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Small Animal Medicine > Renal - Urinary Incontinence > Flashcards

Renal - Urinary Incontinence Flashcards

1
Q

What is dysuria?

A

painful urination

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2
Q

What is stranguria?

A

slow/strained urination

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3
Q

What is pollakiuria?

A

Frequent urination of small amounts

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4
Q

What is polyuria?

A

urination of large amounts

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5
Q

What is incontinence?

A

involuntary (unconscious) release of urine through the urethra

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6
Q

What is incontinence associated with (like behaviorsish)?

A

A wet bed, licking penis/vulva, dribbling urine while walking

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7
Q

What behaviour is associated with polyuria?

A

positions itself in a micturition position - increased volume of urine is associated

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8
Q

What are the general components of micturition?

A

nerves and muscles

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9
Q

What nerves are involved with micturition?

A

Hypogastric, pelvic, and pudendal

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10
Q

What muscles are involved with micturition?

A

Detrusor, interrnal urethral sphincter, and external urethral sphincter

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11
Q

What are the two phases of micturition?

A

Filling and voiding

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12
Q

Filling is associated with parasympathetic/sympathetic control under the control of norepinephrine/acetylcholine.

A

Sympathetic, norepinephrine

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13
Q

Voiding is associated with parasympathetic/sympathetic control under the control of norepinephrine/acetylcholine.

A

Parasympathetic, acetylcholine

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14
Q

What are the three broad mechanisms of urinary incontinence?

A

Failure of bladder to sufficiently accommodate urine
Abnormal anatomy of ureteral termination, urinary bladder or urethral development
Failure of sufficiently functional urethral closure

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15
Q

Define destrusor instability.

A

Involuntary bladder contractions at low bladder volumes

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16
Q

What populations should you consider that detrusor instability is the cause of incontinence?

A

Incontinent dogs refractory to standard therapy

ectopic ureter patients

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17
Q

How is detrusor instability treated?

A

Enhance bladder relaxation

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18
Q

How do you enhance bladder relaxation?

A

Anticholinergics (counter the pelvic nerve from contracting the bladder)- Oxybutinin and dicyclomine
Tricyclic antidepressants

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19
Q

What is/are ectopic ureters?

A

incorrect termination of one or both ureters

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20
Q

Where are ureters normally located?

A

Dorsolateral insertion with short tunneling prior to termination in trigone

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21
Q

What are the different forms of ectopic ureters? Define.

A

intramural - penetrates serosa at the correct spot but then tunnels and opens in a different spot of the bladder
extramural - open in urethral

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22
Q

Do males or females typically get ectopic ureters more commonly?

A

Females - they also present earlier

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23
Q

What are the breed predisposition for ectopic ureters?

A

Siberian Husky, labrador retriever, golden retriever, newfoundland, english bulldog, westies

24
Q

True or False: Most cases of ectopic ureters are bilateral.

A

True

25
Q

Is intramural or extramural ectopic ureters more common?

A

intramulal

26
Q

Where is the most common termination of ectopic ureters?

A

the urethra

27
Q

What abnormalities are associated with ectopic ureters?

A

UTIs, hydroureter, hydronephrosis/pyelectasia, and vestibulovaginal septal remnants

28
Q

How are ectopic ureters diagnosed? What is the gold standard?

A

Contrast cystourethrogram
US
CT
Cystoscopy - Gold standard

29
Q

How are extramural ectopic ureters treated?

A

Neoureterocystostomy - reimplantation in correct location in the bladder

30
Q

How are intramural ectopic ureters treated?

A

Neoureterotomy and cytoscopic-guided laser ablation

31
Q

What is the outcome postop of surgical ectopic ureter correction?

A

37-74% are continent post op

32
Q

What is the outcome postop of cystoscopic laser ablation?

A

Ablation alone has continence rates of 31-57%

Ablation with other treatment has continence rates of 38-77%

33
Q

Are complications more commonly associated with surgery or laser ablation?

A

surgery

34
Q

What are common ectopic ureter correction complications?

A

Uroabdomen, ureteral stenosis, hydroureter/nephrosis

35
Q

What are some minor complications associated with ectopic ureter correction?

A

hematuria and dysuria

36
Q

What is urethral sphincter mechanism incompetence (USMI)?

A

Weak urethral pressure resulting in incontinence

Note: it is the most common cause of incontinence in dogs and also known as ‘spay incontinence’

37
Q

What are the proposed mechanisms of USMI?

A

Adhesion between the bladder neck and uterine stump
Anatomical/neural damage
Changes secondary to hormonal alterations
Caudal (pelvic) positioning in the bladder

38
Q

What is the epidemiology of USMI?

A

Seen in 5-20% of spayed female dogs
Young/middle aged large-breed dogs
Breeds: GSH, dobermans, boxers, and rottweilers

39
Q

At what age of spay is there an increased risk of USMI?

A

<3 months

40
Q

What is the gold standard of treatment for USMI?

A

Urethral pressure profilometry

Must exclude other causes of incontinence

41
Q

What are the general treatment options to USMI?

A

medical, endoscopic, and surgical

42
Q

What are the medical treatment options to USMI?

A

Alpha-agonists, estrogen analogues, and testosterone cypionate

43
Q

What is the endoscopic USMI treatment option?

A

Collagen injection

44
Q

What are the surgical USMI treatment options?

A

Colposuspension, cystourethropexy, and urethral hydraulic occluder

45
Q

What is the main alpha-agonist we use for treatment of USMI?

A

Phenylpropanolamine (PPA)

46
Q

What is the MOA of PPA?

A

Direct stimulation of urethral alpha 1 adrenergic receptors

47
Q

What are the adverse effects of PPA?

A

CV effects - hypertension, tachycardia, and excitement

48
Q

What other alpha agonists can be used to treat USMI?

A

Ephedrine and pseudoephedrine

49
Q

Why is PPA better than ephedrine and pseudoephedrine?

A

It is more effective and has less side effects

50
Q

What is the MOA of estrogens in medical therapy of USMI?

A

Increased sensitivity of alpha receptors of the urethra
Hypertrophy of urethral epithelium
Improved urethral vascularity

51
Q

What are the adverse effects of using estrogens to treat USMI?

A

Reproductive (estrus, male attraction) alopecia, bone marrow suppression

52
Q

What estrogen can be used with USMI?

A

Diethylstilbesterol and Estriol (FDA approved and more effective)

53
Q

What do urethral collagen injections do?

A

Endoscopic bulking of the proximal urethra with SQ collagen injections

54
Q

How long do collagen injections work?

A

17-21 months - will need repeated procedures

55
Q

What is colposuspension?

A

Where the vagina is affixed to the prepubic tendon to lengthen and compress the urethra
Good short term

56
Q

What is a cystourethropexy?

A

Anchoring of urethra to the ventral abdominal wall

57
Q

What does an inflatable urethral occluder do?

A

Increases the urethral tone

Small Animal Medicine (100 decks)

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