Urinary incontinence & prostatic dz

Question 1

List the differentials for urinary incontinence in males

Answer 1

Ectopic ureter
Prostatic disease
Atonic bladder
Sphincter mechanism incompetence (SMI)
Reflex dyssngeria

Question 2

List the differentials for urinary incontinence in females

Answer 2

Ectopic ureter
Reflex dyssnergia
Vestibulovaginal defects
Atonic bladder
Sphincter mechanism incompetence

Question 3

Describe the common history and clinical signs associated with ectopic ureters

Answer 3

Hx - 12 wks - 1yo, wet bed, normal urine stream
Clinical exam - wet coat, inflamed perineum, skin pigmentation
Males - adults, can be asymptomatic

Question 4

What findings would be expected on a contrast radiograph of a femal with an ectopic ureter?

Answer 4

Third line of contrast between the urethra and repro tract

Question 5

What findings would be expected on a contrast radiograph of a male with an ectopic ureter?

Answer 5

Hydroureter

Long urethra

Question 6

How would an ectopic ureter be treated?

Answer 6

1. treat the skin condition prior to sx - bathe and coat skin in water repelling ointment
2. make a hole in the bladder, tie off the ureter distally, feed into the bladder and suture in place

Question 7

What are common complications of ectopic ureter sx?

Answer 7

Missed contralateral ectopic.
Double ureters.
Concurrnet sphincter mechanism incompetence.

Question 8

What are the clinical signs associated with SMI?

Answer 8

Clinically normal, urinate when asleep/relaxed/jumping into car

Question 9

What radiographich changes are evident with SMI?

Answer 9

Normal
Wide urethra
Intrapelvic bladder

Question 10

How is SMI treated?

Answer 10

Medically: phenylpropanolamine (alpha adrenergic agonsit), Estriol (stimualtes urethral tone)
Surgery should be a last resort if medical management fails.

Question 11

What are the surgical options of SMI?

Answer 11

Colposuspension
Moves the bladder cranially into the abdomen, away from the pelvis.
Suture the vagina to the prepubic tendon.