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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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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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Current Concepts in Urinary Surgery. Vet Clin North Am Small Anim Pract 2022; 52:387-417. [DOI: 10.1016/j.cvsm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fournet A, Maurey C, Decambron A, Viateau V, Manassero M. Treatment of urinary incontinence in a cat with genitourinary dysplasia using an urethral sphincter occluder. J Small Anim Pract 2020; 62:391-396. [DOI: 10.1111/jsap.13176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 12/07/2018] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A. Fournet
- Université Paris‐Est, Ecole Nationale Vétérinaire d'Alfort (Enva) 94700 Maisons‐Alfort France
| | - C. Maurey
- Université Paris‐Est, Ecole Nationale Vétérinaire d'Alfort (Enva) 94700 Maisons‐Alfort France
| | - A. Decambron
- Université Paris‐Est, Ecole Nationale Vétérinaire d'Alfort (Enva) 94700 Maisons‐Alfort France
| | - V. Viateau
- Université Paris‐Est, Ecole Nationale Vétérinaire d'Alfort (Enva) 94700 Maisons‐Alfort France
| | - M. Manassero
- Université Paris‐Est, Ecole Nationale Vétérinaire d'Alfort (Enva) 94700 Maisons‐Alfort France
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MacLachlan L, Mourtzinos A. Current Update on Management of Male Stress Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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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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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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Currao RL, Berent AC, Weisse C, Fox P. Use of a Percutaneously Controlled Urethral Hydraulic Occluder for Treatment of Refractory Urinary Incontinence in 18 Female Dogs. Vet Surg 2013; 42:440-7. [DOI: 10.1111/j.1532-950x.2012.01040.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rachael L. Currao
- Department of Surgery; Bobst Hospital of The Animal Medical Center; New York; NY
| | - Allyson C. Berent
- Department of Diagnostic Imaging and Interventional Radiology; Bobst Hospital of The Animal Medical Center; New York; NY
| | | | - Philip Fox
- Department of Cardiology; Bobst Hospital of The Animal Medical Center; New York; NY
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Reeves L, Adin C, McLoughlin M, Ham K, Chew D. Outcome after Placement of an Artificial Urethral Sphincter in 27 Dogs. Vet Surg 2012; 42:12-8. [DOI: 10.1111/j.1532-950x.2012.01043.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren Reeves
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus; OH
| | - Christopher Adin
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus; OH
| | - Mary McLoughlin
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus; OH
| | - Kathleen Ham
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus; OH
| | - Dennis Chew
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus; OH
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Delisser PJ, Friend EJ, Chanoit GPA, Parsons KJ. Static hydraulic urethral sphincter for treatment of urethral sphincter mechanism incompetence in 11 dogs. J Small Anim Pract 2012; 53:338-43. [DOI: 10.1111/j.1748-5827.2012.01228.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adin CA. Complications of Ovariohysterectomy and Orchiectomy in Companion Animals. Vet Clin North Am Small Anim Pract 2011; 41:1023-39, viii. [DOI: 10.1016/j.cvsm.2011.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Byron JK, Chew DJ, McLoughlin ML. Retrospective evaluation of urethral bovine cross-linked collagen implantation for treatment of urinary incontinence in female dogs. J Vet Intern Med 2011; 25:980-4. [PMID: 21781163 DOI: 10.1111/j.1939-1676.2011.0759.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transurethral collagen injections are an alternative treatment for canine urinary incontinence. There is controversy regarding the long-term effectiveness of collagen and the impact urethral coaptation and injection site have on outcome. HYPOTHESIS/OBJECTIVES To evaluate outcome and client satisfaction after urethral collagen injections, and correlation between degree of urethral coaptation and collagen placement with outcome. ANIMALS Thirty-six procedures on 31 dogs, 10 with ureteral ectopia. METHODS Retrospective review of records and video evaluation of injection procedures. Follow-up communication with owners was performed between 1 and 56 months after bovine cross-linked collagen implantation to evaluate duration of continence, need for additional medical therapy, and owner satisfaction. Continence score was evaluated before and after the procedure, and after additional medical therapy, if needed. Injection location and degree of urethral coaptation was assessed with respect to duration of continence. RESULTS Dogs had a significant increase in continence score after the procedure. Mean (SD) duration of continence in dogs without addition of medication was 16.4 (15.2) months, and 5.2 (4.3) months in dogs needing additional medical therapy. No significant difference was found with respect to degree of coaptation. Median client satisfaction with the procedure was 100%. CONCLUSIONS AND CLINICAL IMPORTANCE Transurethral collagen implantation may be a viable option for treatment of female dogs with urethral sphincter mechanism incompetence, particularly after medical failure. Duration and degree of improvement are variable. Client satisfaction was excellent despite lack of complete continence in some dogs, and highlights the importance of discussing outcome expectations with owners.
