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Kendall A, Byron JK, Westropp JL, Coates JR, Vaden S, Adin C, Oetelaar G, Bartges JW, Foster JD, Adams LG, Olby N, Berent A. ACVIM consensus statement on diagnosis and management of urinary incontinence in dogs. J Vet Intern Med 2024; 38:878-903. [PMID: 38217372 PMCID: PMC10937496 DOI: 10.1111/jvim.16975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 01/15/2024] Open
Abstract
Urinary incontinence (UI) is a disorder of micturition that can occur in dogs of any age, sex, and breed depending on the underlying cause and time of onset. Diagnosis and treatment for various causes of UI in dogs have been described by multiple comprehensive single author review articles, but large prospective clinical trials comparing treatment outcomes in veterinary medicine are lacking. The objectives of this consensus statement therefore are to provide guidelines on both recommended diagnostic testing and treatment for various causes of UI in dogs. Specifically, pathophysiology directly related to the canine urinary system will be reviewed and diagnostic and therapeutic challenges will be addressed. A panel of 12 experts in the field (8 small animal internists [L. Adams, J. Bartges, A. Berent, J. Byron, J. Foster, A. Kendall, S. Vaden, J. Westropp], 2 neurologists [J. Coates, N. Olby], 1 radiologist [G. Oetelaar], and 1 surgeon [C. Adin]) was formed to assess and summarize evidence in the peer-reviewed literature and to complement it with consensus recommendations using the Delphi method. Some statements were not voted on by all panelists. This consensus statement aims to provide guidance for management of both male and female dogs with underlying storage or voiding disorders resulting in UI.
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Affiliation(s)
- Allison Kendall
- Department of Veterinary Clinical SciencesNC State University College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Julie K. Byron
- Department of Veterinary Clinical SciencesThe Ohio State University College of Veterinary MedicineColumbusOhioUSA
| | - Jodi L. Westropp
- Department of Veterinary Medicine and EpidemiologyUniversity of CADavisCaliforniaUSA
| | - Joan R. Coates
- Department of Veterinary Medicine and SurgeryUniversity of Missouri College of Veterinary MedicineColumbiaMissouriUSA
| | - Shelly Vaden
- Department of Veterinary Clinical SciencesNC State University College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Chris Adin
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, University of FloridaGainesvilleFloridaUSA
| | - Garrett Oetelaar
- VCA Canada Calgary Animal Referral and Emergency (CARE) CentreCalgaryAlbertaCanada
| | - Joe W. Bartges
- College of Veterinary MedicineUniversity of GeorgiaAthensGeorgiaUSA
| | | | - Larry G. Adams
- Department of Veterinary Clinical SciencesPurdue University College of Veterinary MedicineWest LafayetteIndianaUSA
| | - Natasha Olby
- Department of Veterinary Clinical SciencesNC State University College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Allyson Berent
- Service of Interventional Radiology and Interventional EndoscopyAnimal Medical CenterNew York CityNew YorkUSA
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Kopecny L, Palm CA, Culp WTN. Diagnosis, management, and outcome of urethral obstruction secondary to the capsule associated with the artificial urethral sphincter device. J Vet Intern Med 2022; 36:1016-1023. [PMID: 35393653 PMCID: PMC9151471 DOI: 10.1111/jvim.16399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Urethral obstruction secondary to artificial urethral sphincter (AUS) implantation is a recognized complication in dogs. However, urethral obstruction secondary to AUS‐associated capsule formation has been described rarely. Hypothesis Describe clinical and diagnostic findings, management, and outcome in 6 dogs with urethral obstruction secondary to AUS‐associated capsule formation. Animals Six client‐owned dogs. Methods Retrospective study. Medical records between January 1, 2010, and June 30, 2021, were reviewed to identify dogs with urethral obstruction associated with the AUS device. Results The AUS device was implanted a median of 884 days (range, 20‐2457 days) before presentation for urethral obstruction. Median age at time of urethral obstruction was 4.7 years (range, 3.1‐8.7 years). Clinical signs at the time of urethral obstruction were stranguria (n = 4), pollakiuria (3), weak urine stream (2), and worsened urinary incontinence (1). In all dogs, the urethra was noted to be stenotic during urethroscopy and positive contrast cystourethrography. All dogs underwent surgery, and a fibrous capsule associated with the AUS was found to be causing urethral stenosis. Resolution of urethral obstruction occurred in all dogs after transection or removal of the capsule. Positive bacterial cultures were obtained from the capsule, AUS, or both in all dogs. Recurrence of urethral obstruction had not occurred in any dog at the time of follow‐up. Conclusions and Clinical Importance Urethral obstruction secondary to capsule formation is an uncommon but clinically important complication associated with use of the AUS. Continued investigation is needed to evaluate this complication more thoroughly, and its possible association with infection.
