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.     

Encrusting cystitis in a cat secondary to Corynebacterium urealyticum infection

An 18-year-old male neutered domestic shorthair cat was presented for investigation of haematuria and lethargy. The cat had sustained a traumatic T3-L3 lesion 5 years prior resulting in upper motor neuron incontinence. On further investigation the cat was found to be hyperkalaemic, hypothermic and dehydrated. Ultrasonography of the bladder revealed a markedly hypoechoic, thickened bladder wall with an irregular, hyperechoic mucosal layer. The patient responded to symptomatic and supportive care and was discharged. Despite initial improvement, the patient returned 10 days after discharge with recurrence of haematuria and lethargy. Ultrasound-guided aspiration and culture of the material on the mucosal surface of the bladder confirmed diagnosis of UTI caused by Corynebacterium urealyticum. On post-mortem examination, gross and histopathological features were consistent with encrusting cystitis. This is the first case report of encrusting cystitis in a cat. C urealyticum, an uncommon urinary tract pathogen in small animals, should be considered in patients with predisposing conditions.     

Ectopic ureterocele in a cat

A 9-month-old, castrated male domestic shorthair cat with urinary incontinence was referred for surgical correction of an ectopic ureter. Excretory urography revealed hydronephrosis of the right kidney, right hydroureter, and ureterocele. A partial ureterocelectomy and neoureterocystostomy were performed. This report describes the surgical modification of the ureterocele and ectopic ureter to correct ipsilateral hydronephrosis, hydroureter, and urinary incontinence.     

Extramural Ectopic Ureter in a Domestic Ferret (Mustela putorius furo)

Ectopic ureter is the most common cause of congenital urinary incontinence in the dog and cat. The occurrence of ectopic ureter in the dog has been estimated to be 0.016%. A 6-month-old ferret was evaluated for urinary incontinence and urine scalding around the perineal and inguinal areas. Ultrasonography showed a nondistended urinary bladder that contained a possible intraluminal blood clot. Excretory urography revealed a left ectopic ureter. The ferret was initially treated with oral amoxicillin-clavulanate and topical silver sulfadiazine ointment for the perineal and inguinal dermatitis associated with the incontinence. Because of the potential for complications and additional surgery with ureteral transplantation, a left nephroureterectomy was performed. Surgical recovery was uneventful and the incontinence improved, although a small amount of incontinence-associated dermatitis was still present 24 days after discharge. Phenylpropanolamine therapy was initiated to address a suspected dysfunction of the urethral sphincter. Urinary incontinence improved with the phenylpropanolamine therapy; however, a small amount of incontinence persisted throughout the 3 months in which the ferret was evaluated. To the authors' knowledge, this is the first report of an ectopic ureter in a domestic ferret.     

Ectopic ureters in the cat – a report of two cases

Two cases of ectopic ureters in cats are described. In both the male and the female cat urinary incontinence was the prominent feature. Diagnosis was made by excretion urography. In both cats the ectopia was bilateral. The ureters were surgically reimplanted in the bladder, which gave total relief of the incontinence. A follow–up study is described, and the results are discussed.     

Urinary incontinence secondary to idiopathic detrusor instability: cystometrographic diagnosis and pharmacologic management in two dogs and a cat

Idiopathic detrusor instability was diagnosed as the cause of urinary incontinence in 2 dogs and a cat. The diagnosis was based on abnormal cystometrographic findings and by exclusion of other causes of detrusor hyperactivity. Anticholinergic or combined anticholinergic, antispasmodic, and local anesthetic treatment resolved the clinical signs in all 3 animals. Increased threshold volumes after treatment were documented by cystometrography in one dog and in the cat.     

Management of incontinence following pre-pubic urethrostomy in a cat using an artificial urethral sphincter

A 14-year-old male neutered domestic shorthair cat presented with a 4-year history of urinary incontinence following prepubic urethrostomy. Physical examination confirmed peristomal dermatitis, urine scalding and constant urine leakage. Haematology, serum biochemistry and urinalysis were unremarkable. Ultrasonography revealed a non-distended urinary bladder. An artificial urethral sphincter mechanism, with subsequent incremental inflation of the cuff 6 weeks later, resulted in complete resolution of clinical signs, return to normal urinary function and excellent quality of life. The cat was still continent at 5-year follow-up. Further studies including additional cases are required to highlight effectiveness and harms of the procedure.     

