Electromyographic evaluation of the external urethral sphincter during cystometry in male cats

Electromyographic (EMG) evaluation of the external urethral sphincter (EUS) was conducted during cystometry in 11 adult male cats sedated with xylazine and ketamine. A percutaneously placed antepubic catheter was used for bladder infusion and recording intravesicular pressures during cystometrography (CMG). A fine-wire electrode was placed percutaneously into or near the EUS for recording EMG during CMG. The bladder was infused with sterile 0.9% NaCl solution at a rate of 2 to 3 ml/min until a detrusor reflex was initiated. Intravesicular pressures at the onset of infusion, immediately prior to micturition, at the onset of urine flow, and at the maximal voiding pressure were recorded. The time from infusion to micturition, from opening pressure to return to baseline, and from the beginning to the end of the CMG were also recorded. The total volume of 0.9% NaCl solution infused and the residual bladder volume after micturition were also measured. Recordings were replicated once during each trial in all cats, and trials were replicated once approximately 1 week later in 4 cats. Micturition patterns were characterized by slight to moderate EUS EMG activity during vesicular filling, with reduction in activity during emptying. Maximal EMG activity was recorded at the completion of the reflex and was associated with pulsatile expulsion of small amounts of urine. The simultaneous recording of CMG and EUS EMG with fine-wire electrodes was simple and reliable for assessing the neuromuscular integrity and synchrony of detrusor and EUS muscles. There were no significant differences in variables between recordings within trial 1, but there were differences (P less than or equal to 0.05) between trials for pressure at the onset of urine flow and maximal voiding pressure.     

Assessment of blood pressure in cats presented with urethral obstruction

Objective: To determine the arterial blood pressure at presentation in male cats with acute urethral obstruction, and to determine whether there was any correlation between these measurements and concurrent metabolic abnormalities. Design: Prospective, single cohort, observational study. Setting: Private, small animal, after‐hours emergency clinic. Animals: Twenty‐eight client‐owned male cats with acute urethral obstruction and no other known coexisting disease. Interventions: Indirect oscillometric blood pressure measurements obtained before blood sampling and treatment. Measurements and main results: Mean arterial blood pressure (MAP) measurements, physical examination parameters, serum blood urea nitrogen (BUN), creatinine, potassium, phosphorus, total calcium and magnesium concentration, venous pH, lead II electrocardiogram, and urine volume in bladder were evaluated. No cats were hypotensive at presentation; 71% (20/28) were normotensive (median MAP=100 mmHg, range 93–140 mmHg); and 29% (8/28) were hypertensive (median MAP=153 mmHg, range 145–176 mmHg). Compared with hypertensive cats, normotensive cats had significantly lower heart rates (P=0.0201) and lower calcium (P=0.0152). For all 28 cats, MAP correlated with serum potassium and total calcium (P=0.0033). Conclusions: Though potassium and total calcium were inversely and directly correlated respectively with blood pressure in cats with urethral obstruction, none of the cats were hypotensive on presentation. Normotension on admission does not support the absence of biochemical and physical abnormalities in obstructed cats.     

Blood pressure assessment in healthy cats and cats with hypertensive retinopathy

OBJECTIVE: To determine whether there was an association between hypertensive retinopathy and high systolic, diastolic, and mean arterial blood pressures in cats. ANIMALS: 181 cats. PROCEDURE: Systolic, diastolic, and mean arterial blood pressures were measured by use of a noninvasive oscillometric technique. The range of blood pressure measurements in healthy cats from various age groups was determined. Associations among systolic, diastolic, and mean arterial blood pressure; hypertensive retinopathy; hyperthyroidism; left ventricular cardiac hypertrophy; chronic renal failure; and serum biochemical abnormalities were determined. RESULTS: All blood pressure measurements increased with age in healthy cats. The frequency of hypertensive retinopathy also increased with age and with blood pressure, and hypertensive retinopathy was particularly found in cats with systolic blood pressures > 168 mm Hg. There was an increased risk for hypertensive retinopathy in cats that were female, > 10 years old, and neutered. The risk of chronic renal failure also increased as blood pressure, particularly systolic blood pressure, increased. CONCLUSIONS AND CLINICAL RELEVANCE: Hypertensive retinopathy was common in cats > or = 10 years of age and was associated with systolic blood pressures > 168 mm Hg when measured by the noninvasive oscillometric technique.     

