Micturition Disorders

Question 1

What categories are micturition disorders divided into?

Answer 1

Neurogenic and non-neurogenic

Question 2

What are some common micturition disorders?

Answer 2

UMN bladder (spastic/autonomic)
Reflex detrusor- urethral dyssynergia
Detrosor atony
LMN bladder (detrusor and urethral areflexia)
Dysautonomia
Urinary incontinence

Question 3

What does the parasympathetic nervous system control in the bladder?

Answer 3

Causes the bladder to contract (bladder emptying)

Question 4

What does the sympathetic nervous system control in the bladder?

Answer 4

Causes the bladder to relax and the internal muscle sphincter to contract (bladder filling)

Question 5

What does the somatic system control in the bladder?

Answer 5

External urethral sphincter contraction (voluntary micturition) and sensory component

Question 6

What nerve provides parasympathetic innervation to the bladder?

Answer 6

Pelvic nerve (S1-3)

Question 7

What nerve provides sympathetic innervation to the bladder?

Answer 7

Hypogastric nerve (dogs L1-4; cats L2-5)

Question 8

What nerve provides somatic innervation to the bladder?

Answer 8

Pudendal nerve (S1-3)

Question 9

What nerve provides sensory information to the bladder?

Answer 9

Pelvic nerve (S1-3)

Question 10

What controls the passive filling phase or urination?

Answer 10

Hypogastric nerve

Question 11

What controls the active voiding phase of urination?

Answer 11

Pelvic nerve and pudendal nerve

Question 12

T/F: Pudendal nerve control of the external urethral sphincter can be overridden by the cerebrum.

Answer 12

True

Question 13

What nerological effects will an UMN bladder have?

Answer 13

Detrusor areflexia with sphincter hyperreflexia

Reflex dyssynergia can also occur

Question 14

What PE signs are characteristic of an UMN bladder?

Answer 14

Small to large distended bladder that is difficult to express and only expels small volumes

Question 15

What spinal lesion will result in an UMN bladder?

Answer 15

Lesions cranial to the sacral segment

Question 16

What is baclofen?

Answer 16

Rx anti-spasmotic that helps UMN bladders by relaxing the skeletal muscle

Question 17

What neurological effects will a LMN bladder have?

Answer 17

Detrusor areflexia and sphincter areflexia

Question 18

What PE signs are characteristic of an LMN bladder?

Answer 18

Large bladder that is easily expressed and may leak constantly

Question 19

What spinal lesion will result in an LMN bladder?

Answer 19

Sacral spinal cord or pelvic segment

Question 20

What drug is typically prescribed for LMN bladders?

Answer 20

Bethenecol

Manual bladder emptying recommended

Question 21

What is detrusor-sphincter reflex dyssynergia?

Answer 21

Initiation of detrusor contraction triggers urethral sphincter spasms

Question 22

What is the treatment for detrusor-sphincter reflex dyssynergia?

Answer 22

Phenoxybenzamine (alpha blockers)

Question 23

What are lower urinary dysautonomias most common in?

Answer 23

Cats- very rare condition with a poor prognosis

Question 24

What is the typical etiology of detrusor atony?

Answer 24

Overfilling of the bladder due to obstruction of UMN dysfunction

Question 25

What are the clinical signs of detrusor atony?

Answer 25

Large flaccid bladder on PE with normal neurological dysfunction

Question 26

What is the doctor term for urge incontinence?

Answer 26

Detrusor instability/hyperreflexia

Question 27

What is detrusor instability/hyperreflexia?

Answer 27

Detrusor contraction during storage phase of urination or low compliance of detrusor muscle

Question 28

How do you confirm detrusor instability/hyperreflexia?

Answer 28

Cystometrography

Question 29

What are the clinical signs of urge incontinence?

Answer 29

Pollakiuria, stranguria, dysuria

Question 30

What is the treatment for urge incontinence?

Answer 30

Anticholinergic drugs- oxybutynin, imipramine, dicyclomine

Question 31

What is urinary incontinence?

Answer 31

The involuntary escape of urine during the storage phase of the urinary cycle

Question 32

How does urinary incontinence manifest clinically?

Answer 32

Intermittent or continuous dribbling of urine with a normal voiding episode

Question 33

What are the mechanisms of urinary incontinence?

Answer 33

- Intravesicular pressure greater than urethral pressure | Anatomic abnormalities

Question 34

What is the most common etiology of urinary incontinence?

Answer 34

Urinary sphincter mechanism incompetence (SMI)

Question 35

What are some differentials of urinary incontinence?

