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Urinary and Reproductive tract surgery > Urethral Sphincter Mechanism Disorders > Flashcards

Urethral Sphincter Mechanism Disorders Flashcards

1
Q

How common is USMI in cats?

A

Rare

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2
Q

Other than USMI what is the common cause of urinary incontinence in juvenile dogs?

A

Ureteral ectopia

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3
Q

Congenital conditions causing USMI? (3)

A

absence of the urethra, diverticula or urethral dilations

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4
Q

How many female dogs will develop USMI after spay?

A

20%

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5
Q

Average interval between spay and USMI?

A

3.75 years

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6
Q

Causes of USMI in male dogs? Congenital (2)

A

Urethral dilation
Protstatic diverticula

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7
Q

Factors increasing USMI risk?

A

Bladder position (intra pelvic bladder)
Urethral tone
Urethral length
Body size
Breed - larger breeds
Gonadectomy
Hormones

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8
Q

What reflex type if micturition?

A

Autonomous

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9
Q

Two components of micturition?

A

Filling/storage
Voiding

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10
Q

Filling/storage phase:
- What muscle relaxes?

A

Detrusor

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11
Q

What receptor stimulate detrusor muscle relax?

A

Beta

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12
Q

What receptors stimulate urethral sphincter contraction?

A

Alpha

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13
Q

Which nerve is involved in filling/storage?

A

Hypogastric

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14
Q

Which fibres are involved in filling/storage?

A

Sympathetic

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15
Q

Filling/storage phase:
Closure of the urethral sphincter (outlet) is further enhanced by other support structures such as urethral wall A) and striated muscle fibres of the B) (under voluntary control via the C) nerve), which are intertwined with the smooth muscle fibres of the internal urethral sphincter.

A

A) collagen
B) external urethral sphincter
C) pudendal

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16
Q

What phase is it when detrusor muscle contracts?

A

Voiding

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17
Q

Which nerve is involved in detrusor contraction?

A

Pelvic nerve

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18
Q

What process leads to detrusor contraction?

A

When there is sufficient stretch of muscle

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19
Q

What nerve is inhibited allowed external urethral sphincter relaxation during voiding phase?

A

Pudendal n

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20
Q

2 nerves in voiding phase?

A

Pelvic
Pudendal

21
Q

What type of fibre is present in the voiding phase?

A

Parasympathetic

22
Q

Pelvic nerve:
A) Nerve type?
B) Neurotransmitter?
C) Action of bladder?
D Action on urethral sphincter?

A

A) Parasympathetic
B) Aceytlcholine
C) Contraction
D) Relaxation

23
Q

Pudendalnerve:
A) Nerve type?
B) Neurotransmitter?
C) Action of bladder?
D Action on urethral sphincter?

A

A) Somatic
B) Acetylcholine
C) No action
D) Contraction

24
Q

Hypogastric nerve:
A) Nerve type?
B) Neurotransmitter?
C) Action of bladder?
D Action on urethral sphincter?

A

A) Sympathetic
B) Norepinephrine
C) Relaxation
D) Contraction

25
Q

How to diagnose USMI

A

Exclusion

26
Q

Diagnostics to perform in an incontinent dog? (6)

A

CBC
Biochem
Urinalysis
Urine culture
Rectal palp
Vestibular exam

27
Q

How to differentiate on exam USMI and ectopic ureter?

A

USMI: weak ureteral sphincter (internal) – intermittent urinary incontinence – mostly dribbling primarily during recumbency.
Ectopic ureter: ectopic ureter bypasses the normal ureteral entry - patients have continual or very frequent dribbling.

28
Q

What are various host defences against urinary tract infection? (5)

A

Normal micturition
Mucosal defense barrier
Antibacterial properties of the urine
Specific anatomical structures such as urethral sphincter, length of urethra
Systemic immunocompetence

29
Q

What imaging should be performed if congenital incontinence is suspected?

A

retrograde urethrocystography and/or IV urography

30
Q

Which weight of dog is 7 times more likely to get USMI after neutering?

A

> 15kg

31
Q

What is the cure rate for single therapy for USMI?

A

50%

32
Q

Most common medical approach to USMI? (2)

A

diethylstilbestrol (DES) and phenylpropanolamine (PPA)

33
Q

Preferred medical treatment for USMI in cats and why

A

PPA is preferred as DES administration in that species cause signs of oestrus.

34
Q

Phenylpropanolamine
A) Class of drug
B) Mechanism of action

A

A) Sympathomimetic
B) Increase contraction of internal sphincter

35
Q

Oestradiol:
A) Class of drug
B) Mechanism of action

A

A) Synthetic hormone
B) Increase contraction of internal sphincter

36
Q

Prazosin
A) Class of drug?
B) Mechanism of action?

A

A) Sympathicolytic
B) Relaxation of the skeletal muscle (external sphincter)

37
Q

Dantrolene:
A) Class of drug?
B) Mechanism of action?

A

A) Muscle relaxant
B) Relaxation of the skeletal muscle (external sphincter)

38
Q

Diazepam:
A) Class of drug?
B) Mechanism of action?

A

A) Benzodiazepine (muscle relaxant)
B) Decrease contraction of internal sphincter

39
Q

Bethanechol:
A) Class of drug?
B) Mechanism of action?

A

A) Parasympathiocomimetic
B) Enhance micturition by increasing detrusor contraction

40
Q

Surgical treatments of USMI? (5)

A
  • Colposuspension
  • Techniques to reposition the bladder (urethropexy/cystourethropexy)
  • Intraurethral injections of bulking agents
  • Transvaginal tape-obturator (TVT-O)
  • Artificial urethral sphincter placement (AUS).
41
Q

Are medical/surgical treatments more successful in male or female?

A

Female

42
Q

What is colpsusension?

A

This involves anchoring the vaginal wall on either side of the urethra to the pre-pubic tendon with the aim of increasing the functional urethral length and re-locating the bladder neck to an intra-abdominal position

43
Q

Colposuspension success rate?

A

The short-term outcome is often excellent, though the success rate for long-term complete continence is only around 50%.

44
Q

Complications of colposuspension? (4)

A
  • Recurrent UTI
  • Tenesmus
    -Pain during 1st defecation
  • Polyuria
45
Q

Examples of intraurethral injections of bulking agents?

A

autologous fat, bovine cross‐linked collagen, polytetrafluoroethylene (PTFE‐Teflon, Polytef) paste, polydimethylsiloxane (PDMS‐Macroplastique), calcium hydroxylapetite (Coaptite), and carbon‐coated zirconium beads (Durasphere).

46
Q

What is Transvaginal tape-obturator?

A

TVT-O involves placement of a tape which is placed around the dorsal urethra, through the obturator foramen and is tied on the ventral aspect of the pubic symphysis

47
Q

What is artifical urethral sphincter?

A

The silicone hydraulic occluder is placed around the proximal urethra and is connected via tubing to a subcutaneous port located on the caudal abdomen where it can be inflated with saline as necessary until continence is achieved.

48
Q

Why des artificial urethral sphincter have an excellent outcome?

A

the ability to inflate cuff (and therefore partially occlude the urethra) as needed.

Urinary and Reproductive tract surgery (10 decks)

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