Urinary Incontinence Flashcards
Define urinary incontinence
Urinary incontinence is defined as involuntary leaking of urine from the bladder during the storage phase of micturition and can result from anatomical or functional abnormalities
What are the causes of urinar incontinence? (8)
- Urinary obstrcution with overflow
- Urethral disease
- Neuro disease
- Baldder disease
- Vaginal disease
- Congenital
- Iatrogenic
- Idiopathic
How do you work up an urinary incontinence case? (3)
Clinical history:
- What do yo need to ask a client to determine whetehr the animal is incontinet/dysuric
- Could the animal be PU/PD?
Physical exam:
- Differentiate between the possible casues
Note:
- Major bit is asking client and finding out about clinical history, our patients cannot speak to us! Appropriate history from own is paramount. Could animal be PUPD instead?
- Important question to ask is does the dog get up and there is urine where its sleeping or lying? (if its physically healthy and can move, a dog will never urinate where its sleeping) is if the animal is aware its urinating?
- How do we classify a dog as being PUPD? Measure the intake of water, more than 90-100ml/kg/24h of water roughly
What would we look for on blood with urinary incontience? (4)
- Look at renal parameters (BUN and creatinine – called azotemia when they are increased together). To differentiate between post, renal and pre:
- Post – most common is obstruction
- Pre-renal vs renal – to differentiate measure USG – ask for urine sample
- Look at potassium and sodium – help determine if renal azotemia or not
- Look at glucose
- Look for alkaline phosphatase – cushings disease?
Why is urinary analysis worht doing for urinary incontinence? (3)
- Look for infeciton
- Do a dipstick to look for glucose
- Do an SG to differentiate and have an appropraite SP
How can we collect urine samples for analysis? (3)
- Free catch
- Cystocentesis
- Catheteristation
Which imaging modality could we use for urinary incontience?
- Ultrasound – look at bladder, any neoplasia, ectopic ureters, congenital abnormalities, uroliths? etc
- Cancers in bladder of dog – transitional call carcinomas
What cancer affects the bladder?
Transitional cell carcinoma
Early spaying is a catch 22.. why is this?
–Early neutering may cause urinary incontinence
–Studies indicate if not spayed before first season higher risk of mammary cancer –Developement of mammary cancer – discussions about early neutering and early neutering can cause some neoplasia? But this is discussion
Note the difference between vets:
–My friend at a large first opinion practice in Phoenix Arizona recommends spaying dogs at 6 months of age………as she says…….she would rather have a dog that MIGHT become incontinent vs. having the risk of the dog developing cancer !!!!
–At Pride we spay dogs pre-season as well
What are the risk factors for developing a urine spinchter mechanism incompetence (USMI)? (4)
–Size & breed
–Neutering
–Discussion about neutering and urethral tone with this - debates
–Urethral tone
–Obesity - If obese, having disucssion about dog may benefit from losing some weight before we look at medications or surgery
What breeds are predisposed to USMI? (7)
•Irish Setters, Rottweilers, Dobermanns, bearded collie, rough collie, Old English Sheepdogs & Dalmatians
What are the 2 treatment options for urinary incontinence?
–Medical
–Surgical
What are the 2 medical options for treating urinary incontience?
–Phenylpropanolamine (Propalin)
–Oestradiol (Incurin)
How does phenylpropanolamine (Propalin) work?
–Acts as α2 agonist – sympathomimetic to increase urethral tone
How many doses of phenylpropanolamine (Propalin) are recommended daily?
BID - TID
How would you interpret these bloods?
- Not anaemic
- WBC little bit low according to computer
- Platelet count within reference range
- No abnormalities on WBC on smear
- So in great scheme of things – nothing too exciting
- If WBC was REALLY low, might worry.
- Repeated bloods in this patient and they were normal at this stage
How would you interpret this biochemistry in a possible incontient dog?
- Alkaline phosphatase – only has ref range of 0-90, are we concerned about 281? Not really, as he said only worry about it until its 7x the high end of the normal reference range.
- Aspartate aminotransferase – normally elevated when creatinine kinase is elevated also. Why would this be? CK is a muscle parameter that will go a little bit up if doing a blood test as going through the muscle. If CK value is just slightly high, don’t be alarmed – to be concerning they have to be up to something silly such as 10,000-15,000! Is AST and CK slightly up, don’t be alarmed – might just be due to us doing a blood test
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- High cholesterol – post-prandial sample. Ask if owner starved the dog. Other things that can cause high cholesterol – hyperthyroid, one of the main players on the field for high cholesterol. No dermatological reasons for hyperthyroid though and had not had weight gain and no behavioural changes. Could ask owner to starve pet for a longer period of time for next test and re-check
- Urea and creatinine and liver parameters (ALT) WNL
- If ALT up, there is something affecting the liver
- Not diabetic
How would you interpret this urinalysis? (done by cysto)
In a possible incontinent dog
- No abnormalities on dipstick
- Okay SG, likely to be more like 1.030 – 1.035
