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Renal > Incontinence > Flashcards

Incontinence Flashcards

1
Q

Causes of incontinene in dogs and cats? Which species is more commonly affected?

A 
> dogs esp female more common 
> juvenile
- ureteral ectopia
- congenital USMI 
- genitourinary dysplasia
- bladder hypoplasia
- intersex
- pervious urachus
- neuro dz
> adult 
- USMI
- prostatic dz
- neuro dz
- urogenital neoplasia
- fistulae
- bladder aotny 
- cystitis
- detrusor instability
- pelvic masses
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2
Q

More common cause of incontinence in dogs?

A

> USMI (urinary sphincter mechanism incontince)

  • most common neutered bitch but also in entire females and castrated makes
  • most commonly acquired after neutering
  • can be congenital with anatomical defects eg. Intersex, ectopic ureters
  • leakage during recumbency
  • severity of leakage variable (hard to monitor Tx efficacy)
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3
Q

Which Breeds most commonly affected by USMI? What is the aetiology

A 
Large/medium dogs 
- shorter urethral length pdf 
- overweight
- docked
> multifactorial aetiology not fully understood
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4
Q

Risk fctors for USMI

A
  • bitch
  • breed (Irish setter, Doberman, Rottweiler, English sheepdog)
  • docked
  • overweight
  • post neutering (within 3 years if it’s going to happen)
    > cause unclear, used to think adhesions form but this has been disproven, oestrogen and progesterone levels and potential gonadotrophins
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5
Q

Diagnosis of USMI

A
  • PE unremarkable
  • Dx based on Hx, CS, investigtion, response to trial tx, r/o other causes
  • caudally positioned bladder neck is supportive but NOT diagnostic
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6
Q

Is USMI common in make dogs?

A
  • no

- but more common in neutered males

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7
Q

Is USMI in males similar to female form?

A
  • similar to bitch (leak when recumbemt)
  • intrapelvic bladder neck and castration risk factors
  • responds to medical and surgical tx less well than the bitch
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8
Q

What is ureteral ectopia?

A

Ureters bypass bladder into urethra or vagina

  • usually congenital (can be acquired)
  • more common in females, dogs
  • probably inherited or familial (golden retriever PDF )
  • openings may be single, double or elongated (troughs)
  • in dogs likely intramural ectopic ureter (joins at correct place but only opens more caudally)
  • in cats likely extramural ectopic ureter
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9
Q

Clinical signs of ureteral ectopia?

A
  • constant dribble
  • severe scalding
  • often UTIs
  • may have concomitant USMI
  • may have other abnormalities eg. Hydroneohrosis, hydroureter, uterocoeles
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10
Q

What is genitourinary dysplasia and which animals is it common in?

A
  • rare cause of incontinence in cats (but more common than ectopic ureters cats than dogs)
  • on rads no urethra seen, really wide elongated bladder straight out to vagina (very easy to catheterise!)
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11
Q

How may Intersexuality cause incontinence? Tx?

A

Rare

  • urine refluxing into another structure
  • concominant SMI possible
  • tx dependent on underlying defect, usually surgical
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12
Q

What is Bladder hypoplasia commonly seen with? Px?

A

Rare

  • usully w/ other congenital defects ef. bilateral ectopic ureters
  • dx radiographically
  • poorly compliant bladder -> overflow, guarded px
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13
Q

Cause of Bladder atony ? Tx and Px?

A
  • 2* to bladder distantion

- tight junctions in bladder wall disrupted -> atonic bladder difficult to manage

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14
Q

Previous urachus

A
  • more common farm species

- rare smallies

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15
Q

Is imaging useful in incontinence investigation?

A

Yes - if normal anatomy seen, suggests functional cause

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16
Q

Outline the order of further investigation for incontinence

A
  • diagnostic imaging
  • plain rads (RLR, VD)
  • IVU (IV urography)
  • retrograde study
  • ultrasound
  • others
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17
Q

Most useful study?

A

Retrograde vagino urethro cysto gram

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18
Q

What is ultrasound useful for?

A
  • confirming ureteral emptying into bladder

- additional information on kidneys bladder and prostate

19
Q

Uses of endoscopy

A

> visualising
- ectopic ureters
- lesions of the bladder neck/urethra that can cause incontinence
- subjective evaluatino of urethral tone
facilitates biopsy
laser sx for intramural ectopic ureters
- no info on urethropelvic relatinoships
not widely available UK

20
Q

Tx urinary incontince

A
  • without dx Tx is trial and symptomatic

- ensure owners understand what you’re doing , not necessarily bad

21
Q

Medical Tx incontinence?

A 
> Tx UTI
- base on culture and sensitivity 
- confirm eradication
> Tx underlying systemic dz 
- PUPD may exaggerate or precipitate condition 
> diet if obese 
> specific mess depend on dx
22
Q

Which nerves supply the bladder and LLUT?

