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Flashcards in Incontinence Deck (44)
1

Causes of incontinene in dogs and cats? Which species is more commonly affected?

> dogs esp female more common
> juvenile
- ureteral ectopia
- congenital USMI
- genitourinary dysplasia
- bladder hypoplasia
- intersex
- pervious urachus
- neuro dz
> adult
- USMI
- prostatic dz
- neuro dz
- urogenital neoplasia
- fistulae
- bladder aotny
- cystitis
- detrusor instability
- pelvic masses

2

More common cause of incontinence in dogs?

> USMI (urinary sphincter mechanism incontince)
- most common neutered bitch but also in entire females and castrated makes
- most commonly acquired after neutering
- can be congenital with anatomical defects eg. Intersex, ectopic ureters
- leakage during recumbency
- severity of leakage variable (hard to monitor Tx efficacy)

3

Which Breeds most commonly affected by USMI? What is the aetiology

Large/medium dogs
- shorter urethral length pdf
- overweight
- docked
> multifactorial aetiology not fully understood

4

Risk fctors for USMI

- bitch
- breed (Irish setter, Doberman, Rottweiler, English sheepdog)
- docked
- overweight
- post neutering (within 3 years if it's going to happen)
> cause unclear, used to think adhesions form but this has been disproven, oestrogen and progesterone levels and potential gonadotrophins

5

Diagnosis of USMI

- PE unremarkable
- Dx based on Hx, CS, investigtion, response to trial tx, r/o other causes
- caudally positioned bladder neck is supportive but NOT diagnostic

6

Is USMI common in make dogs?

- no
- but more common in neutered males

7

Is USMI in males similar to female form?

- similar to bitch (leak when recumbemt)
- intrapelvic bladder neck and castration risk factors
- responds to medical and surgical tx less well than the bitch

8

What is ureteral ectopia?

Ureters bypass bladder into urethra or vagina
- usually congenital (can be acquired)
- more common in females, dogs
- probably inherited or familial (golden retriever PDF )
- openings may be single, double or elongated (troughs)
- in dogs likely intramural ectopic ureter (joins at correct place but only opens more caudally)
- in cats likely extramural ectopic ureter

9

Clinical signs of ureteral ectopia?

- constant dribble
- severe scalding
- often UTIs
- may have concomitant USMI
- may have other abnormalities eg. Hydroneohrosis, hydroureter, uterocoeles

10

What is genitourinary dysplasia and which animals is it common in?

- rare cause of incontinence in cats (but more common than ectopic ureters cats than dogs)
- on rads no urethra seen, really wide elongated bladder straight out to vagina (very easy to catheterise!)

11

How may Intersexuality cause incontinence? Tx?

Rare
- urine refluxing into another structure
- concominant SMI possible
- tx dependent on underlying defect, usually surgical

12

What is Bladder hypoplasia commonly seen with? Px?

Rare
- usully w/ other congenital defects ef. bilateral ectopic ureters
- dx radiographically
- poorly compliant bladder -> overflow, guarded px

13

Cause of Bladder atony ? Tx and Px?

- 2* to bladder distantion
- tight junctions in bladder wall disrupted -> atonic bladder difficult to manage

14

Previous urachus

- more common farm species
- rare smallies

15

Is imaging useful in incontinence investigation?

Yes - if normal anatomy seen, suggests functional cause

16

Outline the order of further investigation for incontinence

- diagnostic imaging
- plain rads (RLR, VD)
- IVU (IV urography)
- retrograde study
- ultrasound
- others

17

Most useful study?

Retrograde vagino urethro cysto gram

18

What is ultrasound useful for?

- confirming ureteral emptying into bladder
- additional information on kidneys bladder and prostate

19

Uses of endoscopy

> visualising
- ectopic ureters
- lesions of the bladder neck/urethra that can cause incontinence
- subjective evaluatino of urethral tone
> facilitates biopsy
> laser sx for intramural ectopic ureters
- no info on urethropelvic relatinoships
> not widely available UK

20

Tx urinary incontince

- without dx Tx is trial and symptomatic
- ensure owners understand what you're doing , not necessarily bad

21

Medical Tx incontinence?

> Tx UTI
- base on culture and sensitivity
- confirm eradication
> Tx underlying systemic dz
- PUPD may exaggerate or precipitate condition
> diet if obese
> specific mess depend on dx

22

Which nerves supply the bladder and LLUT?