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Affiliation(s)
- Lucy Kopecny
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Carrie A Palm
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - William T N Culp
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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Jacobson E, Meler EN, Delisser PJ, Thompson AL. Cystoscopic-guided scissor transection of intramural ectopic ureters as a novel alternate minimally invasive treatment option to laser ablation in female dogs: 8 cases (2011-2020). J Am Vet Med Assoc 2022; 260:S12-S20. [PMID: 35290202 DOI: 10.2460/javma.21.03.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of cystoscopic-guided scissor transection of ectopic ureters (CST-EU) in female dogs. ANIMALS 8 incontinent female dogs with intramural ectopic ureters. PROCEDURES For this retrospective case series, data were collected from medical records of dogs that underwent CST-EU to relocate the ectopic ureteral orifice to an anatomically normal trigonal location between June 2011 and December 2020. Outcome after hospital discharge was determined using owner telephone questionnaires. RESULTS Ectopic ureters were bilateral in 4 of the 8 dogs, and all dogs had other urogenital tract anomalies. Owner questionnaire follow-up was available for 7 dogs, and results indicated 6 dogs had improved urinary continence immediately following the procedure. At the last follow-up (44 to 3,384 days after CST-EU), 3 of the 7 dogs were completely continent with CST-EU alone, 3 others became continent or were markedly improved with the addition of medications for urethral sphincter mechanism incompetence, and 1 required ureteroneocystostomy, colposuspension, and an artificial urethral sphincter to become fully continent. Owners of 5 of the 7 dogs reported that they considered the outcome of CST-EU as good to excellent, and all owners reported that they would consider having CST-EU performed again should they have another incontinent dog. Complications were minor, and only 3 dogs showed transient lower urinary tract signs after CST-EU. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated CST-EU could provide a safe, effective, minimally invasive alternative in the absence of laser technology for the treatment of intramural ectopic ureters in female dogs.
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Affiliation(s)
- Else Jacobson
- Internal Medicine Department, Veterinary Specialist Services, Underwood, QLD, Australia
| | - Erika N Meler
- Small Animal Medicine Department, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Peter J Delisser
- Surgery Department, Veterinary Specialist Services, Underwood, QLD, Australia
| | - Ann L Thompson
- Internal Medicine Department, Veterinary Specialist Services, Underwood, QLD, Australia
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Bohlen M, Nickel R. Artificial urethral sphincter in male dogs with urethral sphincter mechanism incompetence: 19 cases (2010-2017). J Small Anim Pract 2022; 63:397-402. [PMID: 35015298 DOI: 10.1111/jsap.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the outcome and safety of surgically placed artificial urethral sphincters in male dogs with urethral sphincter mechanism incompetence. MATERIALS AND METHODS We included dogs with urethral sphincter mechanism incompetence treated by placing an artificial urethral sphincter from January 1, 2010 to December 31, 2017. The continence score (scale 1 to 5, with 5 indicating complete continence) was evaluated before and after implantation. Follow-up information was obtained from the institution's medical records (short-term up to 12 months) and questionnaires were completed by telephone (long-term ≥12 months) for evaluation. RESULTS Nineteen Medical therapy was unsuccessful in 18 dogs and unknown in one dog before the artificial urethral sphincter placement. Short-term continence improved in 16 of the 19 (84%) dogs. Four patients were lost to follow-up. Nine of 15 (60%) dogs showed long-term continence improvement, eight of 15 (53%) remained completely continent. The median follow-up was 1785 (range 2 to 3234) days. The complication rate was 56% (9/16). Minor complications, including haematoma, stranguria/temporary dyssynergia and mild inflammation at the port, were reported in four of 16 (25%) dogs. Five of 16 (31%) experienced major complications, including stranguria/mechanical urethral obstruction, persistent dyssynergia, fistula at the port and port rotation. CLINICAL SIGNIFICANCE Artificial urethral sphincter placement is a valid option for treating incontinent male dogs that show an insufficient response or become refractory to medical or other prior surgical management. A high-complication rate is associated with this procedure.