Ectopic ureter in a male cat

A male cat with persistent urinary incontinence is described. Definitive diagnosis of unilateral ectopic ureter was obtained by intravenous urography, after which surgical re-implantation of the ureter into the bladder was performed. The literature on ureteral ectopia in cats is discussed.     

Ectopic ureter in a male cat

A male cat with persistent urinary incontinence is described. Definitive diagnosis of unilateral ectopic ureter was obtained by intravenous urography, after which surgical re-implantation of the ureter into the bladder was performed. The literature on ureteral ectopia in cats is discussed.     

Use of a self-expanding metallic stent for the treatment of a urethral stricture in a young cat

A 4-month-old intact male domestic shorthair cat was evaluated for urinary outflow obstruction after several weeks of medical management for traumatic urethral rupture. Positive-contrast retrograde urethrography and anterograde cystoscopy performed 4 weeks after the initial urethral injury confirmed a stricture approximately 1cm distal to the bladder trigone at the site of the initial urethral tear. A self-expanding metallic urethral stent (SEMS) was placed under fluoroscopic guidance to relieve the urethral stricture and re-establish luminal patency. After stent placement, the cat was able to void urine normally with minimal urinary incontinence noted. This resolved several months post-stent placement. No known clinical complications persisted other than mild intermittent hematuria.     

Malignant peripheral nerve sheath tumour of the urinary bladder in a cat

A 14-year-old domestic shorthair cat presented with a 5-month history of urinary incontinence and inappro-priate elimination. Ultrasonography revealed a well-marginated, vascular mass of mixed echogenicity ex-tending from the dorsal wall of the urinary bladder into the lumen. Partial cystectomy was performed for re-moval of the urinary bladder mass; histopathological evaluation revealed a spindle cell neoplasm with a prominent palisading pattern. Histomorphologic features and immunohistochemical demonstration of vimentin, glial fibrillary acidic protein and S-100 protein, combined with negativity for smooth muscle actin and desmin were consistent with malignant peripheral nerve sheath tumour. This case report describes a novel location of malignant peripheral nerve sheath tumour; to the authors' knowledge, the bladder has not been described as a site of origin in the cat or any other domestic species.     

Spinal dermoid sinus in a Burmese cat with paraparesis

A 2-year-old, male, Burmese cat was evaluated for chronic progressive hindlimb weakness, ataxia and urinary incontinence. Radiographic examination, myelography and magnetic resonance imaging defined congenital vertebral anomalies and a space-occupying intradural, extramedullary mass. A dermoid sinus was subsequently identified dorsal to the affected spine. Surgical excision of the tract necessitated a dorsal laminectomy and removal of a 1-cm diameter intradural dermoid sinus 'cyst' that contained hair and sebaceous debris. The cat recovered hindlimb function after surgery and remains asymptomatic 50 months after surgery except for a persistent inability to urinate voluntarily.     

Surgical management of a recurrent spinal meningioma in a cat

A 13-year-old male neutered Persian crossbred cat was evaluated for hindlimb paresis, ataxia and urinary incontinence that had been progressing over the previous 3 months. Neurologically, the cat had thoracolumbar spinal cord deficits and a myelogram detected the presence of a mass compressing the thoracic spinal cord. A hemilaminectomy was performed to excise the soft tissue mass, subsequently identified histologically as a psammomatous meningioma. The cat regained ambulatory function and continence following surgery until a recurrence of paresis and ataxia 36 months later. A second myelogram suggested local recurrence of the tumour, which was confirmed by histological examination of the tumour after its removal at a second laminectomy. The cat again regained normal neurological function, until a further recurrence 16 months after the second surgery. The meningioma was surgically debulked a third time and the cat regained ambulation and continence postoperatively. This case demonstrates the successful use of repeated surgical resection in the management of a recurrent spinal meningioma in a cat. The cat was ambulatory and continent at a follow-up examination 63 months after the initial presentation.     

