Micturition Disorders and Management

Question 1

what are the 2 types of ectopic ureters?

Answer 1

1. intramural: tunnels in bladder wall and ends up somewhere beyond the bladder
   -MOST COMMON
   -tx: use a laser to cut middle wall back, take opening back to where other opening is; high success rate than sx (sx: lower success rate, 50%)
2. extramural: ureter totally bypasses bladder, inserts into urethra or vagina
   -tx: surgically cut where entering, reimplant into bladder: neouretocystostomy (75% continent post sx)

Question 2

describe urinary incontinence

Answer 2

can be separated into

1. overflow: urethral blockage or bladder unable to empty properly
   -functional/mechanical issue
2. stress: relaxed pelvic floor or increased abdominal pressure
   -cats with FIC
   -tx with parasympatholytics!
3. urge: bladder oversensitivity from infection or neuro disorder
4. USMI: decreased internal urethral sphincter tone, potentially decreased bladder capacity
   -FUNCTIONAL PROBLEM
   -don’t leak when awake, because somatic tone can override
   -when relax/asleep: leak

Question 3

describe parasympatholytics to manage FIC incontinence

Answer 3

1. antimuscarininc: propantheline, oxybutynin
2. antispasmodic agents: oxybutynin, flavoxate
3. TCAs: some pain relief and relaxation

Question 4

describe urethral sphincter mechanism incompetency

Answer 4

USMI

1. most common micturition disorder!!
2. super common in spayed female dogs:
   -5-20% of female dogs
   -months to years after OHE
   -middle aged to older large breeds (the larger the dog and the earlier they are spayed, the higher the risk, risk lowers if you allow them to go through one heat cycle too)
   -increased BCS
   -associated with tail docking
   -no difference between spay method
   -loose association with hypothyroidism
3. fine when awake (external urethral sphincter works fine, under conscious control)
   -when asleep/relaxed: take away conscious control and starts to leak

Question 5

describe pathology of USMI

Answer 5

1. bladder neck position
2. urethral or vaginal comformation
3. tail docking
4. reproductive hormone imbalance: decreased estrogen/testosterone, increased FSH/LH
5. reduced UCP due to
   -increased collagen, decreased smooth muscle

Question 6

describe what drug to use to manage USMI

Answer 6

sympathomimetics!!

1. alpha agonists:
   -phenylpropanolamine: side effects are systemic hypertension and hyperactivity; another problem is human abuse (precursor for meth)
   -pseudophedrine
   -ephedrine
2. reproductive hormones:
   -estrogens!!: not sympathomimetic; just increase number of receptors in smooth m. of proximal urethra and increase secretions (more foldy and more sticky together = increase tone)
   -incurin (estriol): only approved!
   -testosterones
   -GnRH analogs
3. surgical slings
4. urethral bulking
5. hydraulic occluder
6. transobturator tape

Question 7

compare and contrast alpha agonists and estrogens to manage USMI

Answer 7

effectiveness:
alpha: 75-90%
estrogens: 45-65%, estriol >90%

indications:
alpha: males or females, animals with poor response to estrogen, younger dogs
estrogens: females in combinations, for recurrent UTI or vaginitis, potentially also for young dogs?

admin:
alpha: q8-24hrs; short residual effects
estrogens: q 3-14 days; possibly prolonged residual effects

adverse effects:
alpha: hyperactivity, hypertension, anorexia, wt loss
estrogens: behavioral changes, bone marrow tox, estrus

contraindications:
alpha: cardiac disease, renal disease, hypertension
estrogen: males, intact females, imm-med diseases

Question 8

describe USMI failure to respond to treatment

Answer 8

1. dosing:
   -could be due to inadequate dose and/or frequency
   -if owner discontinues when continent
   -failure to use PPA with estrogen
2. complicating problem:
   -UTI: subclinical other than incontinence; tx infection and will become continent (CULTURE URINE!! UA looks pristine)
   -PU/PD: diet, medication, metabolic dz
   -hypothyroidism

Question 9

describe pelvic bladder (FYI)

Answer 9

doesn’t ALWAYS mean they will have problems

but if become incontinent are much harder to control with drugs bc urethra is so short

Question 10

describe surgical treatment of pelvic bladder (FYI)

Answer 10

high complication rate, low success rate longterm

1. culposuspension: pull vagina forward
2. urethropexy
3. cystourethropexy: anchor bladder and urethra
4. sling urethroplasty
5. any combo of above

Question 11

describe urinary incontinence in male dogs

Answer 11

1. usually secondary to another problem
2. USMI: usually secondary to lumbosacral disease
   -can be testosterone responses (only about 50% effective)
   -use sympathomimetic (phenylpropanolamine)

Question 12

describe urinary incontinence in cats

Answer 12

1. voiding disorders are common, esp post obstruction
2. urinary incontinence (rare) but can be due to:
   -neurogenic: trauma, meningioma, congenital
   -FIC
   -urethral disease: PU, stricture, etc.
   -cancer: bladder, urethra
   -USMI (6%)
3. UTI in 39%
4. 50% of the incontinent are euthanized; worse prognosis with spinal disease

Question 13

see and study table!!

Answer 13

go look at it!!