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Affiliation(s)
- M Bohlen
- Evidensia Small Animal Hospital Norderstedt, Kabels Stieg 41, Norderstedt, Germany
| | - R Nickel
- Evidensia Small Animal Hospital Norderstedt, Kabels Stieg 41, Norderstedt, Germany
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Eayrs MK, Moores AL. Management of incontinence following pre-pubic urethrostomy in a cat using an artificial urethral sphincter. J Small Anim Pract 2020; 62:604-607. [PMID: 33022766 DOI: 10.1111/jsap.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
A 14-year-old male neutered domestic shorthair cat presented with a 4-year history of urinary incontinence following prepubic urethrostomy. Physical examination confirmed peristomal dermatitis, urine scalding and constant urine leakage. Haematology, serum biochemistry and urinalysis were unremarkable. Ultrasonography revealed a non-distended urinary bladder. An artificial urethral sphincter mechanism, with subsequent incremental inflation of the cuff 6 weeks later, resulted in complete resolution of clinical signs, return to normal urinary function and excellent quality of life. The cat was still continent at 5-year follow-up. Further studies including additional cases are required to highlight effectiveness and harms of the procedure.
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Affiliation(s)
- M K Eayrs
- Anderson Moores Veterinary Specialists, Poles Lane, Winchester, Hampshire, SO21 2LL, UK
| | - A L Moores
- Anderson Moores Veterinary Specialists, Poles Lane, Winchester, Hampshire, SO21 2LL, UK
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Milodowski EJ, Friend EJ, Granger N, Doran ICP. Canine urethral sphincter pressure profile under incremental inflation of an artificial cuff: a cadaver study. J Small Anim Pract 2018; 60:313-318. [PMID: 30430575 DOI: 10.1111/jsap.12961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 09/07/2018] [Accepted: 09/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether artificial urethral sphincter filling volume is proportional to peak pressure exerted on the urethra. MATERIALS AND METHODS Urethral pressure profilometry was performed in five female, medium-sized, mixed-breed canine cadavers following artificial urethral sphincter placement. Maximum urethral pressure was recorded following sequential incremental inflation of 0.15 mL and compared to baseline pressure and between dogs using two-way analysis of variance. RESULTS Artificial urethral sphincter placement in cadavers was associated with an increase in urethral pressure, which was significantly correlated with inflation volume. The correlation was non-linear and demonstrated considerable individual variation. Maximum urethral pressures after artificial urethral sphincter placement exceeded those reported in conscious continent dogs within a narrow volume range, in which a 0.15 mL infusion more than doubled maximal urethral pressures. CLINICAL SIGNIFICANCE Rapid increases in urethral pressure from the artificial urethral sphincter over a small range of filling volumes (0.15 mL increments) might explain why some clinical cases can become suddenly dysuric following incremental inflations. We suggest that smaller increments of filling (0.05 to 0.1 mL) may achieve finer pressure control.
