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Small Animal Med. I > Urinary Incontinence - Green > Flashcards

Urinary Incontinence - Green Flashcards

1
Q

How do we define urinary incontinence?

A

Involuntary escape of urine during the storage/filling phase of the urinary cycle

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2
Q

What are the 2 important Autonomic nerves involved in the control of micturition?

A

Pelvic n. & Hypogastric n.

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3
Q

What nerve is involved in the filling phase?

A

Hypogastric n. ⇒ Internal Urethral Sphincter

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4
Q

Which nerve is involved in the emptying phase (voiding)?

A

Pelvic n. ⇒ Detrusor mm. in bladder wall

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5
Q

Which Somatic nerve is involved in micturition?

A

Pudendal n. ⇒ External Urethral Sphincter

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6
Q

Which sphincter mm. is most important for maintaining urinary continence?

A

Internal urethral sphincter

(controlled by the Hypogastric n.)

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7
Q

List some C/S of Urinary Incontinence.

A
  • Continously dribbles urine & is unaware they are doing it
  • Normal posture & normal urine upon urination
  • Has to wear a diaper
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8
Q

Why are diapers not the best idea for your patients that have Urinary Incontinence?

A

Constant moisture increases the chance of a UTI

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9
Q

Which tests are important to perform in patients with Urinary Incontinence?

A
  • **Neuro exam **
  • **Rectal exam **
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10
Q

Why is good anal tone & an intact Sacral Reflex Arc significant for these patients?

A

Good anal tone tells you that you have good urethral tone

(Controlled by the same nerves)

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11
Q

List the 4 DDX for Neurogenic Urinary Incontinence.

A
  • UMN bladder
  • LMN bladder
  • Detrusor-urethral dyssynergy
  • Dysautonomia
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12
Q

How is an UMN bladder different from a LMN bladder?

A
  • UMN bladder
    • Lesion is cranial to L4
    • Large, hard to express bladder w/ high urethral tone
    • Pressure builds up ⇒ involuntary overflow
  • LMN bladder
    • ​Lesion is btwn S1 & S3
    • Large, _easy to express bladder _
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13
Q

List some possible DDXs for Non-Neurogenic Urinary Incontinence.

A
  • Anatomic
  • Paradoxical (obstructive)
  • Post-prostatectomy
  • Post perineal urethrostomy
  • Urge incontinence (small volume)
  • **PSMI (Spay incontinence) **
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14
Q

List possible Anatomic causes of Urinary Incontinence.

A
  • Ectopic ureters
  • Ureteroceles
  • Pelvic bladder
  • Ureterovaginal/ureterorectal fistula
  • Patent urachus
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15
Q

What does a large bladder point you towards?

A
  • UMN bladder
  • LMN bladder
  • Paradoxical incontinence due to obstruction
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16
Q

What does a small bladder point you towards?

A
  • PSMI ⇒ 1° Sphincter Mechanism Incontinence
  • Urge incontinence
  • Ectopic ureters
17
Q

What is the most likely cause for urinary incontinence in a young female dog?

A

Ectopic ureters

18
Q

What is the most likely cause for urinary incontinence in a mature female dog?

A

PSMI

(50% reduction in urethral tone once you spay a dog)

19
Q

What breeds have a predilection for PSMI?

A
  • Boxers
  • GSD
  • Dachshunds
  • Dobies
  • Giant Schnauzers

(Large breed dogs are more likely to get PSMI)

20
Q

How common is PMSI?

A

~20% developed PSMI

(avg. was 3 yrs. post-OHE)

21
Q

What is the most effective TX for PSMI?

A

Phenylpropanolamine ⇒ alpha receptor agonist

(PPA)

22
Q

DDX for Hydroureter?

A
  • Obstruction ⇒ increased pressure
  • Infection
  • Neoplasia
  • Ectopic ureters
23
Q

What is the best way to DX ectopic ureters?

A
  • Cystoscopy/urethroscopy
  • Abdominal CT w/ contrast
24
Q

Are the majority of ectopic ureters Intramural or Extramural?

A

Intramural

25
Q

Who gets Ectopic Ureters?

A
  • Dogs > cats
  • Females > males
  • Young > old
26
Q

What dog breeds tend to get ectopic ureters?

A
  • Labs
  • Goldens
  • Huskies
  • Fox terrier
  • Soft-coated Wheaton terrier
27
Q

60% of the time, patients with ectopic ureters will have _____ urinary incontinence.

A

Constant

28
Q

Where are the 2 most common places that we find ectopic ureters?

A
  • Distal urethra ⇒ 46%
  • Urethral-bladder jxn ⇒ 21%
29
Q

The more ______ the ectopic ureter, the more likely you will have urinary incontinence.

A

Distal

30
Q

Which 2 ectopic ureter locations lead to increased risk

of developing hydroureters or hydronephrosis?

A

Mid & distal terminations

31
Q

What is the SX of choice for TX Ectopic Ureters?

A

Ureteral stripping (85% success rate)

NB:Refer to expert surgeon

32
Q

What is a less invasive method for TXing Ectopic Ureters?

A
  • Hydraulic occluders
  • Cystoscopic-guided laser ablation
33
Q

What can you do if incontinence returns post-TX?

A
  • Consider medical management⇒ PPA, estrogens, etc.
  • Consider Hydraulic occluder

Small Animal Med. I (18 decks)

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