Answer 35

``` Neurological disease Ectopic ureters Vaginal stricture Pelvic bladder Ureterocele Ureterovaginal fistula ```

Question 36

What kind of neurological condition will result in apparent urinary incontinence?

Answer 36

LMN bladder- not TECHNICALLY true urinary incontinence

Question 37

What is a common anatomical abnormality that will present with apparent incontinence?

Answer 37

Hooded/recessed vulva- will also see dermatitis and urine scalding

Question 38

What are conditions that will present with apparent incontinence?

Answer 38

- Pollakiuria - PU/PD - Behavioral issues

Question 39

What are two anatomical abnormalities that can predispose to sphincter mechanism incompetence?

Answer 39

Intrapelvic bladder and wide urethra

Question 40

What percentage of true incontinence issues is SMI responsible for?

Answer 40

85%

Question 41

What will a clinical examination show in an animals with SMI?

Answer 41

Soiled perineal coat with urine scald and anatomical correctness Neuro exam rules out UMN/LMN dysfunction

Question 42

What will urinary tone depend on?

Answer 42

Urethral tone, urethral length, reproductive status

Question 43

What effect does estrogen have on the urethra?

Answer 43

Thins the mucosal wall and lower number of alpha-1 receptors

Question 44

T/F: Urinary sphincter incompetence is most commonly reported in male dogs.

Answer 44

False- very rarely reported in male dogs

Question 45

What is the typical signalment of a urinary sphincter incompetence patient?

Answer 45

Spayed female dog

Question 46

Is the incidence of urinary sphincter incompetence higher in large breed or small breed dogs?

Answer 46

Large breed

Question 47

What is estrogen responsive incontinence?

Answer 47

Lack on estrogen causing a decrease in sensitivity of the smooth muscle receptor to sympathetic stimulation

Question 48

Will estrogen therapy help with estrogen responsive incontinence?

Answer 48

Kinda- 61-65% improval

Question 49

What is the pressure transmission theory?

Answer 49

When the urethral neck is not in the abdominal cavity, it is not subjected to the same pressures as the bladder and the bladder pressure will exceed the urethral pressure resulting in leakage of urine

Question 50

What is the hammock theory?

Answer 50

In cases where the anatomic structures maintaining the bladder ant he urethra are abnormal - supporting layers of the urethra are formed by pelvic fascia and suburethral vaginal wall and by distal fixation to pubic bones. During increased abdominal pressure, stabilization occurs and adds tone to the urethra

Question 51

What are the indications for a urethral pressure profile?

Answer 51

1. Urethral sphincter mechanism incompetence 2. Detrusor instability 3. Reflex dyssynergia 4. Neurogenic abnormalities

Question 52

What are some other tests for determining urodynamics?

Answer 52

Cystometry and electromyography

Question 53

T/F: Spaying dogs results in decreased urethral pressures typically within 18 months.

Answer 53

True- compensatory increase in striated muscle in the cauldal 1/3 of the urethra

Question 54

T/F: Tail docking increases incidence of urinary incontinence.

Answer 54

True

Question 55

What is the concern with treating incontinence female dogs with etrogen or estriol?

Answer 55

Bone marrow supression/aplasia

Question 56

What is an implantation treatment for urinary incontinence?

Answer 56

Implant of bovine collagen into the urethra to increase urethral pressures - May necessitate repeat procedures

Question 57

What is the typical surgical procedure to correct urinary incontinence?

Answer 57

Coposuspension and urethropexy 53% regain continence and 37% improved continence Complication rate 21%

Question 58

What is the difference in treatment of urinary incontinence with phenylpropanolamine (PPA) and ephedrine?

Answer 58

Similar effects to the bladder and overall outcome but ephedrine has more cardiovascular side effects making it a worse choice Pseudoephedrine has a very poor outcome when compared to PPA and ephedrine treatments

Question 59

Is there a difference in outcome/symptoms between treatment with estriol alone and estriol and PPA combination?

Answer 59

No, similar outcomes so long as a singular therapy is not sufficient

Question 60

What is the typical presentation of ectopic ureters?

Answer 60

Wet coat, inflamed perineum, excoriation and urine scald

Question 61

How are ectopic ureters diagnosed definitively?

Answer 61

Excretory urogram CT and cystoscopy are best IVP and CT can have false positives

Question 62

What is the typical treatment of choice for ectopic ureters?

Answer 62

Cystoscopic laser ablation

Question 63

What will you also see with ectopic ureters on IVP?

Answer 63

Hydronephrosis and hydroureter

Question 64

T/F: Ectopic ureters can be hereditary.

Answer 64

True- may likely have other developmental anomalies in the urogenital tract

Question 65

What is a common complication of ectopic ureters?

Answer 65

Recurrent UTI and pyelonephritis Need to treat and rid infection before proceeding with surgery to fix ureters

Question 66

What is a complication after surgery to fix ectopic ureters?

Answer 66

Urinary Sphincter mechanism incompetence