Urinary Incontinence in Dogs and Cats: Straightforward to Frustrating!
Not just in female dogs…..male dogs and cats can be incontinent!
Most common causes:
Functional (muscular vs. neurologic):
- Primary urethral sphincter mechanism incompetence (PMSI) is the most common cause of urinary incontinence in adult female dogs.1 Hyperactive bladder and urethral dyssynergia rarely occur.
- Ectopic ureters, short urethras, intrapelvic or hypoplastic bladders, ureterocoele/urethrocoele, fistulas (ureterovaginal, urethrorectal), vaginal or prostatic abnormalities ect…(often concurrent abnormalities exist).
- Blood work, rectal, vaginal examination, urinalysis and urine culture
- Abdominal radiographs, urinary ultrasound: to detect common concurrent urinary tract abnormalities such as hydroureters, hydronephrosis
- Cystoscopy: 100% diagnostic for ectopic ureters and therapeutic
(CT evaluation is not as accurate as cystoscopy for lower urinary tract abnormalities).
Therapies and Prognosis:
1. Medical management: 85-90% anatomically normal dogs will respond to PPA and/or DES
2. Historically: Surgery colposuspension or urethropexy resulted in 50-75% continence and 20% complication. Rarely indicated with less invasive techniques.
New Therapeutics offered:
3. Transurethral bulking agents: 75-93% response from 8-17 months 5,6
4. Endoscopic laser ablation of ureteral ectopia: will resolve 50% incontinent dogs. 7
(Above) Cystoscopic image of urethra. A) arrow urethral lumen, arrowhead: ectopic ureteral opening in urethra distal to trigone. B) ureteral catheter advanced into ectopic ureter in preparation for laser ablation. Courtesy of Dr. Berent.
5. Artificial urethral sphincter (hydraulic occluder) placement: will increase continence in 85-95% of dogs refractory to medical management.
Above image courtesy of Norfolk Medical, INC.
Why ACCESS Specialty Animal Hospital -Los Angeles?
1) Our doctors have extensive experience and formal training with endourologic procedures to accurately diagnose and discuss options for therapy and prognosis with owners.
2) Equipment: Cystoscopy is 100% sensitive for ectopic ureters, vestibulovaginal abnormalities, and fluoroscopy allows differentiation between intra and extramural ectopia. Eliminates the need for expensive contrast studies or additional anesthesia for a CT scan prior to visit.
3) We have flexible urethroscopes to accommodate male dogs as small as 7Kg in size and small rigid cystoscopes for female cats and small female dogs.
4) All in one procedure: Diagnostic cystoscopy and therapeutic repair of intramural ectopic ureters, vaginal septations and injection of urethral bulking agents can be performed under one anesthesia.
5) Hydraulic occluder placement and management: Our doctors have extensive experience with placement and management of artificial urethral sphincters (HO) for those frustrating, refractory incontinence cases.
We are always pleased to discuss ANY urinary incontinence cases at any time.
For more information, please contact our Internal Medicine Department at (310) 558-6100.