Long-Term Outcome of Female Dogs Treated with Static Hydraulic Urethral Sphincter for Urethral Sphincter Mechanism Incompetence

Combined cystourethroplasty and urethral sphincter occluder placement for treatment of urinary incontinence in a cat with genitourinary dysplasia

A 10-month-old female neutered domestic shorthair cat presented with a history of urinary incontinence and recurrent bacterial cystitis since 2 months of age. Physical examination was unremarkable other than vulval hypoplasia. Genitourinary dysplasia was diagnosed following a physical examination, CT imaging and retrograde positive contrast urethrocystography. Attempted medical management of the urinary incontinence was unsuccessful. Surgical treatment consisted of cystourethroplasty combined with artificial urethral sphincter placement, resulting in marked improvement of urinary continence. Following multiple adjustments of the artificial urethral sphincter near-total continence was achieved, which was maintained at 10 months post-surgery.

Diagnosis, management, and outcome of urethral obstruction secondary to the capsule associated with the artificial urethral sphincter device

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.

Artificial urethral sphincter in male dogs with urethral sphincter mechanism incompetence: 19 cases (2010-2017)

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.

Long-term outcome of female dogs treated for intramural ectopic ureters with cystoscopic-guided laser ablation

OBJECTIVE

To report the complications and long-term outcome of female dogs with intramural ectopic ureter(s) (iEU) undergoing cystoscopic-guided laser ablation (CLA) and determine the effect of post-CLA neutering on urinary continence.

STUDY DESIGN

Retrospective clinical study.

ANIMALS OR SAMPLE POPULATION

Thirty-four client-owned dogs.

METHODS

Medical records of female dogs that had iEU-CLA were reviewed. A 10-point continence score was assigned before, immediately after, and at a minimum of 12 months postprocedure via owner telephone contact. Neutering status prior to and postprocedure was recorded.

RESULTS

Continence scores increased in all dogs after CLA (p < .0001, mean duration of follow-up: 63.9 ± 5.7 months) with an increase of the median score from 2 (preprocedure) to 10 (postprocedure). A urethral tear occurred in 2/34 dogs immediately after the procedure, successfully managed conservatively. Mild hematuria was present in 2/34, lasting less than 48 h. Postoperative urinary tract infections were documented in 6/34 dogs. Two dogs died of urinary-related issues at 1 and 5 months after CLA. Complete and near-complete urinary continence (scores 9 and 10/10) was achieved in 26/32 dogs including 3 dogs requiring medical (2) or surgical interventions (1). Post-CLA neutering did not affect continence scores (p = .44).

CONCLUSION

A large proportion of dogs regained and maintained full continence after CLA alone. Subsequent medical or surgical therapy allowed further improvements when needed. Post-CLA neutering did not negatively impact urinary continence score.

CLINICAL SIGNIFICANCE

The beneficial effect of iEU-CLA in female dogs is long standing and not affected by postprocedural neutering.

Bladder and Bowel Management in Dogs With Spinal Cord Injury

Spinal cord injury in companion dogs can lead to urinary and fecal incontinence or retention, depending on the severity, and localization of the lesion along the canine nervous system. The bladder and gastrointestinal dysfunction caused by lesions of the autonomic system can be difficult to recognize, interpret and are easily overlooked. Nevertheless, it is crucial to maintain a high degree of awareness of the impact of micturition and defecation disturbances on the animal's condition, welfare and on the owner. The management of these disabilities is all the more challenging that the autonomic nervous system physiology is a complex topic. In this review, we propose to briefly remind the reader the physiology of micturition and defecation in dogs. We then present the bladder and gastrointestinal clinical signs associated with sacral lesions (i.e., the L7-S3 spinal cord segments and nerves) and supra-sacral lesions (i.e., cranial to the L7 spinal cord segment), largely in the context of intervertebral disc herniation. We summarize what is known about the natural recovery of urinary and fecal continence in dogs after spinal cord injury. In particular we review the incidence of urinary tract infection after injury. We finally explore the past and recent literature describing management of urinary and fecal dysfunction in the acute and chronic phase of spinal cord injury. This comprises medical therapies but importantly a number of surgical options, some known for decades such as sacral nerve stimulation, that might spark some interest in the field of spinal cord injury in companion dogs.

Management of incontinence following pre-pubic urethrostomy in a cat using an artificial urethral sphincter

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.

Canine urethral sphincter pressure profile under incremental inflation of an artificial cuff: a cadaver study

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.