Influence of dietary protein and lipid on weight loss in obese ovariohysterectomized cats

OBJECTIVE: To determine effects of dietary lipid and protein on development of hepatic lipidosis (HL) and on physical and biochemical indices following rapid weight loss in cats. ANIMALS: 24 ovariohysterectomized cats. PROCEDURE: Cats were fed a high energy diet until they gained 30% of their ideal body weight and then randomly assigned to receive 1 of 4 weight-reduction diets (6 cats/diet) at 25% of maintenance energy requirements per day. Diets contained a low or high quality protein source and a lipid source deficient or sufficient in long chain essential fatty acids (LCEFA). Serum and plasma samples and liver biopsy specimens were obtained for biochemical analyses and determination of hepatic lipid content before and after weight gain and during and after weight loss. RESULTS: Irrespective of weight-reduction diet fed, all cats lost weight at a comparable rate (4.51 to 5.00 g/d/kg of obese body weight). Three cats developed hepatic lipidosis. Significant changes in plasma insulin, cholesterol, triglyceride, and serum glucose concentrations were detected after weight gain and weight loss in all diet groups, but values for these variables did not differ among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Cats can lose 25 to 30% of their obese body weight over 7 to 9 weeks without developing overt clinical signs of HL, provided that weight-reduction diets are highly palatable, contain a high quality protein, have a source of LCEFA, and are fortified with vitamins and microminerals. However, rapid weight loss may increase risk factors associated with development of diabetes mellitus.     

Catheter-induced urethral trauma in cats with urethral obstruction

Fifteen cats were evaluated with urethral obstruction. Penile trauma by catheterization was the major indication for perineal urethrostomy. Ten cats had developed a urethral stricture and five had rupture of the urethra following medical management. All cats had abnormalities in penis and/or prepuce and/or scrotal sacs including hyperemia or swelling. Perineal urethrostomy was performed in all cases and they were evaluated for 6 months after surgery. Few complications were noted. Urinary tract infection was the most frequent complication observed. The clients considered their cats to have a good quality of life following surgery.     

Use of fine-wire electrodes for electromyographic evaluation of the external urethral sphincter during urethral pressure profilometry in male cats

Evaluation of urethral pressure profilometry (UPP) with simultaneous fine-wire electromyography of the external urethral sphincter (EUS) was conducted in 11 healthy adult male cats sedated with xylazine and ketamine. A 3.5-F urethral catheter with a closed end and two 1-mm side-ports was infused with sterile 0.9% NaCl solution at a rate of 2 to 3 ml/min. A fine-wire electromyographic (EMG) electrode was placed percutaneously into or near the external urethral sphincter prior to the onset of the UPP. The maximal urethral pressure achieved and functional profile length were recorded from UPP. Setting both catheter withdrawal rate and paper speed at 5 mm/s enabled the measurement of actual urethral length directly from UPP. Sphincter EMG activity was rated as slight (+), moderate (+ +), or intense (+ + +). All recordings were replicated once during each trial for 8 cats and trials were replicated 5 to 7 days later in 4 cats. Before catheterization, EMG activity of the external urethral sphincter was rated slight (+), whereas intense (+ + +) activity accompanied insertion. The activity evoked by movement of the catheter subsided, but intense EMG activity of the external urethral sphincter was recorded from onset to completion of catheter withdrawal in all cats in both trials. The mean maximal urethral pressure was 93.1 +/- 13.29 cm H2O. The mean function urethral length was 8.1 +/- 0.93 cm. Maximal urethral pressure or function profile length did not differ significantly between recordings within trials or between trials. Simultaneous recording of EMG activity and UPP of the external urethral sphincter was shown to be a simple, noninvasive technique for assessing neuromuscular and anatomic urethral function.     

