12.7.5: Urinary incontinence Flashcards
Micturition
filling the bladder + emptying
What should be you first steps in an animal presenting with urinary incontinence?
- Neuro exam
- Urinalysis
How can we subdivide incontinence to create an appropriate list of differentials?
- Neurogenic
- Non-neurogenic
- (Urinary retention -> overflow): can further split into neurogenic and non-neurogenic. Sometimes seen as not true incontinence.
Differential diagnoses for neurogenic incontinence
- Sacral fracture
- Pelvic nerve or pelvic plexus trauma
- Lumbosacral disease (IVDD, lumbosacral stenosis, neoplasia)
- Sacral malformation
- FeLV - associated incontinence
- Generalised peripheral lower motor neurone disease
- Dysautonomia
Differential diagnoses for non-neurogenic incontinence
- Urethral sphincter mechanism incompetence (USMI)
- Urethral hypoplasia
- Lower urinary tract inflammation (bacterial cystitis, sterile cystitis, urolithiasis)
- Detrusor instability
- Ectopic ureter
- Partial outflow obstruction (uroliths, neoplasia, polyps)
- Patent urachus
- Vestibulovaginal stenosis/septum
- Primary detrusor atony with outflow
Which nervous system dominates during filling of the bladder?
Which nervous system dominates during emptying of the bladder?
1-4
5
6
7
8
1
2
3
Potential causes of neurogenic incontinence
Potential causes of non-neurogenic incontinence
1 and 2
3 and 4
5 and 6
What is an automatic bladder and how does it develop?
Automatic bladder: may develop over time when initial shock from injury has passed. This is when sympathetic and parasympathetic pathways enable the bladder emptying reflex when the threshold is reached; this is not under voluntary control.
True/false: when managed the neurological patient, you should wait and try to avoid putting a urinary catheter in for as long as possible.
False.
* Bladder care is an important part of managing neuro patients
* Catheterisation post-surgery is common in most cases
* Animals with incontinence get sore very quickly; there can be scald in the vestibule and prepuce and then issues with overgrooming
* UTI is a risk but on the whole putting a catheter in is preferable. Regular (4x daily) expression will help prevent overflow/ over-distension and UTI
Which bladder is it fine for owners to express at home?
a) LMN bladder
b) UMN bladder
a) LMN bladder (flaccid)
Should not empty UMN bladder.
Common presentation of USMI
May present with peri-vulvar dermatitis (why would they only have a skin issue here? Suggests urinary)
Aetiology of USMI
If you have a puppy presenting with USMI, what might you investigate, and if this is not the cause, what could you do?
- Puppy with USMI -> check for ectopic ureters
- Could consider leaving for a couple of seasons, may settle down
Overall plan for USMI patients
- Check healthy, no neuro problems
- Check for UTI (urinalysis and microscopy)
- Try medications aimed at improving urethral resistance (PPA is first line)
Medical management of USMI
1
Medical management of USMI
2
Which is more common: medical or surgical management of USMI?
Medical treatment is more common
Surgical management of USMI
Congenital non-neurogenic causes of incontinence
- Intersex patients (rare) - different anatomy
- Ectopic ureters
- Destrusor instability (=urge incontinence; overactive bladder presenting as pollakiruia)
Presentation, cause and treatment of ectopic ureters
- If bilateral ectopic ureters, signs will be very early in life as no control.
- Ureter normally enters the bladder at the trigone - anywhere else is ectopic
Presentation and pathogenesis of detrusor instability
- Often seen in young excited male dogs - hard to differentiate from behavioural causes
- Overactive bladder presenting at pollakiruria
- Most animals have underlying cystitis, irritating the bladder lining and overstimulating the detrusor reflex
Broad causes and management of urinary retention
Causes of neurogenic urinary retention
Detrusor-urethral dyssergia: detrusor and urethra not coordinating.
Dysautonomia: very rare, may see ataxia, loss of proprioception as well.
Detrusor atony: usually secondary to over-stretching of bladder; if caught acutely, we can probably reverse them. This is why we put catheters in.
Example cause and treatment of LMN bladder
Causes and treatment of UMN bladder
Idiopathic reflex dyssynergia (detrusor-urethral dyssynergia) : problems and treatment
Non-neurogenic urinary retention : possible causes
Broad treatment approaches to urinary disorders