Prepubic urethrostomy: A long-term study in 16 cats

OBJECTIVE: To investigate the indications for and long-term outcome of prepubic urethrostomy (PPU) in the cat. STUDY DESIGN: Retrospective survey. ANIMALS: Sixteen cats that had undergone PPU. METHODS: Data were recovered from the medical records of the cats. Follow-up information was obtained from the owners and referring veterinarians. RESULTS: Indications for PPU were: failed perineal urethrostomy for the management of idiopathic lower urinary tract disease (ILUTD) (8 cats) or urethral trauma (1 cat); unresolved pelvic urethral obstruction after recurrent ILUTD (5 cats); and stenosis of the pelvic urethra as a result of trauma (2 cats). A patent urethral stoma was created in all cases. Signs of lower urinary tract disease were present in 8 cats postoperatively. With appropriate dietary management, these signs resolved in 2 cats and improved in another 4 cats. Eleven cats experienced postoperative complications that consisted of peristomal skin irritation or necrosis (7 cats) and urinary incontinence (6 cats). Complications developed in the immediate postoperative period in 6 cats, and resolved in 2 of these. Six cats developed late complications, at 6 to 84 months postoperatively. Six cats were euthanatized between 1 and 26 months' postoperatively. The mean survival time in these cats was 13 months. Reasons for euthanasia included urinary incontinence (3 cats), skin necrosis (2 cats), and unresolvable ILUTD (1 cat). CONCLUSIONS: PPU is a salvage procedure that is successful in relieving the signs of urinary tract obstruction and preventing further obstruction. However, potential complications should limit its use to cases in which standard techniques for perineal urethrostomy cannot be performed. CLINICAL RELEVANCE: PPU is a comparatively simple procedure that should be considered as a salvage technique for obstructive disease of the pelvic urethra.     

Transpelvic urethrostomy in 11 cats using an ischial ostectomy

OBJECTIVE: To investigate the feasibility and long-term outcome of a modified subpubic urethrostomy technique termed transpelvic urethrostomy (TPU) in cats. STUDY DESIGN: Prospective clinical study. ANIMALS: Eleven male cats with obstructive lower urinary tract disease that could not be relieved, and requiring a surgical urinary diversion, were selected for TPU. METHODS: With the cat in dorsal recumbency, the penis was exposed and the ventral pelvis was denuded by median adductor muscle elevation. An approximately 12 mm x 15 mm area of ischium was removed. The pelvic urethra, 8-20 mm cranial to the bulbourethral glands, was incised longitudinally and sutured to the skin to create a urethrostomy. RESULTS: All cats were neutered males (2-9 years); none were uremic or hyperkalemic at admission. Urine was cultured if there was leukocyturia, nitrituria, and/or bacteriua. Bacteria were isolated from 2 specimens. A patent urethrostomy was created in all cats without operative complications. Except for 1 cat without associated clinical signs, stricture was not evident between 9 and 42 months after urethrostomy. One cat had postoperative urinary incontinence (UI) that resolved within 4 weeks. Two cats each had 1 episode of idiopathic lower urinary tract disease after 6-month follow-up; both responded to medical therapy. CONCLUSIONS: TPU was used as a successful urinary diversion procedure relieving signs of urinary tract obstruction and preventing further obstruction, with few complications. The incidence of UI after TPU remains minimal. CLINICAL RELEVANCE: TPU should be considered as a salvage urinary diversion procedure in cats (as an alternative to prepubic and subpubic techniques). TPU may also be considered as a possible primary urinary diversion solution (an alternative to perineal urethrostomy) for obstructive lower urinary tract disease in cats.     

Recurrent spinal arachnoid cyst in a cat

Spinal arachnoid cysts (SACs) are uncommon expanding lesions in the spinal canal. They are rarely diagnosed in dogs, and there are only four published cases in cats. We report a case of a 12-year-old cat with recurrent signs of intermittent urinary incontinence and hind limb ataxia 2 years after surgical marsupialisation of a spinal arachnoid cyst at T11/12. Recurrence of a cyst was diagnosed by myelography. Repeated marsupialisation after laminectomy was successful and the cat recovered satisfactorily although intensive physical therapy was necessary. SACs are very rare in cats and seem to occur mainly as a secondary lesion to spinal and meningeal trauma or irritation due to bony changes of the vertebrae.     