Calcium-stimulation test for the assessment of beta-cell function in cats

To assess the potential of an intravenous calcium-stimulation test (CST) as an indicator of insulin secretion in cats, indices calculated from CST results were compared with indices of insulin secretion derived from an intravenous glucose tolerance test (ivGTT) and hyperglycaemic glucose clamp (HGC) in 11 healthy, normal glucose tolerant, conscious cats. Intravenous administration of 2.5mg/kg Ca(2+) resulted in a significant increase in plasma free Ca(2+) (P<0.001) and plasma insulin (P=0.047) concentrations but did not affect the plasma glucose concentration. The indices of insulin secretion based on the CST did not correlate significantly with corresponding indices based on the ivGTT and HGC. In conclusion, the CST is not a useful test for assessing insulin secretion in cats. Other indices of insulin secretion, such as fasting insulin concentrations and the homeostasis model assessment of beta-cell function (HOMA-B), are easier to obtain and correlate better with indices of insulin secretion derived from the HGC, the gold standard technique for assessing insulin secretion.     

Observations on urethral obstruction in male cats

The clinical management of urethral obstruction in male cats is described and discussed.
Résumé. Les soins cliniques de l'ohstruction urétrale dans les chats mâles sont décrits et discutés.
Zusammenfassung. Die klinische Behandlung der Harnrährenobstruktion bei Katern wird heschriehen und besprochen.     

Functional urethral obstruction in 3 dogs: clinical and urethral pressure profile findings

Three dogs with dysuria and urine retention caused by excessive functional urethral resistance are described. All dogs had clinical histories and urologic signs that previously would have been classified as detrusor-urethral dyssynergia. Diagnosis of functional urinary obstruction was established by exclusion of anatomic urinary obstruction and confirmed by urethral pressure profilometry. In 2 cases, multiple pressure deflections recorded in the urethral pressure profile suggested spasm of urethral musculature, whereas in a 3rd dog, abnormally high pressures were recorded along a portion of the proximal urethra. Functional urinary obstruction was associated with prostatitis in 1 dog and with a history of urethral calculi in 1 dog, and no underlying disorder could be identified in the remaining dog. All 3 dogs improved with medical treatments that included alpha adrenergic antagonists. The etiology, diagnosis, and pharmacologic management of functional urinary obstruction are discussed.     

Evaluation of a selective neurectomy model for low urethral pressure incontinence in female dogs

OBJECTIVE: To develop a model of low urethral pressure incontinence and compare the relative contributions of the pudendal and hypogastric nerves with urethral function by performing selective neurectomy and ovariohysterectomy in dogs. ANIMALS: 19 healthy Foxhounds. PROCEDURE: Dogs were allocated into 2 groups. The first group (10 dogs) underwent bilateral hypogastric neurectomy and ovariohysterectomy and subsequent bilateral pudendal neurectomy. The second group (9 dogs) underwent bilateral pudendal neurectomy and subsequent hypogastric neurectomy and ovariohysterectomy. Urethral pressure profilometry and leak point pressure (LPP) tests were performed before and after each neurectomy. RESULTS: Before surgery, mean +/- SD LPP and maximal urethral closure pressure (MUCP) in all dogs were 169.3 +/- 24.9 cm H2O and 108.3 +/- 19.3 cm H2O, respectively; these values decreased to 92.3 +/- 27 cm H2O and 60.7 +/- 20.0 cm H2O, respectively, after both selective neurectomy surgeries. There was a progressive decline of LPP after each neurectomy; however, MUCP decreased only after pudendal neurectomy. Fifteen dogs had mild clinical signs of urinary incontinence. All dogs appeared to have normal bladder function as indicated by posturing to void and consciously voiding a full stream of urine. Urinary tract infection did not develop in any dog. CONCLUSIONS AND CLINICAL RELEVANCE: Hypogastric and pudendal neurectomy and ovariohysterectomy caused a maximum decrease in LPP whereas pudendal neurectomy caused a maximum decrease in MUCP. IMPACT ON HUMAN MEDICINE: This model may be useful for evaluation of treatments for improving urinary control in postmenopausal women.     

