sophie messineo a case study amelie hatfield. sophie messineo’s history golden retriever 9 months...
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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
Ultrasound Findings
Left ureterocele
Possible more caudal location of left ureter
Dilated urethra, possible membrane
Mild renal pelvic dilation bilaterally
Enlarged jejunal lymph nodes
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.
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.