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Y4 SA - Urogenital > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Describe the nerves and muscles involved in bladder filling and storage

A
  1. Primarily sympathetic via hypogastric nerve
    - Beta-adrenoreceptors in the detrusor muscle (relaxation)
    - Alpha-adrenoreceptors in the urethral smooth muscle and trigone (contraction)
  2. Somatic (voluntary) nervous system via the pudendal nerve
    - Urethral striated muscle contraction
    - Inhibition of the detrusor reflex
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2
Q

Describe the nerves and muscles involved in bladder emptying

A

Parasympathetic nervous system predominates via the pelvic nerve
- Stimulation of stretch receptors in the bladder wall
- Contraction of the detrusor muscle
- Relaxation of the urethral muscle (Detrusor reflex)

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3
Q

How is urinary continence maintained?

A

Cerebral cortex gives voluntary control by over-riding the detrusor reflex

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4
Q

How is urinary incontinence investigated?

A

Detailed history
Clinical examination
Biochemistry and haematology
Felv test (cats)
Urinalysis
Urine culture and sensitivity
Observe patient urinating

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5
Q

How can urinary incontinence be further investigated?

A
  1. Plain abdominal radiographs - Useful screening procedure (eg. calculi?)
  2. Intravenous urogram/CT angiography - Essential to achieve opacification of kidneys and ureters
  3. Retrograde (vagino) urethrogram
  4. Ultrasound examination of the urinary tract
  5. Urethroscopy/cystoscopy?
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6
Q

What are the typical findings in a patient with abnormalities of the filling phase?

A

Patients can urinate normally
Patients can empty bladder normally
Patients dribble urine between urinations
Patients often have reduced bladder capacity

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7
Q

List the DDx for abnormalities of the filling phase

A
  • Congenital or acquired ectopic ureter
  • Reduced pressure at the bladder neck: congenital or acquire USMI, intrapelvic/caudal bladder, short urethra, hypoplastic bladder (probably all part of USMI), bladder neck mass, urethral dysplasia
  • Involuntary contractions: bacterial infections, cystitis, drug induced
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8
Q

What are the typical findings in a patient with abnormalities of the emptying phase?

A

Distended bladder
? Constant dribbling of urine
Often no normal urination

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9
Q

List the DDx for abnormalities of the emptying phase

A

Partial/complete urethral obstruction
Chronic distension of bladder
- Urethral obstruction
- Pelvic trauma
- Intervertebral disc protrusion
- Feline dysautonomia: idiopathic polyneuropathy

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10
Q

Define dyssynergia

A

Urethral spasm during bladder contraction, urine dribbling, ddx: urethral obstruction, tx: muscle relaxants

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11
Q

What is urethral sphincter mechanism incontinence

A
  • Commonest cause of incontinence in bitch
  • Intermittent involuntary passage of urine
  • Incontinence usually whilst dog is relaxed (lying down/sleeping)
  • Do not constantly dribble urine, can urinate normally
  • Acquired and congenital forms
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12
Q

Describe the aetiology of USMI

A

Low urethral tone: striated m. tone reduced
- ? Hormonal influence
- Spayed bitches
- Prior to 1st season
- Obesity
- Intrapelvic bladder

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13
Q

Acquired USMI is more commonly seen in which dogs?

A

Usually medium/large breeds
- Dobermans
- Boxers
- Irish setters
- OESD
Usually neutered females
Can occur long time after spay

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14
Q

Congenital USMI is more commonly seen in which dogs?

A
  • Juvenile bitches (prior to 1st season)
  • 50% resolve after 1st season (don’t spay these bitches until after 1st season)
  • Ectopic ureter is main ddx for this condition but both conditions can be present
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15
Q

How can USMI be medically managed?

A
  1. Increase muscle tone
    - Phenylpropanolamine or ephedrine
    - Estriol (alone or in combination with above drugs)
  2. Reduce contributing factors
    - Weight loss
    - Treat secondary UTI
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16
Q

How can USMI be surgically managed?

A
  • Colposuspension (relocation of bladder neck cranially, increase in functional urethral length)
  • Urethropexy (relocation of bladder neck cranially, increase in urethral resistance)
  • Colposuspension and urethropexy
  • Artificial urethral sphincter (hydraulic occluder) (constant low level of urethral compression)
  • Submucosal urethral injections of bulking agents (increase in urethral resistance)
17
Q

Describe acquired USMI in male dogs

A

Uncommon
Usually older, castrated medium/large breeds
Usually overweight

18
Q

How is acquired USMI in male dogs treated?

A

Phenylpropanolamine or ephedrine
Oestrogen based dugs?
Weight loss
Surgery

19
Q

What are ectopic ureters?

A

Congenital anomaly, ureter bypasses bladder to empty into urethra, vagina or rectum
- Intramural
- Extramural

20
Q

Describe the predispositions of ectopic ureters

A

80-90% are unilateral
Intramural more common
Female: male 20:1
Golden/Labrador Retrievers, Skye terriers, Siberian Huskies have greater incidence

21
Q

Describe the physical exam of a patient with ectopic ureters

A

Particular attention should be paid to the following areas:
1. External genitalia
- Wet or dry?
- Inflamed?
- Normal in appearance?
2. Abdominal palpation
- Palpable bladder?

22
Q

How can ectopic ureters be treated?

A
  • Treatment of associated UTI
  • Early surgical management (before irreversible secondary changes)
  • Technique depends on whether uni/bilateral and intra/extramural ectopia, and secondary changes
  • Exploratory coeliotomy
  • Cystotomy to assess trigone area
23
Q

What is the most common cause of feline urinary incontinence?

A

Neurogenic
eg. tail pull, sacral fracture
Poor prognosis if no improvement after 6 weeks

24
Q

What are the three types of ureter obstruction

A
  1. Intraluminal
    - Ureteric calculus
    - Pedunculated mass
  2. Intramural
    - Tumour (very rare)
    - Fibrosis/stricture
  3. Extramural
    - Compression or invasion by abdominal tumour/mass
    - Ligation during spey (!)
    - Uterine stump infection
25
Q

What condition can develop following prolonged ureter obstruction?

A

Hydronephrosis

26
Q

How is uretic trauma definitively diagnosed?

A

Intravenous urography

27
Q

How is uretic trauma/avulsion treated?

A

Correct electrolyte/metabolic abnormalities
Management depends on site and severity of injury

Y4 SA - Urogenital (12 decks)

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