Urinary Incontinence Flashcards
What is dysuria?
Painful urination
What is stranguria?
Strained urination
What is pollakiuria?
Frequent urination of small amounts
What is polyuria?
Urination of large amounts
What is incontinence?
Involuntary release of urine through the urethra
____ ml/mg/day of urine is considered polyuric in a dog/
50 ml/kg/day
What are 3 clinical signs of incontinence?
- Wet bed
- Licking vulva/penis
- Dribbling while walking
With which of the following would the animal position (squat): incontinence or polyuria?
Polyuria
True or False: Incontinence and polyuria can occur simultaneously.
TRUE
What are the 3 nerves involved in micturition?
- Hypogastric
- Pudendal
- Pelvic
What are the 3 muscles involved in micturition?
- Detrusor
- Internal urethral sphincter
- External urethral sphincter
Which is smooth muscle, the internal urethral sphincter or the external urethral sphincter?
Internal urethral sphincter
Which is striated muscle, the internal urethral sphincter or the external urethral sphincter?
External urethral sphincter
What are the 2 phases of micturition?
- Filling
2. Voiding
What type of neurological control is filling under?
Sympathetic control
What type of neurological control is voiding under?
Parasympathetic control
What is the main neurotransmitter in filling?
Norepinephrine
What is the main neurotransmitter in voiding?
Acetylcholine
From which vertebra does the hypogastric nerve come in the dog?
L1-L4
From which vertebra does the hypogastric nerve come in the cat?
L2-L5
What effect does the hypogastric nerve have on the detrusor muscle?
Relaxation
What receptors in the detrusor muscle are targeted by the hypogastric nerve?
Beta-adrenergic receptors
What effect does the hypogastric nerve have on the internal urethral sphincter?
Contraction
What receptors in the internal urethral sphincter are targeted by the hypogastric nerve?
Alpha 1-adrenergic receptors
Is the hypogastric nerve under sympathetic or parasympathetic control?
Sympathetic
Is the hypogastric nerve involved in bladder filling or voiding?
Filling
The filling phase is also under voluntary control. What nerve is involved here?
Pudendal nerve
From which vertebra does the pudendal nerve come?
S1-S2
What is the pudendal nerve’s effect on the external urethral sphincter?
Contraction
Which receptors does the pudendal nerve effect at the level of the external urethral sphincter?
Nicotinic receptors
The pelvic nerve is involved in the voiding phase. From which vertebra does this nerve come?
S1-S3
The pelvic nerve stimulates what receptors?
Muscarinic
What is the pelvic nerve’s effect on the internal urethral sphincter?
Relaxation
What is the pelvic nerve’s effect on the detrusor muscle?
Contraction
Are ectopic ureters more common females or males?
Females
What are the 3 most common breeds predisposed to ectopic ureters?
- Siberian husky
- Labrador retriever
- Golden retriever
Are most ectopic ureter cases unilateral or bilateral?
Bilateral
Are most ectopic ureters extramural or intramural?
Intramural
What are 4 abnormalities associated with ectopic ureters?
- UTIs
- Hydronephrosis
- Hydroureter
- Vestibulovaginal septal remnants
What is the GOLD STANDARD for diagnosing ectopic ureters?
Cystoscopy
What surgical procedure is used to treat extramural ectopic ureters?
Neoureterocystostomy
What surgical procedure is used to treat intramural ectopic ureters?
Neoureterotomy
Which can be treated cystoscopically with laser ablation: intramural or extramural ectopic ureter?
Intramural ectopic ureter
With treatment of ectopic ureters, which tends to have the better outcome, males or females?
Males
What is detrusor instability?
Involuntary bladder contractions at low bladder volumes
What is the concept in treating detrusor instability?
Enhancing bladder relaxation
What type of drug would you use to enhance bladder relaxation?
Anti-cholinergic
What are 2 side effects of anti-cholinergic drugs?
- GI signs
2. Ptyalism
What are 2 anticholinergic drug options for treating detrusor instability?
- Dicyclomine
2. Oxybutinin
What are 2 tricyclic antidepressants that also work in treating detrusor instability?
- Imipramine
2. Amitryptaline
What does USMI stand for?
Urethral sphincter mechanism incompetence
What is the definition of a urethral sphincter mechanism incompetence?
Weak urethral pressure resulting in incontinence
What is the most common cause of incontinence in dogs?
Urethral sphincter mechanism incompetence
USMI is seen in what percentage of spayed females?
5-20%
Which breeds are predisposed to USMI, small breeds or large breeds?
Large breeds
Which 4 breeds, specifically, are predisposed to USMI?
- German shepherd
- Doberman
- Rottweilers
- Boxers
Clinical signs associated with USMI most commonly occur within ___ months of spaying.
3
What is the GOLD STANDARD for diagnosing USMI?
Urethral pressure profilometry
What are your 2 general medical options for treating USMI?
- Estrogen analoques
2. Alpha-adrenergics
What are the 2 alpha-adrenergic options for treating USMI?
- PPA - phenylpropanolamine
2. Ephedrine/pseudoephedrine
What are the adverse effects associated with alpha-adrenergics?
- Hypertension
- Tachycardia
- Excitement
Estrogens are another treatment option for USMI. What are the 3 mechanisms of action of estrogens?
- Increased urethral vasculature
- Hypertrophy of urethral epithelium
- Increased sensitivity of alpha1-adrenergic receptors
What is the efficacy rate of Prion (PPA - phenylpropanolamine)?
85%
What is the efficacy rate of estrogens in treating USMI?
18-65%
What are the adverse effects associated with estrogen use?
- Estrus
- Alopecia
- Bone marrow suppression
Endoscopic collagen injections are another treatment option for USMI. How long does the collagen last?
17-21 months
What is a colposuspension?
Where the vagina is affixed to the prepubic tendon, causing lengthening and compression of the urethra.
What is a cystourethropexy?
Anchoring the urethra to the ventral abdominal wall.