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Affiliation(s)
- E J Milodowski
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, BS8 1TD, UK
| | - E J Friend
- Bristol Veterinary Specialists at Highcroft, Bristol, BS14 9BE, UK.,Vale Referrals, The Animal Hospital, Gloucestershire, GL11 6AJ, UK
| | - N Granger
- Bristol Veterinary Specialists at Highcroft, Bristol, BS14 9BE, UK.,The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - I C P Doran
- Bristol Veterinary Specialists at Highcroft, Bristol, BS14 9BE, UK
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Owen LJ. Ureteral ectopia and urethral sphincter mechanism incompetence: an update on diagnosis and management options. J Small Anim Pract 2018; 60:3-17. [DOI: 10.1111/jsap.12950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 03/18/2018] [Accepted: 09/20/2018] [Indexed: 02/02/2023]
Affiliation(s)
- L. J. Owen
- Department of Veterinary Medicine; University of Cambridge; Cambridge CB3 0ES UK
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Gomes C, Doran I, Friend E, Tivers M, Chanoit G. Long-Term Outcome of Female Dogs Treated with Static Hydraulic Urethral Sphincter for Urethral Sphincter Mechanism Incompetence. J Am Anim Hosp Assoc 2018; 54:276-284. [DOI: 10.5326/jaaha-ms-6709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
The purpose of the study was to report the postoperative outcome, complications, and long-term follow-up of the use of a static hydraulic urethral sphincter for the management of urethral sphincter mechanism incompetence in female dogs. Medical records were reviewed to extract information on long-term (>365 days) outcome data. Telephone owner questionnaire was performed to assess postoperative urinary continence scores (scale 1–10, where 10 is complete continence) and the presence and frequency of complications. Twenty female dogs were included. Mean (±standard deviation) time to follow-up was 1,205.1 (±627.4) days. Median continence score/10 (range) was 3.5 (2–6) preoperatively, and 9.0 (7–10) at the last follow-up. Median continence score was significantly higher at all time points postoperatively compared with before surgery (P < .001). Complete continence was achieved in 90% of bitches. Minor complications occurred in 13 bitches and included dysuria (8), bacterial cystitis (8), longer urination time (10), incisional seroma (5), urinary retention (3), hematuria (2), and pain when urinating (2). Major complications occurred in one dog (static hydraulic urethral sphincter removed 28 mo after placement). Continence scores were sustainably improved in the long-term. Complications were mostly minor. Urinary tract infections were the most common but resolved with conventional antibiotic treatment.
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Affiliation(s)
- Cesar Gomes
- From the School of Veterinary Sciences, University of Bristol, Langford, Bristol, United Kingdom
| | - Ivan Doran
- From the School of Veterinary Sciences, University of Bristol, Langford, Bristol, United Kingdom
| | - Edward Friend
- From the School of Veterinary Sciences, University of Bristol, Langford, Bristol, United Kingdom
| | - Mickey Tivers
- From the School of Veterinary Sciences, University of Bristol, Langford, Bristol, United Kingdom
| | - Guillaume Chanoit
- From the School of Veterinary Sciences, University of Bristol, Langford, Bristol, United Kingdom
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Morgan K, Milner HR, Tikekar A, Smith HL, Coomer AR. Long term use of hydraulic artificial urethral sphincters in nine dogs from New Zealand with urethral sphincter mechanism incompetence. N Z Vet J 2018; 66:205-209. [PMID: 29669479 DOI: 10.1080/00480169.2018.1464975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS To report on the long-term outcomes of hydraulic artificial urethral sphincter (HAUS) placement for the correction of urethral sphincter mechanism incompetence (USMI) in New Zealand dogs. METHODS Retrospective data were obtained from cases of dogs which had a HAUS placed after failed medical and/or surgical management of USMI between August 2012 and November 2016. Owner assessment of urinary incontinence was evaluated by an online survey in May 2017 using a visual analogue scale (0 being normal, 100 being severely affected) for the frequency, volume and severity of any straining to urinate, immediately prior to the placement of the HAUS and at the time of the survey. The number of days between surgery and the completion of survey were recorded. RESULTS Seven females and two male dogs, which were all desexed except for one female, were eligible for inclusion in the study. The period of follow-up following HAUS placement ranged from 206-1,685 days. Following HAUS placement, frequency and volume of urinary incontinence decreased for six dogs and were practically unchanged for three dogs. The median frequency score decreased from 70 to 13 and the volume score decreased from 73 to 12. There was no consistent change in the perceived degree of straining to urinate. Complications occurred in three dogs; one required repositioning of a dislodged injection port, one required management for haematuria and a hypoplastic bladder, and one required surgical removal of fibrous tissue around the HAUS cuff. CONCLUSIONS AND CLINICAL RELEVENCE HAUS placement was an effective method for the treatment of persistent USMI in most dogs and provided good clinical results based on owner assessment. The technique was associated with few complications and allowed successful long-term control of urinary incontinence without the need for medical management.