Stress leak point pressures and urethral pressure profile tests in clinically normal female dogs.

OBJECTIVE: To develop a stress leak point pressure (LPP) test for dogs, determine LPP for continent female dogs, and determine urethral pressure profile (UPP) values for nonanesthetized, continent female dogs. ANIMALS: 22 continent female dogs weighing from 21 to 29 kg. PROCEDURE: A standard UPP test and a modification of the LPP test used in women were performed on all dogs. On 3 occasions, dogs underwent UPP testing while awake. They then were anesthetized with propofol, and LPP was measured at bladder volumes of 75, 100, and 150 ml. For LPP tests, abdominal pressure was applied by inflating a human blood pressure cuff placed around the dog's abdomen. LPP were recorded through a urethral catheter (bladder LPP) and a rectal balloon catheter (abdominal LPP). RESULTS: Mean +/- SD and median maximal urethral closure pressure was 110.1+/-20.2 and 109.0 cm water, respectively. Mean bladder LPP for the 75, 100, and 150 ml bladder volumes was 172.4 cm water. Significant differences among LPP for the 3 bladder volumes were not detected. CONCLUSIONS: Stress LPP can be recorded in female dogs.     

Emergency treatment of urethral obstruction in male cats

Cats with mild urethral obstruction are anesthetized, the obstruction removed and the bladder lavaged. Moderately affected cats are sedated and given IV fluids, and usually return to normal soon after the obstruction is removed. Severely affected cats are given IV fluids, NaHCO3 and Ca gluconate, sedated or anesthetized and unblocked. Fluid administration is continued to avoid renal failure. The bladder can be expressed 3-4 times daily or bethanechol given to aid recovery of detrusor muscle function. Halothane, 1% thiopental or thiamylal, or ketamine-acepromazine can be used to anesthetize blocked cats. An 18- or 20-ga, 2 1/2-inch over-the-needle catheter or a lacrimal needle is used to relieve the obstruction, after which a 3 1/2-Fr Silastic or vinyl catheter is used for catheterization and bladder lavage with sterile saline. Cystotomy allows recuperation before definitive corrective surgery.     

Serum bile acids and the assessment of hepatic function in dogs and cats

Current literature in veterinary internal medicine regarding the clinical use of the serum bile acids test to assess hepatobiliary function in dogs and cats is reviewed. The test is best used in cases where clinical signs and routine laboratory tests are suggestive of liver disease. It is a highly sensitive and specific test of hepatic function, and is the best method of assessing liver function available to the private practitioner. Abnormal results do not determine etiology, severity, or prognosis of the disorder. They merely indicate the need for hepatic biopsy. The serum bile acids concentration should always be measured in both a fasting and a two-hour postprandial sample.     

Comparison of the effect of propofol and sevoflurane on the urethral pressure profile in healthy female dogs