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Affiliation(s)
- J K Byron
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, USA.
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Claeys S, Noël S, Hamaide A. Acquired urinary incontinence in the bitch: update and perspectives from human medicine. Part 3: The urethral component and surgical treatment. Vet J 2010; 186:25-31. [PMID: 19926505 DOI: 10.1016/j.tvjl.2009.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 09/11/2009] [Accepted: 10/02/2009] [Indexed: 10/20/2022]
Abstract
Urethral sphincter mechanism incompetence (USMI) is the most common cause of urinary incontinence in dogs. Surgery may be recommended if the animal does not respond to medical treatment or becomes refractory. In this third part of a three-part review, surgical options for the treatment of USMI are described. Colposuspension is the most frequently described procedure and offers a fair prognosis, with about 50% of the dogs being continent after surgery and most of the reminder being improved or more responsive to medical treatment. Urethropexy offers a similar success rate, but with a higher rate of complications. Endoscopic injection of collagen is an attractive technique due to its minimally invasive nature and low risk of adverse effects. Initial results may however deteriorate with time. Other procedures have been reported, but involve a low number of cases and have resulted in variable success rates. In women, stress urinary incontinence is mainly treated by minimally invasive procedures involving vaginal placement of sub-urethral slings.
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Affiliation(s)
- Stéphanie Claeys
- Department of Companion Animal Clinical Sciences B44, College of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
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ROSE SCOTTA, ADIN CHRISTOPHERA, ELLISON GARYW, SEREDA COLINW, ARCHER LINDAL. Long-Term Efficacy of a Percutaneously Adjustable Hydraulic Urethral Sphincter for Treatment of Urinary Incontinence in Four Dogs. Vet Surg 2009; 38:747-53. [DOI: 10.1111/j.1532-950x.2009.00560.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sereda CW, Adin CA, Batich CD, Archer LL, Goldman CG, Burns CG. Evaluation of manufacturing variability, diffusion of filling solutions, and long-term maintenance of occlusion in silicone hydraulic occluders. Am J Vet Res 2006; 67:1453-8. [PMID: 16881861 DOI: 10.2460/ajvr.67.8.1453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate manufacturing variability, diffusion of filling solutions, and maintenance of occlusion over time in 3 sizes of silicone hydraulic occluders (HOs). SAMPLE POPULATION 2-, 5-, and 20-mm HOs (HO2, HO5, and HO20, respectively). PROCEDURES Manufacturing variability was analyzed by comparing variation in internal luminal areas and filling volumes within each size group. Occluders were filled to 100% occlusion with air (n = 4), saline (0.9% NaCl) solution (4), or sodium hyaluronate (4) and submerged in simulated body fluid. Changes in luminal area and weight were recorded for 133 days to evaluate maintenance of occlusion. RESULTS Considerable variability in uninflated luminal area and fill volumes was observed among the 3 sizes of HOs. Loss of occlusion developed in the first 12 hours in all air-filled HOs. Fluid-filled occluders were reliable in maintenance of occlusion after 133 days (99.99% for HO20, 99.59% for HO5, and 90.40% for HO2), although diffusion of saline solution and hyaluronate from all HOs was confirmed by detection of significant decreases in weight over time. There was no significant difference in weight loss between HOs filled with saline solution and HOs filled with sodium hyaluronate. CONCLUSIONS AND CLINICAL RELEVANCE Saline solution or sodium hyaluronate may be used as a filling solution in the HOs tested. Maintenance of occlusion was best in the larger sizes. Saline solution or sodium hyaluronate should be used in future clinical investigations of HOs. Retrograde filling to remove air should be used when filling HOs with fluid.
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Affiliation(s)
- Colin W Sereda
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, 32610, USA
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