Urinary Incontinence

Question 1

How can you broadly categorise incontinence?

Answer 1

Neurogenic / Non-neurogenic

By presenting signs

Question 2

What presenting signs can you use to categorise urinary incontinence?

Answer 2

Congenital - anatomical 
Overflow -leaking due to obstruction
- Paradoxical 
Stress -increases in abdo pressure e.g. cough 
Urge - UTI 
Response to treatment 
Hormonal - sphincter mechanism

Question 3

What is paradoxical incontinence ?

Answer 3

Overflow incontinence due to obstruction

Often when patient lies down

Question 4

What are the juvenile causes of incontinence?

Answer 4

OFTEN ANATOMICAL

Ectopic ureters 
USMI
Genitourinary dysplasia 
Bladder hypoplasia 
Intersex 
Patent urachus 
Neuro dz

Question 5

What is USMI

Answer 5

Urethral sphincter mechanism incontinence

Question 6

What is the most common cause of adult incontinence?

Answer 6

USMI

Question 7

What are the causes of incontinence in adults ?

Answer 7

USMI
Prostatic dz
Neuro
Urogenital neoplasia 
Fistulae 
Bladder atony 
Cystitis 
Detruser instability 
Pelvic masses

Question 8

What dogs are more likely to get USMI?

Answer 8

Neutered bitches

Castrated male and entire bitches also

Question 9

What urine leakage is associated with USMI?

Answer 9

Leakage during recumbency as increased intra-abdominal pressure

May be progressive or manifests when another condition presents e.g. PUPD increases volume in bladder

Question 10

What risk factors are associated with USMI?

Answer 10

Neutering esp in large breeds

Breed- Irish setter, Rottie, Old English Sheepdog

Large

Question 11

How do you diagnose USMI?

Answer 11

History
PE - unremarkable

Rule out other causes with clin path. urine, biochem

and observe response to trial tx

Diagnostic imaging if no response

Question 12

How can you treat USMI?

Answer 12

Treat UTI
Treat systemic dz
Diet if obese
Medicate to increase urethral tone - PPA, oestriol (f) testosterone (m)

Question 13

What controls bladder relaxation?

Answer 13

Beta adrenergic fibres (sympathetic) from the hypogastric n

Question 14

How is urethral tone maintained?

Answer 14

Alpha adrenergic fibres from the hypogastric n (Sympathetic)

Question 15

How does the bladder contract?

Answer 15

Parasympathetic action of the pelvic n on the detruser muscle

Question 16

Which nerve is responsible for sphincter tone?

Answer 16

Pudendal n (somatic)

Question 17

What is ureteral ectopia?

What is it more common in?

Answer 17

Ureters bypass bladder and open into urethra or vagina

Female dogs

Question 18

What clinical signs are associated with ureteral ectopia?

Answer 18

Continual dribbling urine
- severity dependent on where ureters empty
Still posture and urinate normally too
Scalding

May also have concomitant USMI, hydronephrosis/ureter

Question 19

What type of ureteral ectopia are dogs more likely to have?

Answer 19

INTRAMURAL

- goes in wall of bladder

Question 20

What type of ureteral ectopia are cats more likely to have?

Answer 20

EXTRAMURAL

Implants directly into urethra or vagina

Question 21

How can you treat ectopic ureters?

Answer 21

Manage UTI if present
Surgically reposition ureteral opening
- CONTINENCE ONLY IN HALF due to concurrent USMI/hypoplastic bladder

Concurrent medical therapy - PPA

Question 22

When is bladder atony seen?

Why does it occur?

How do you treat?

Answer 22

Secondary to bladder distension

Tight junctions in bladder wall disrupted.

Need in dwelling catheter