Urinary Incontinence - Green Flashcards
How do we define urinary incontinence?
Involuntary escape of urine during the storage/filling phase of the urinary cycle
What are the 2 important Autonomic nerves involved in the control of micturition?
Pelvic n. & Hypogastric n.
What nerve is involved in the filling phase?
Hypogastric n. ⇒ Internal Urethral Sphincter
Which nerve is involved in the emptying phase (voiding)?
Pelvic n. ⇒ Detrusor mm. in bladder wall
Which Somatic nerve is involved in micturition?
Pudendal n. ⇒ External Urethral Sphincter
Which sphincter mm. is most important for maintaining urinary continence?
Internal urethral sphincter
(controlled by the Hypogastric n.)
List some C/S of Urinary Incontinence.
- Continously dribbles urine & is unaware they are doing it
- Normal posture & normal urine upon urination
- Has to wear a diaper
Why are diapers not the best idea for your patients that have Urinary Incontinence?
Constant moisture increases the chance of a UTI
Which tests are important to perform in patients with Urinary Incontinence?
- **Neuro exam **
- **Rectal exam **
Why is good anal tone & an intact Sacral Reflex Arc significant for these patients?
Good anal tone tells you that you have good urethral tone
(Controlled by the same nerves)
List the 4 DDX for Neurogenic Urinary Incontinence.
- UMN bladder
- LMN bladder
- Detrusor-urethral dyssynergy
- Dysautonomia
How is an UMN bladder different from a LMN bladder?
-
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 _
List some possible DDXs for Non-Neurogenic Urinary Incontinence.
- Anatomic
- Paradoxical (obstructive)
- Post-prostatectomy
- Post perineal urethrostomy
- Urge incontinence (small volume)
- **PSMI (Spay incontinence) **
List possible Anatomic causes of Urinary Incontinence.
- Ectopic ureters
- Ureteroceles
- Pelvic bladder
- Ureterovaginal/ureterorectal fistula
- Patent urachus
What does a large bladder point you towards?
- UMN bladder
- LMN bladder
- Paradoxical incontinence due to obstruction
What does a small bladder point you towards?
- PSMI ⇒ 1° Sphincter Mechanism Incontinence
- Urge incontinence
- Ectopic ureters
What is the most likely cause for urinary incontinence in a young female dog?
Ectopic ureters
What is the most likely cause for urinary incontinence in a mature female dog?
PSMI
(50% reduction in urethral tone once you spay a dog)
What breeds have a predilection for PSMI?
- Boxers
- GSD
- Dachshunds
- Dobies
- Giant Schnauzers
(Large breed dogs are more likely to get PSMI)
How common is PMSI?
~20% developed PSMI
(avg. was 3 yrs. post-OHE)
What is the most effective TX for PSMI?
Phenylpropanolamine ⇒ alpha receptor agonist
(PPA)
DDX for Hydroureter?
- Obstruction ⇒ increased pressure
- Infection
- Neoplasia
- Ectopic ureters
What is the best way to DX ectopic ureters?
- Cystoscopy/urethroscopy
- Abdominal CT w/ contrast
Are the majority of ectopic ureters Intramural or Extramural?
Intramural
Who gets Ectopic Ureters?
- Dogs > cats
- Females > males
- Young > old
What dog breeds tend to get ectopic ureters?
- Labs
- Goldens
- Huskies
- Fox terrier
- Soft-coated Wheaton terrier
60% of the time, patients with ectopic ureters will have _____ urinary incontinence.
Constant
Where are the 2 most common places that we find ectopic ureters?
- Distal urethra ⇒ 46%
- Urethral-bladder jxn ⇒ 21%
The more ______ the ectopic ureter, the more likely you will have urinary incontinence.
Distal
Which 2 ectopic ureter locations lead to increased risk
of developing hydroureters or hydronephrosis?
Mid & distal terminations
What is the SX of choice for TX Ectopic Ureters?
Ureteral stripping (85% success rate)
NB:Refer to expert surgeon
What is a less invasive method for TXing Ectopic Ureters?
- Hydraulic occluders
- Cystoscopic-guided laser ablation
What can you do if incontinence returns post-TX?
- Consider medical management⇒ PPA, estrogens, etc.
- Consider Hydraulic occluder