OBJECTIVE: To compare the effects of propofol and sevoflurane on the urethral pressure profile in female dogs. ANIMALS: 10 healthy female dogs. PROCEDURE: Urethral pressure profilometry was performed in awake dogs, during anesthesia with sevoflurane at 1.5, 2.0, and 3.0% end-tidal concentration, and during infusion of propofol at rates of 0.4, 0.8, and 1.2 mg/kg/min. A consistent plane of anesthesia was maintained for each anesthetic protocol. Maximum urethral pressure, maximum urethral closure pressure, functional profile length, and functional area were measured. RESULTS: Mean maximum urethral closure pressure of awake dogs was not significantly different than that of dogs anesthetized with propofol at all infusion rates or with sevoflurane at 1.5 and 2.0% end-tidal concentration. Functional area in awake dogs was significantly higher than in anesthetized dogs. Functional area of dogs during anesthesia with sevoflurane at 3.0% end-tidal concentration was significantly lower than functional area for other anesthetic protocols. Individual differences in the magnitude of effects of propofol and sevoflurane on urethral pressures were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Sevoflurane is an alternative to propofol for anesthesia in female dogs undergoing urethral pressure profilometry. Use of these anesthetics at appropriate administration rates should reliably distinguish normal from abnormal maximum urethral closure pressures and functional areas. Titration of anesthetic depth is a critical component of urodynamic testing.     

'Simultaneous' urethral pressure profilometry: variations in intravesical pressure with respiration

Pressure changes in the urinary bladder due to respiration were measured in 75 bitches. The changes fell within a narrow range (0.5 to 2.5 cm water) and were unaffected by size or whether the bitches were entire or spayed. Significant differences were found, however, between continent (mean +/- SD, 1.1 +/- 0.4 cm water) and incontinent (mean +/- SD, 1.4 +/- 0.5 cm water) animals (P less than 0.01).     

Preservation of striated-muscle urethral sphincter function with use of a surgical technique for perineal urethrostomy in cats

It has been reported that perineal urethrostomy resulted in impairment of striated-muscle urethral sphincter function in male cats, as measured by urethral pressure profilometry and electromyography (EMG). Our study was undertaken to describe and evaluate a surgical technique for perineal urethrostomy that reduces trauma to the urethral branches of the pudendal nerve. Perineal urethrostomy was performed on 10 healthy neutered cats after demonstrating that they had normal urethral sphincter function by urethral pressure profilometry (maximal urethral closure pressure [MUCP] = 151 +/- 52 cm of water) and EMG activity at the level of the striated-muscle sphincter before surgery. All cats had normal urethral sphincter function 1 week (MUCP = 194 +/- 19 cm of water, EMG activity present) and 3 weeks (MUCP greater than 200 cm of water, EMG activity present) after surgery. These results indicated that preservation of the urethral branches of the pudendal nerve during urethrostomy preserved striated-muscle urethral sphincter function.     

Management of traumatic urethral rupture in 11 cats using primary alignment with a urethral catheter

OBJECTIVE: To assess the management of traumatic urethral ruptures using a systematic attempt at urethral catheterisation. METHODS: Eleven cats that had been diagnosed with a traumatic urethral rupture over a five-year period were included in this study. Rupture was assessed by positive-contrast retrograde urethrography. An attempt was made to manage these ruptures by placing an indwelling urethral catheter. RESULTS: The placement of an indwelling urethral catheter, could be performed in 10 out of 11 cats, which indicated a partial rupture. In one cat, catheterisation was not possible because of complete urethral rupture. A urethral catheter was placed into the urinary bladder via the urethra in five animals. In the other five animals, urethral catheterization required cystotomy using a modified 'inside to outside' technique. Urethral catheter removal occurred between five and 14 days after placement. Urethral healing was accomplished in all cases of catheterisation with a good outcome in eight of the 10 cats. Two cats showed clinical signs related to stricture formation during the follow-up period (seven to 72 months). Retrograde urethrography provided a definitive diagnosis of partial rupture in only six of the 10 cases of partial rupture. CLINICAL SIGNIFICANCE: Results suggested that primary alignment with the placement of a urethral catheter should be attempted for the management of traumatic urethral ruptures in cats. Gentle urethral catheterisation seems to be an effective procedure for diagnosing and dealing with partial urethral rupture in cats. Clinical stricture formation can occur, but the risk does not seem to be high. Further studies are warranted in order to define the ideal duration for maintenance of an indwelling urethral catheter in cases of traumatic partial urethral rupture.