Hi again Pat,
So, there are a number of possibilities for what may be going on with this pup.
Let me explain a bit more about infection, incontinence and about ectopic ureters and then explain how we differentiate between them.
1. Infection -
A urinary tract infection is quite a common thing in a puppy.
They are more prone to infections of all sorts because their immune systems are immature.
She should have a urine sample taken directly from the bladder with a small needle by her veterinarian to check for infection. This is the place I would start with a puppy.
Most infections clear up very quickly with a course of antibiotics.
Unless a sample of urine is sent to a lab for a culture and sensitivity test, then antibiotic choices are simply a guess. MOST dogs get better if they are treated with Clavamox (which is very safe in pups). However, it is possible that she has something that is resistant to whatever antibiotic she is on.
When we get a urine sample, we usually check it in the clinic for bacteria. AND THEN we send it out. Although we may not see any under a microscope there can still be bacteria present but just at a low level. So, perhaps she does have a simple UTI but it is just at a low level and that is why no bacteria were seen.
A culture and sensitivity would answer this question! (Obtaining the sample and sending out for culture and sensitivity would cost about $120 where I work).
2. Urinary incontinence
With this, dogs urinate in their sleep or when lying down. It is something we see fairly commonly - but generally in middle aged to older, spayed female dogs. In those animals, it can be because the sphincter to the bladder is not strong enough. There are a number of medications that can help to improve the tone of the sphincter.
3. Ectopic ureters
Unfortunately, in a dog this age with urinary incontinence, we do have to wonder if there could be congenital defects such as a ureter in the wrong place.
I'll include links:
And more about the congenital (born with it) problem where the ureter is not in the right place (which may be fixable with surgery):
So, your dog may have a urinary tract infection, or she may have urinary incontinence, or a combination of the two. If she has urinary incontinence, it may be due to a weak sphincter muscle or it may be due to ectopic ureters.
Now, if this pup were my patient, I would start with a urine culture. If that was negative, I would refer her to a specialist for further testing. When ectopic ureters are suspected, the test options are:
With this, an endoscope it passed up into the bladder. A camera is used to look for the TWO entrances into the bladder from the 2 ureters. If only one is seen, then we can diagnose ectopic ureters.
IVP double contrast urethrocystogram, but to do this test, the pup needs to be 14 - 16 weeks of age at least. With this, x-rays are taken of the bladder area. A dye is injected into the bladder by passing a catheter up the urethra and into the bladder. The bladder is FILLED with dye and more x-rays taken. The dye shows up on x-rays and we look to see 2 ureters filled with dye. This is not quite such a good test, but a good option if you don't have access to cystoscopy.
Given your location, UCDAvis would be a great choice to have further testing done. It has been a while since I sent a pup for these tests, so it's hard for me to remember how much it would cost. I'd guess about $1500 for either one.
Now, in terms of treatment....I will quote here from a specialist who deals with ectopic ureters. Her name isXXXXX and she is an Internal Medicine veterinary specialist at MJR-Veterinary Hosptial of the University of Pennsylvania. Here is what she says:
Either surgery or laser ablation is the suggest treatment of choice. We prefer laser ablation since it is a lot less invasive (done via cystoscopy), and the continence rate is a little better than surgery, it seems, but hard to say with only 30-40 dogs done so far to be about 65% without meds, 75% with meds and about 85-90% if we place a hydraulic occluder on when all else fails (new device placed surgically).
Laser is great and quick. There are only a few places doing it though.
I hope that this has been helpful?
If it has, please "accept" my answer and leave feedback. I will still be here to provide more information if you need it!
The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.
Best wishes to you and to this puppy!