> hypogastric n (symp)
- L1-4
- facilitates bladder filling
- b fibres bladder, a fibres neck
> pudendal n. (Somatic)
- S1-S3
> pelvic n. (Parasympathetic)
- S1-3

23

Give 4 drug options for Tx incontinence LOOK UP TABLE

> phenylpropanolamine
- best but more expensive
- less effective in males
> ephedrine hydrochloride
> oestrol
> testosterone
- prostatic hyperplasia side effect etc.

24

Which drugs are licenced?

- phenylopropanolamine (propalin, Vetoquinol)
- ephidrine hydrochloride (Enurace 50, Janssen)
- Oestriol (Incurin, Intervet)
- Testeosterone (Durateston, Intervet)

25

Side effects of phenylpropanolamine

- irritability
- hypertension
- anorexia

26

How does the risk of adverse effects with oestriol compare to phenylpropanolamine?

- lower

27

how can medical tx be escalated before resorting to surgery?

> off lic increase dose of PPA (phenylopropanilamine)
- watch for side effects
- combine with oestriol tx
> Imipramine
- a adrenergic
- improves bladder storage
- anecdotally helps dogs unresponsive to PPA
> GnRH analogues
-> v FSH and LH
- successful

28

Further medical options

- see above

29

When is surgical Tx indicated?

Specific diagnosis has to be made
- not responsive to medical Tx

30

Which abnormalities has surgery been described for?

- ureteral ectopia
- USMI
- genitourinary dysplasia
- congenital Genito-urinary malformation
- masses
- prostatic dz

31

What should be managed prior to surgery?

- weight and UTIs

32

Are surgical procedures effective?

Not very!! No perfect techniques, many described

33

Which techniques have most and least support for them?

> most
- colposuspension
- urethropexy
- prosthetic sphincter
- endoscopic injection of collagen
> occasional reports
- vas deferens pexy
- urethrocystoplasty (cats)
- sling urethroplasty
- cyst-urethroplasty
- other transpelvic slings
- other combos
(2 types essentially: Own tissues v implants)

34

General Aims of surgery for USMI?

- improve pressure transmission to bladder neck
- increase urethral resistance
- or both

35

What is the oldest described surgery for incontinence?

> colposuspension
- move bladder neck into an intra-abdominal position.
- fix with non absorbable sutures from prepubic tendon to the vagina

36

Which 3 methods are more popular for treating female incontincnece?

> urethropexy
- similar to colposuspension (sutures urethra - prepubic tissue, bladder neck relocated cranially)
> prosthetic sphincters
- currently fashionable
- ^ urethral resistacne (inflatable band around bladder neck)
- filled with saline and allows post-op tweaks
> collagen or synthetic alternatives
- injected into peri-urethral tissues
- open surgery or endoscopic injector
- gets degraded over time, can accidentally cause obstruction

37

Is surgical Tx of males as successful ?

No bitches always do better

38

Surgical treatment for male SMI?

> Vas deferens pexy
- male colposuspension using deferent ducts
- results variable
> Prostapexy
- male colposuspension using prostate to pull bladder forward
- better success rates, no complicatiosn

39

Surgical Tx of ectopic ureters?

> reimplantation of ureter
- neo-ureterocystostomy for intramural (surgery, laser)
- ureteral transaction and reimplantation for extramural
> ureteronephrectomy
- good for charity setting
- providing contralateral is still functioning

40

Complications of ectopic ureter re-implantation?

- continued incontincnece
- UTIs -> pyelonephritis
- bladder oedema and dysuria
- stenosis or new stoma
- recanalisation of lighted distal ureter
- wound breakdown

41

Give egs. Of specific Tx of specific less common causes of urinary incontinence

- correction congenital genito-urinary malformation
- tx prostatic dz (omentalisation etc.)
- excision of bladder, urethral or vaginal masses
- permemenant cystotomy

42

Which tumour is most common in the bladder?

Transitional cell carcinoma
- not amenable to surgery

43

How can incontinene be categorised? Is this useful?

-

44

Madical tx of neurogenic atonic bladdders?

> v urethral tone
- phenoxybenzamine
- diazepam
> ^ bladder tone/contractility
- bethanecol (onl once bladder easily expressed)
> physical bladder emptying
- abdo pressure
- indwelling catheter
- permanent cystotomy