Aspergillus species cystitis in a cat.

A Persian male cat with a history of lower urinary tract disease was presented because of polydipsia, polyuria, constipation and nasal discharge. Ten weeks before admission, the cat had been treated for lower urinary tract disease by catheterisation and flushing of the bladder. The animal was thin, dehydrated, anaemic and azotaemic. Urine culture revealed Aspergillus species cystitis. Antibodies against Aspergillus nidulans were identified in serum. Fluconazole was administered orally (7.5 mg/kg, q 12 h) for 10 consecutive weeks. The azotaemia was resolved, the kidney concentrating ability was recovered and the cat has remained healthy without similar problems.     

Vaginourethroplasty as a salvage procedure for management of traumatic urethral rupture in a cat

This report describes a cat that suffered pelvic urethral rupture associated with multiple pelvic fractures. A vaginourethroplasty was performed as a salvage procedure, via intrapelvic anastomosis of the proximal urethra to the caudal vagina, following failure of a primary urethral anastomosis. Urinary diversion was achieved via tube cystostomy and a vagino-urethral catheter was maintained for 3 days postoperatively. Anterograde cystourethrography was performed at 7 days and 14 days postoperatively. Absence of contrast leakage from the vagino-urethral anastomosis was documented at 14 days postoperatively and the tube cystostomy was removed. An Escherichia coli urinary tract infection was treated following removal of the tube cystostomy and subsequent urine culture revealed no evidence of urinary tract infection. The cat retained normal urinary continence and elimination behaviour during the 7-month follow-up period. Vaginourethroplasty could be considered as a salvage option for management of traumatic pelvic urethral rupture in the neutered female cat.     

Congenital ectopic ureters in a continent male dog and cat

A male dog and cat were evaluated because of clinical signs associated with hydronephrosis. Both animals had ectopic ureters, but neither had urinary incontinence. The diagnoses were made by use of ultrasonography, excretory urography, retrograde urethrocystography, and surgery. In both animals, hydronephrosis was bilateral but of unequal severity, such that unilateral ureteronephrectomy could be performed. Both animals underwent ureteroneocystostomy of the remaining ureter. This treatment resulted in good clinical outcome during follow-up periods of 18 months and 3 years.     

Clinicopathologic analysis of herpesvirus-induced urinary tract infection in specific-pathogen-free cats given methylprednisolone

The clinicopathologic manifestations of bovid herpesvirus-4 (BHV-4; FCAHV strain)-induced infection of the lower portion of the urinary tract were characterized in 12 adult neutered male and 6 female specific-pathogen-free cats, and were compared with those in 12 neutered male control cats. Six neutered male and 6 female cats were given immunosuppressive doses of methylprednisolone acetate prior to inoculation of their urinary bladders with BHV-4. Six neutered male control cats were given immunosuppressive doses of methylprednisolone acetate prior to inoculation of their urinary bladders with uninfected tissue culture control inoculum. Six additional neutered male control cats were exposed only to uninfected tissue culture control inoculum. All cats were observed for 90 days following inoculation. Dysuria and gross hematuria were observed in only 1 BHV-4-exposed cat. Radiographic abnormalities of the lower portion of the urinary tract were not observed. Microscopic hematuria, crystalluria, and lipiduria were identified with similar frequency in BHV-4-exposed and control cats. Results of urine culturing for bacteria, mycoplasma, ureaplasma, and viruses were negative. Viruses were not isolated from blood leukocytes collected from exposed or control cats. Three to 6 weeks after inoculation, high concentrations of BHV-4 serum antibodies were detected in all exposed cats by an indirect fluorescent antibody test. Light microscopic examination of the urinary tract revealed multifocal lymphoid cystitis in 2 BHV-4-exposed cats. Except for suppurative bronchitis in 1 BHV-4-exposed cat given glucocorticoids, morphologic differences in urinary and extraurinary tissues were not observed. In urinary bladder tissue collected 90 days after inoculation, BHV-4 was reisolated from urinary bladder explants of all but 1 exposed cat. Virus was also isolated from a kidney explant of 1 exposed male cat, and spleen cell co-cultures of 1 exposed female cat given glucocorticoids.(ABSTRACT TRUNCATED AT 250 WORDS)