A 
> hypogastric n (symp)
- L1-4
- facilitates bladder filling 
- b fibres bladder, a fibres neck 
> pudendal n. (Somatic)
- S1-S3
> pelvic n. (Parasympathetic)
- S1-3
23
Q

Give 4 drug options for Tx incontinence LOOK UP TABLE

A 
> phenylpropanolamine 
- best but more expensive 
- less effective in males 
> ephedrine hydrochloride 
> oestrol
> testosterone 
- prostatic hyperplasia side effect etc.
24
Q

Which drugs are licenced?

A
  • phenylopropanolamine (propalin, Vetoquinol)
  • ephidrine hydrochloride (Enurace 50, Janssen)
  • Oestriol (Incurin, Intervet)
  • Testeosterone (Durateston, Intervet)
25
Q

Side effects of phenylpropanolamine

A
  • irritability
  • hypertension
  • anorexia
26
Q

How does the risk of adverse effects with oestriol compare to phenylpropanolamine?

A
  • lower
27
Q

how can medical tx be escalated before resorting to surgery?

A 
> off lic increase dose of PPA (phenylopropanilamine)
- watch for side effects
- combine with oestriol tx
> Imipramine
- a adrenergic
- improves bladder storage 
- anecdotally helps dogs unresponsive to PPA
> GnRH analogues
-> v FSH and LH 
- successful
28
Q

Further medical options

A
  • see above
29
Q

When is surgical Tx indicated?

A

Specific diagnosis has to be made

- not responsive to medical Tx

30
Q

Which abnormalities has surgery been described for?

A
  • ureteral ectopia
  • USMI
  • genitourinary dysplasia
  • congenital Genito-urinary malformation
  • masses
  • prostatic dz
31
Q

What should be managed prior to surgery?

A
  • weight and UTIs
32
Q

Are surgical procedures effective?

A

Not very!! No perfect techniques, many described

33
Q

Which techniques have most and least support for them?

A 
> most
- colposuspension
- urethropexy
- prosthetic sphincter 
- endoscopic injection of collagen 
> occasional reports 
- vas deferens pexy 
- urethrocystoplasty (cats)
- sling urethroplasty 
- cyst-urethroplasty
- other transpelvic slings
- other combos 
(2 types essentially: Own tissues v implants)
34
Q

General Aims of surgery for USMI?

A
  • improve pressure transmission to bladder neck
  • increase urethral resistance
  • or both
35
Q

What is the oldest described surgery for incontinence?

A

> colposuspension

  • move bladder neck into an intra-abdominal position.
  • fix with non absorbable sutures from prepubic tendon to the vagina
36
Q

Which 3 methods are more popular for treating female incontincnece?

A

> urethropexy
- similar to colposuspension (sutures urethra - prepubic tissue, bladder neck relocated cranially)
prosthetic sphincters
- currently fashionable
- ^ urethral resistacne (inflatable band around bladder neck)
- filled with saline and allows post-op tweaks
collagen or synthetic alternatives
- injected into peri-urethral tissues
- open surgery or endoscopic injector
- gets degraded over time, can accidentally cause obstruction

37
Q

Is surgical Tx of males as successful ?

A

No bitches always do better

38
Q

Surgical treatment for male SMI?

A

> Vas deferens pexy
- male colposuspension using deferent ducts
- results variable
Prostapexy
- male colposuspension using prostate to pull bladder forward
- better success rates, no complicatiosn

39
Q

Surgical Tx of ectopic ureters?

A

> reimplantation of ureter
- neo-ureterocystostomy for intramural (surgery, laser)
- ureteral transaction and reimplantation for extramural
ureteronephrectomy
- good for charity setting
- providing contralateral is still functioning

40
Q

Complications of ectopic ureter re-implantation?

A
  • continued incontincnece
  • UTIs -> pyelonephritis
  • bladder oedema and dysuria
  • stenosis or new stoma
  • recanalisation of lighted distal ureter
  • wound breakdown
41
Q

Give egs. Of specific Tx of specific less common causes of urinary incontinence

A
  • correction congenital genito-urinary malformation
  • tx prostatic dz (omentalisation etc.)
  • excision of bladder, urethral or vaginal masses
  • permemenant cystotomy
42
Q

Which tumour is most common in the bladder?

A

Transitional cell carcinoma

- not amenable to surgery

43
Q

How can incontinene be categorised? Is this useful?

A

-

44
Q

Madical tx of neurogenic atonic bladdders?

A 
> v urethral tone
- phenoxybenzamine
- diazepam 
> ^ bladder tone/contractility
- bethanecol (onl once bladder easily expressed) 
> physical bladder emptying 
- abdo pressure
- indwelling catheter 
- permanent cystotomy

Renal (23 decks)

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