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Affiliation(s)
- Krs Morgan
- a Veterinary Specialist Group , 97 Carrington Road, Mt Albert, Auckland 1025 , New Zealand
| | - H R Milner
- b Veterinary Surgical Specialties (Vetspecs) , 90 Disraeli St, Addington, Christchurch 8024 , New Zealand.,d Current address: Milner Consulting , PO Box 36595, Merivale 8146 , Christchurch
| | - A Tikekar
- b Veterinary Surgical Specialties (Vetspecs) , 90 Disraeli St, Addington, Christchurch 8024 , New Zealand
| | - H L Smith
- c 10 Reading Street, Greytown 5712 , New Zealand
| | - A R Coomer
- a Veterinary Specialist Group , 97 Carrington Road, Mt Albert, Auckland 1025 , New Zealand
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Applegate R, Olin S, Sabatino B. Urethral Sphincter Mechanism Incompetence in Dogs: An Update. J Am Anim Hosp Assoc 2018; 54:22-29. [DOI: 10.5326/jaaha-ms-6524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Urethral sphincter mechanism incompetence (USMI) is the most common cause of acquired urinary incontinence in dogs. The pathogenesis of USMI is multifactorial and complex. Studies have shown variable results regarding the effects and timing of sterilization on the incidence of USMI. Diagnosis of USMI is often based on history, physical examination, and elimination of other differentials. Treatment options for USMI include medications, such as α-adrenergic agents and estrogen products, minimally-invasive urethral bulking procedures, surgical procedures (e.g., indwelling urethral occluders), or combination therapy. The overall prognosis for USMI is typically fair to good with long-term therapy.
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Affiliation(s)
- Rory Applegate
- From the University of Tennessee, Knoxville, Tennessee (R.A., S.O.); and Affiliated Veterinary Specialists, Gainesville, Florida (B.S.)
| | - Shelly Olin
- From the University of Tennessee, Knoxville, Tennessee (R.A., S.O.); and Affiliated Veterinary Specialists, Gainesville, Florida (B.S.)
| | - Bethany Sabatino
- From the University of Tennessee, Knoxville, Tennessee (R.A., S.O.); and Affiliated Veterinary Specialists, Gainesville, Florida (B.S.)
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Owen L. Urinary incontinence in dogs. Vet Rec 2016; 179:260. [DOI: 10.1136/vr.i4832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Laura Owen
- University of Cambridge; Madingley Road Cambridge CB3 0ES
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Luckring EJ, Ham K, Adin CA, McLoughlin MA, Stull JW. Laparoscopic placement and urodynamic effects of an artificial urethral sphincter in cadaveric dogs. Vet Surg 2016; 45:O20-O27. [DOI: 10.1111/vsu.12496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/16/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Emilee J. Luckring
- Department of Clinical Sciences, College of Veterinary Medicine; North Carolina State University; Raleigh North Carolina
| | - Kathleen Ham
- Department of Clinical Sciences; College of Veterinary Medicine, The Ohio State University; Columbus Ohio
| | - Christopher A. Adin
- Department of Clinical Sciences, College of Veterinary Medicine; North Carolina State University; Raleigh North Carolina
| | - Mary A. McLoughlin
- Department of Clinical Sciences; College of Veterinary Medicine, The Ohio State University; Columbus Ohio
| | - Jason W. Stull
- Department of Preventative Medicine, College of Veterinary Medicine; The Ohio State University; Columbus Ohio
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Reichler IM, Hubler M. Urinary incontinence in the bitch: an update. Reprod Domest Anim 2015; 49 Suppl 2:75-80. [PMID: 24947864 DOI: 10.1111/rda.12298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urinary incontinence (UI), defined as the involuntary loss of urine during the filling phase of the bladder (Abrams et al. 2002), is a commonly seen problem in veterinary practice. Urinary sphincter mechanism incompetence (USMI) after spaying is the most common micturition disorder, and its medical treatment is normally successful, even though the underlying pathophysiological mechanism is not fully understood. Hormonal changes inducing structural and functional alterations in the bladder, as well as in the urethra composition, are discussed. To manage incontinent patients successfully, possible underlying abnormalities besides USMI should be ruled out. In the majority of cases, history, physical examination and simple tests including urinalysis and urine bacterial culture lead to a presumed aetiology. If USMI is the most likely cause, then the advantage of further diagnostic tests should be discussed with the owner before starting a trial therapy with alpha-adrenergic drugs. Potential side effects of this therapy have to be mentioned even though they rarely occur. It is important to thoroughly evaluate the success of the initial treatment. Its failure should lead to further diagnostic testing. Specialized clinical assessments may provide an aetiological diagnosis, and this could serve as a basis for discussing further treatment options. Surgical procedures, which may in rare cases cause irreversible side effects, may be instituted. If incontinence reoccurs after initial treatment was successfully performed, the diagnostic work-up including urinalysis should always be repeated. As results of urinalysis did not correlate well with results of bacterial culture, a urine culture is recommended (Comer and Ling 1981). Cystocentesis is the preferred method of urine collection (Bartges 2004). Equivocal results of quantitative cultures of urine samples obtained during midstream voiding or by catheterization require repeat collection by cystocentesis (Comer and Ling 1981).
