Treatment of urinary incontinence in bitches by endoscopic injection of glutaraldehyde cross-linked collagen

Thirty-two spayed bitches with urinary incontinence due to urethral sphincter incompetence, non-responsive to phenylpropanolamine administration, were treated by urethral submucosal injection of glutaraldehyde cross-linked collagen. Urinary incontinence resolved after a single injection in 19 of the bitches. Additional medication with phenylpropanolamine was necessary in five of these dogs, however. Of the 13 bitches that remained incontinent, the injections were repeated in nine. This resulted in a return to continence in five dogs, although two of these required additional medication for complete continence. The cure rate due to collagen injections alone is 53 per cent (17 of the 32 cases). A total of 41 injections were performed and no postoperative complications were observed.     

Pelvic bladder in dogs without urinary incontinence

Double-contrast cystography was performed simultaneously with cystometrography in 6 male and 6 female dogs. All dogs were continent, and results of urinalyses were normal. Initial radiographs were made following intravesical infusion of 0.88 ml of positive contrast medium/kg of body weight. Additional radiographs were made during infusion of CO2. The last radiographs were made at the time of detrusor reflex (11 dogs) or when intravesical pressure reached 50 cm H2O (1 female). An average of 34% (range, 11% to 67%) of bladder length was within the pelvic canal when only the positive contrast medium was infused into the bladders. By the end of CO2 infusion, the bladder neck was more cranially located in 5 of 6 males and in 5 of 6 females. On the last radiographs made, an average of 19% (range, 10% to 35%) of bladder length was within the pelvic canal in 3 of 6 males and in 4 of 6 females. The bladder neck was rounded in 10 of 12 dogs. Thus, it was concluded that previous reports associating pelvic urinary bladder with urinary incontinence and other urologic abnormalities are questionable.     

Delayed-onset urinary incontinence in five female dogs with ectopic ureters

This case series describes five female dogs with congenital ectopic ureter presenting with delayed-onset urinary incontinence out of 22 female dogs diagnosed with ectopic ureter over a 102-month period at a veterinary teaching hospital. All five dogs improved following surgical treatment of ectopic ureter, but only three remained continent long-term without further intervention. Delayed-onset urinary incontinence in female dogs with ectopic ureters may be more common than the current literature suggests. Congenital ectopic ureter should be considered and investigated as a possible contributing factor in female dogs presenting with delayed-onset urinary incontinence.     

The diagnosis of urinary incontinence and abnormal urination in dogs and cats.

No single technique allows one to diagnose all causes of urinary incontinence and abnormal increased frequency of urination. Cystography is indicated for cases of abnormal urinary bladder position, size, or shape. Ultrasonography is best for mass effects, calculi, and extrinsic nonskeletal abnormalities. The combined cystography and excretory urography technique is recommended for diagnosing ectopic ureteral insertions. Computerized tomography and MR imaging are indicated when the techniques described previously fail to elucidate the problem sufficiently, but these methods are usually not selected as primary diagnostic techniques.     

Surgical treatment of urinary incontinence resulting from a complex congenital abnormality in two dogs

Two young dogs were presented for the investigation of urinary incontinence. Both were found to have complex urogenital anatomy including a micropenis and a midline vestibuloperineal fistula situated just below the anus. Both dogs were considered to be intersexes and had the karyotype 78XX. In both cases, incontinence was attributed to increased resistance to the passage of urine, with vaginal reflux and subsequent passive leakage. This report details the investlgation of these dogs and their surgical treatment to resolve the urinary incontinence.     

Treatment of bitches with acquired urinary incontinence with oestriol.

Oestriol, a naturally occurring short-acting oestrogen, was used to treat acquired urinary incontinence in 129 bitches selected by 48 veterinary practitioners in the Netherlands, Belgium, France and Germany. The dogs were treated daily for 42 days with oestriol tablets, using a self-controlled study design. The dogs were examined and blood sampled at the beginning and end of the trial. According to the veterinary practitioners 83 per cent of the dogs either became continent or improved, but the others showed no change or became worse. The owners reported similar results: 82 per cent of the dogs responded to treatment and the others did not. The dose and treatment schedule for each dog were established on the basis of clinical efficacy. Mild and transient oestrogenic effects such as swelling of the vulva and attractiveness to male dogs were observed soon after the treatment began and at the higher dose schedule used in 12 of the dogs. A haematological examination of 114 of the dogs revealed no abnormalities.     

Use of a particulate extracellular matrix bioscaffold for treatment of acquired urinary incontinence in dogs

OBJECTIVE: To evaluate use of a particulate bioscaffold consisting of the extracellular matrix (ECM) of the urinary bladder from pigs for treatment of acquired urinary incontinence in dogs resistant to medical treatment. DESIGN: Case series. ANIMALS: 9 female dogs with acquired urinary incontinence. PROCEDURE: In 6 dogs, 30 mg of particulate ECM in 1.0 mL of a carrier consisting of glycerin and saline 10.9% NaCI) solution was injected into each of 3 equally spaced sites around the circumference of the internal urethral sphincter via an endoscopic technique. In the remaining 3 dogs (control dogs), 1.0 mL of the carrier alone was injected in 3 equally spaced sites around the circumference of the internal urethral sphincter in a similar manner. RESULTS: For dogs treated with the ECM, median duration of urinary continence following treatment was 168 days (range, 84 to 616 days), whereas for the control dogs, median duration of urinary continence following the procedure was 14 days (range, 7 to 31 days). Two of the 3 control dogs were treated with the ECM at the end of the study and were continent for 119 and 252 days. No adverse effects were observed in any dog. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that endoscopically guided injection of particulate ECM into the internal urethral sphincter may be useful for the treatment of acquired urinary incontinence in female dogs.     

