NorthStar VETS Cool Case Parker

The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This is the first in a new series of posts to be shared highlighting cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. Read the story below and watch the doctor tell you the story in their own words via the video at the end. We begin with the story of Parker, a patient of Veterinary Surgeon, Dr. Heather Knapp-Hoch, and how new technology helped this dog in a minimally-invasive way.

About Parker
Parker is a miniature poodle that presented to NorthStar VETS at 18 weeks of age for urinary incontinence. Her owners noted that she had been incontinent since they rescued her. She would constantly dribble urine and had been diagnosed with multiple urinary tract infections. A contrast study was performed by her referring veterinarian which was suspicious for a left ectopic ureter. She presented to the surgery service for evaluation and treatment options.

Ectopic Ureters
Ectopic ureters are a congenital abnormality where the distal aspect of the ureter does not enter the bladder in the normal location of the trigone of the bladder. They most commonly bypass this location and enter the urinary tract system distal to the urethral sphincter which results in urinary incontinence. Surgical correction of the abnormal ureter is recommended to improve urinary incontinence. Traditionally this was accomplished with an open abdominal surgery which involved a cystotomy and the creation of a new ureteral opening in the trigone of the bladder via various surgical techniques. Recently the surgical treatment of this disease has shifted to a minimally invasive procedure which allows for diagnosis and treatment of this disease in the same anesthesia episode with no need for an open abdominal surgery.

About the new procedure
Cystoscopic laser ablation of intramural ectopic ureters is accomplished via a minimally invasive scoping procedure and ablation of the ureteral wall with a cystoscopically-guided laser fiber. Advantages of this technique over an open surgical approach are diminished surgical time, postoperative pain and hospitalization time as well as the diagnosis and treatment of this disease within the same anesthesia episode. The rate of continence post laser ablation or open abdominal surgery is similar with 50-75% of dogs improving or becoming fully continent post-procedure.

How things went for Parker
Parker was the first patient at NorthStar VETS to undergo this new minimally-invasive treatment for ectopic ureters. During the scoping procedure, she was diagnosed with a definitive left ectopic ureter which entered the urinary tract in the urethra. A holmium – yag laser was used to ablate the ureteral wall and take the opening of the ureter to the level of the trigone in the bladder. She stayed in our hospital overnight and went home on antibiotics and nonsteroidal anti-inflammatory medication to help with pain and inflammation. She was discharged from our hospital less than 24 hours after surgery and the best news of all is that she was fully continent when she was discharged.

It has been 3 months since Parker’s procedure and her owners were happy to report she was doing great at home. She is a normal puppy with no evidence of dribbling urine or incontinence. Her long-term prognosis is expected to be excellent with a decreased risk of urinary tract infections in the future.

Learn more about the Surgery service at NorthStar VETS

Heather Knapp-Hoch, DVM, MS, DACVSHeather Knapp-Hoch, DVM, MS, DACVS
Originally from New Jersey, Dr. Knapp-Hoch is excited to return home and join the NorthStar VETS surgical team. Dr. Knapp-Hoch earned her Bachelor of Science in biology from Long Island University in 2001. She then traveled across the US to obtain a Masters degree in genetics and cell and molecular biology from Washington State University where she also obtained her Doctorate of Veterinary Medicine in 2007. Dr. Knapp-Hoch then completed a small animal rotating internship at Cornell University in 2008. Following her internship she completed a three-year surgical residency at Cornell University in 2011. She obtained board certification in 2012 and practiced as a small animal clinical instructor at Cornell University from 2011-2014.

Dr. Knapp-Hoch’s special areas of interest include surgical oncology and minimally invasive surgery including laser ablation of ectopic ureters. She is proficient in advanced wound management and has a special interest in the use of negative pressure wound therapy (NPWT) to treat difficult surgical and traumatic wounds. She is trained in both the tibial plateau leveling osteotomy (TPLO) and the tibial tuberosity advancement (TTA) surgical procedures for cranial cruciate ligament disease.

The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

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