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Affiliation(s)
- I M Reichler
- Small Animal Reproduction, Clinic for Reproductive Medicine, Vetsuisse-Faculty, University of Zurich, Zurich, Switzerland
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Roundell CDG, Friend EJ. Resolution of incontinence using an artificial urethral sphincter in feline genitourinary dysplasia. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2015-000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Martinoli S, Nelissen P, White RAS. The outcome of combined urethropexy and colposuspension for management of bitches with urinary incontinence associated with urethral sphincter mechanism incompetence. Vet Surg 2013; 43:52-7. [PMID: 24256340 DOI: 10.1111/j.1532-950x.2013.12084.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 09/01/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To report 1) a combined technique of urethropexy and colposuspension; 2) intra- and postoperative complications; and 3) medium term outcome. STUDY DESIGN Retrospective case series. ANIMALS Female dogs (n = 30) with urinary incontinence associated with urethral sphincter mechanism incompetence (USMI) unresponsive to medical management. METHODS Through a ventral median celiotomy, the bladder was positioned abdominally to permit the urethra to be anchored with single interrupted polypropylene sutures to the prepubic tendon and linea alba. The vagina was freed from the vesicovaginal and rectovaginal attachments and advanced cranially by traction before attachment to the prepubic tendon with polypropylene mattress sutures. Bitches were re-examined 2 weeks postoperatively; medium term outcome (>6 months) was evaluated by telephone interview of owners. RESULTS At a median follow up of 39.5 months, 21 bitches (70%) were considered to have an "excellent" medium term outcome with complete resolution of their urinary signs; 8 (26.6%) had a "good" outcome, and 3 (10%) had mild transient dysuria postoperatively. CONCLUSION Combined urethropexy and colposuspension resulted in complete resolution of urinary incontinence in 70% of bitches with USMI and was not associated with major complications.
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Tong K, Nelson LL, Hauptman J, Nelson NC. Evaluation of percutaneously adjustable hydraulic urethral sphincters with and without induced mechanical failure. Vet Surg 2013; 42:774-82. [PMID: 24033796 DOI: 10.1111/j.1532-950x.2013.12052.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 07/05/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe (1) the radiographic appearance of intact hydraulic urethral sphincters (HUS) and (2) the success of leak detection using clinically feasible methods. STUDY DESIGN Prospective, blinded in vitro study. SAMPLE POPULATION Thirty HUS devices (10 each of 8, 10, and 12 mm diameter sizes). MATERIALS AND METHODS All devices were inflated with saline (0.9% NaCl) solution to complete occlusion, inspected, and weighed over a 24-hour period for manufacturing defects. HUS phantoms were created to mimic surrounding soft tissues. One randomly selected HUS of each size was evaluated radiographically at different inflation volumes and angles. All HUS systems were then evaluated in random order before and after puncture with volumetry, manometry, radiography, and contrast fluoroscopy. Volumetry was the total volume (mL) retrieved from each HUS system. Manometry was the pressure (cm H2 O) within each HUS system. The HUS devices were filled to a known volume before each measurement. RESULTS When all HUS sizes were considered, volumetry did not reveal significant differences before and after puncture, but manometry was significantly different (P < .001). Radiography was 63.8% sensitive and 88.3% specific for puncture diagnosis, with inter-observer agreement of 0.58. Contrast fluoroscopy was 78.4% sensitive and 100% specific, with inter-observer agreement of 0.97. CONCLUSIONS Of those methods tested, contrast fluoroscopy was the most sensitive, specific, and consistent method of leak detection. Manometry was also helpful, but may be difficult to use clinically. Volumetry and radiography were relatively poor indicators of leakage in this model.
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Affiliation(s)
- Kim Tong
- Department of Small Animal Clinical Sciences, Veterinary Medical Center, Michigan State University College of Veterinary Medicine, East Lansing, MI
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