Applicability of endoscopic examination as a diagnostic approach in urinary tract ailments in dogs

The purpose of this study was to evaluate the applicability of endoscopic examination as a diagnostic method in urethra and bladder ailments in dogs. The experiment involved 60 dogs of different breeds and gender, weighing from 5 to 65 kg, aged between 7 months and 12 years. The dogs were divided into two groups. Group I consisted of clinically healthy animals on which all the lower urinary tract endoscopic examinations described in the literature as well as biopsies of mucosa were performed. Group II consisted of clinical patients, on which endoscopic diagnostic examination was conducted and, on some of them, biopsies for histopathologic examination were made. The results of the experiment suggest that the lower urinary track endoscopy is a suitable diagnostic technique for recognition and differentiation of mucosa inflammation, establishment of causes of haematuria, diagnostics of neoplasms and detection of the existence of an ectopic ureter. Biopsy and histopathologic examination improved the diagnostic value of endoscopy. The techniques tested in our study, inclusive of more invasive method like PPC and cystoscopy on males preceded by the perineal urethrotomy, enable doctors to perform the lower urinary tract endoscopic examination on dogs, especially up to 5 kg. regardless of their gender.     

Retrospective evaluation of urethral bovine cross-linked collagen implantation for treatment of urinary incontinence in female dogs

Background: Transurethral collagen injections are an alternative treatment for canine urinary incontinence. There is controversy regarding the long‐term effectiveness of collagen and the impact urethral coaptation and injection site have on outcome. Hypothesis/Objectives: To evaluate outcome and client satisfaction after urethral collagen injections, and correlation between degree of urethral coaptation and collagen placement with outcome. Animals: Thirty‐six procedures on 31 dogs, 10 with ureteral ectopia. Methods: Retrospective review of records and video evaluation of injection procedures. Follow‐up communication with owners was performed between 1 and 56 months after bovine cross‐linked collagen implantation to evaluate duration of continence, need for additional medical therapy, and owner satisfaction. Continence score was evaluated before and after the procedure, and after additional medical therapy, if needed. Injection location and degree of urethral coaptation was assessed with respect to duration of continence. Results: Dogs had a significant increase in continence score after the procedure. Mean (SD) duration of continence in dogs without addition of medication was 16.4 (15.2) months, and 5.2 (4.3) months in dogs needing additional medical therapy. No significant difference was found with respect to degree of coaptation. Median client satisfaction with the procedure was 100%. Conclusions and Clinical Importance: Transurethral collagen implantation may be a viable option for treatment of female dogs with urethral sphincter mechanism incompetence, particularly after medical failure. Duration and degree of improvement are variable. Client satisfaction was excellent despite lack of complete continence in some dogs, and highlights the importance of discussing outcome expectations with owners.     

Urinary incontinence in dogs and cats

The differential diagnosis of canine urinary incontinence is discussed. Where appropriate, comparisons are made to similar causes of incontinence in the cat.     

Treatment of two mares with obstructive (vaginal) urinary outflow incontinence

Two mares were examined because of urinary incontinence. Abnormalities of the genitourinary tract were identified and were corrected surgically. Urinary incontinence in mares generally is associated with a poor prognosis. The importance of a thorough physical examination of the genitourinary tract in the mare is emphasized, and the simple and successful surgical correction of structural abnormalities of the tract in 2 mares is described.     

Clinical and radiographic findings compared with urodynamic findings in neutered female dogs with refractory urinary incontinence.

Possible correlations were investigated between the clinical and urodynamic findings in 77 neutered female dogs with urinary incontinence refractory to standard medical management. The clinical data used in the analysis were age, bodyweight, breed, the characteristics of the dribbling of urine and whether it developed before or after neutering, the type of response to previous treatments, signs of polyuria/polydipsia, and the results of urinalysis and culture. In 50 of the dogs, a standardised contrast radiographic examination was made to locate the neck of the bladder and to assess the morphology of the bladder. These findings were analysed for their correlation with the results of multichannel urethral pressure profilometry and diuresis cysto-urethrometry. Logistic regression analysis revealed that neither the clinical nor the radiographic findings could predict any of the abnormal urodynamic findings. Functional abnormalities of the bladder, such as a low compliance, detrusor instability, or a low bladder capacity may therefore be particularly difficult to detect in dogs with urinary incontinence.     

Surgical management of urinary incontinence.

Urethral sphincter mechanism incompetence and ureteral ectopia are the two most common causes of urinary incontinence in dogs and cats. Surgical treatments for both disorders have been described.Once a diagnosis is made, surgical intervention may lead to improved outcomes with resolution of incontinence in many patients. Proper case selection and surgical technique are critical in achieving clinical success when managing these difficult cases.