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Sem 6: SAM 2 > Micturition Disorders > Flashcards

Micturition Disorders Flashcards

1
Q

What is the normal residual volume?

A

< 0.2 - 0.5 mL/kg

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2
Q

What normally occurs during the storage phase of micturition?

A
  • SNS pathway causes increased urethral tone and relaxation of detrusor muscle to allow filling and prevent urination
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3
Q

What normally occurs during the voiding phase of micturition?

A
  • PNS pathway causes Ach release from pelvic nerve to contract detrusor muscle and relax urethral sphincter to allow urination
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4
Q

What is the drug of choice for promoting voiding by increasing detrusor muscle activity?

A

Bethanechol

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5
Q

What is the drug of choice to increase the tone of the urethral sphincters and promote urinary storage and filling phase of micturition?

A

Phenylpropanolamine (PPA) (Proin)

(to help with urinary leakage and incontinence)

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6
Q

What is the drug of choice to decrease the tone of the urethral sphincters and promote voiding and urination?

A

- Prazosin
- Phenoxybenzamine
- Tamsulosin

(Skeletal muscle relaxants like Diazepam IV, Aceprom and methocarbamol help too)

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7
Q

What clinical signs can be seen with an UMN bladder?

A
  • Firm, distended bladder that is difficult to express
  • CS of urinary retention!!
  • History of IVDD, spinal trauma, neoplasia, FCE (lesions cranial to S1-S3)
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8
Q

What is the treatment protocol for a patient presenting with signs consistent with an UMN bladder?

A
  • Reduce urethral tone with Prazosin or Phenoxybenzamine
  • Stimulate bladder contractility with Bethanechol
  • Treat underlying cause (ex: spinal cord lesion)
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9
Q

What is the treatment protocol for a patient presenting with signs consistent with an LMN bladder?

A

Increase urethral sphincter tone with Phenylpropanolamine (PPA / Proin)

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10
Q

What clinical signs can be seen with a LMN bladder?

A
  • Flaccid bladder that is easily expressed
  • Tail paralysis
  • Loss of sensation to perineum
  • Fecal incontinence
  • Seen with lesions affecting S1-S3
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11
Q

What is detrusor urethral dyssynergy?

A
  • Incoordination between detrusor muscle contraction and sphincter relaxation
  • Results in an interruption in urine stream during peeing and incomplete voiding
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12
Q

What clinical signs can be seen with Detrusor urethral dyssynergy?

A
  • Normal initiation of urination followed by a stop in urine stream
  • Results in incomplete voiding followed by dribbling
  • Seen in middle aged, large breed males

(Note: these patients have normal sacral reflexes and bladder tone, no nerve deficits)

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13
Q

How can Detrusor urethral dyssynergy be diagnosed?

A
  • Measure residual urine volume!! Dyssynergy if > 20 mL/kg
  • Presumptive diagnosis made based on interrupted urine pattern, large residual urine volume, and easy passage of catheter
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14
Q

What is the treatment plan for a dog with Detrusor urethral dyssynergy?

A
  • Reduce urethral tone with Prazosin, Phenoxybenzamine, or Tamsulosin
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15
Q

What is USMI?

A

Urethral sphincter mechanism incompetence

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16
Q

What signmalment in dogs is a risk factor for Urethral sphincter mechanism incompetence (USMI)?

A
  • Large breed spayed females (Due to lack of Estrogen which is normally protective)
  • Dobermans , Schnauzers, Sheepdogs, Rotties, Boxers
  • Increased risk if spayed < 3 months old or after 1st heat
  • History of hooded vulva
  • Short urethra (females)
  • Obesity
17
Q

List non neurogenic disorders of micturition resulting in an inability to store urine

A
  • USMI
  • Ectopic ureters
  • Detrusor hyperreflexia (cystitis)
18
Q

List non neurogenic disorders of micturition resulting in an inability to completely void urine

A
  • Obstructive FIC (urethral plugs, stones, etc)
  • Detrusor muscle atony from over distention
19
Q

What history and presenting complaints do patients with USMI come in with?

A
  • Incontinence when animal is relaxed, asleep, or after exertion
  • Increased grooming
20
Q

What is the treatment protocol for a female dog with USMI?

A
  • Synthetic Estrogen: DES or Estriol (Incurin)
  • PPA / Proin to increase sphincter tone and decrease incontinence

(Beware of BM toxicity with estrogen!!)

21
Q

What is the treatment protocol for a male dog with USMI?

A
  • Testosterone IM for 4-6 weeks
  • Can also use PPA / proin to increase sphincter tone and decrease incontinence
22
Q

What signalment can be consistent with ectopic ureters?

A
  • YOUNG females < 1 yr old
  • Golden Retrievers
  • History of leaking urine without conscious awareness
23
Q

A 4 year old female spayed dog is presenting after the owner found the dog this morning sleeping in a puddle of pee on her bed. The owner notes she urinates normally throughout the day. What do you suspect and how do you treat?

A

Suspect USMI treat with Phenylpropanolamine (PPA / Proin)

24
Q

What dog breeds are predisposed to ectopic ureters?

A
  • Golden retrievers
  • Huskies
  • Labs

(Young dogs!! < 1 yr old)

Sem 6: SAM 2 (26 decks)

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