephropathy, bilateral distended ure- ters (up to 3.6 cm in diameter), and bilateral ureteral ectopia. Cystoscopy revealed intramural ureteral ectopia with abnormally caudally positioned ureteral ostia in both horses. TREATMENT AND OUTCOME Ureteral ostioplasty was performed under cystoscopic guidance. Laparo- scopic scissors (horse 1) or a vessel-sealing device (horse 2) was intro- duced, and the tissue separating the intramural portion of the ureter from the urethra and bladder was cut longitudinally in a cranial direction toward the trigone. After surgery, both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 20 and 9 months for horse 1 and horse 2, respectively. CLINICAL RELEVANCE Cystoscopically guided ureteral ostioplasty provided an effective and mini- mally invasive surgical treatment option for correction of ureteral ectopia in 2 fillies. ( J Am Vet Med Assoc 2018;253:1467–1472) fibrinogenemia (plasma fibrinogen concentration, 600 mg/dL; reference range, < 400 mg/dL). No abnormali- ties were suggested from results of serum biochemical analyses or revealed during ultrasonographic evalua- tion of the umbilicus and thorax. A urine sample for urinalysis and bacterial culture was collected during the cystoscopic examination. Two days later (day 3), hematologic testing was repeated, and the WBC count and fibrinogen con- centration were within reference ranges. In addition, ultrasonographic evaluation of the kidneys was per- formed and revealed no abnormalities. Further, re- sults of the urinalysis were unremarkable, and there was no growth on bacterial culture of the urine. On day 5, ureteral ostioplasty was performed on horse 1. Cefazolin sodium (10 mg/kg [4.5 mg/lb], IV, q 6 h) and flunixin meglumine (1.1 mg/kg [0.5 mg/ lb], PO, q 24 h) were administered 1 hour before surgery and for the following 36 hours. The surgical procedure was performed with horse 1 standing and sedated with an initial dose of xylazine hydrochloride (1.1 mg/kg, IV) that was later followed by an addition- al dose of xylazine hydrochloride (0.5 mg/kg [0.23 mg/lb], IV) and butorphanol tartrate (0.025 mg/kg [0.011 mg/lb], IV). After horse 1 was sedated, its va- gina, urethra, and urinary bladder were insufflated with air via the endoscope while the vulva was held closed by hand to maintain distension. A 2% lidocaine hydrochloride solution was sprayed topically through