Urinary Incontinence in the Bitch: An Update

Abstract

Contents Urinary incontinence (UI), defined as the involuntary loss of urine during the filling phase of the bladder (Abrams et al. 2002), is a commonly seen problem in veterinary practice. Urinary sphincter mechanism incompetence (USMI) after spaying is the most common micturition disorder, and its medical treatment is normally successful, even though the underlying pathophysiological mechanism is not fully understood. Hormonal changes inducing structural and functional alterations in the bladder, as well as in the urethra composition, are discussed. To manage incontinent patients successfully, possible underlying abnormalities besides USMI should be ruled out. In the majority of cases, history, physical examination and simple tests including urinalysis and urine bacterial culture lead to a presumed aetiology. If USMI is the most likely cause, then the advantage of further diagnostic tests should be discussed with the owner before starting a trial therapy with alpha‐adrenergic drugs. Potential side effects of this therapy have to be mentioned even though they rarely occur. It is important to thoroughly evaluate the success of the initial treatment. Its failure should lead to further diagnostic testing. Specialized clinical assessments may provide an aetiological diagnosis, and this could serve as a basis for discussing further treatment options. Surgical procedures, which may in rare cases cause irreversible side effects, may be instituted. If incontinence reoccurs after initial treatment was successfully performed, the diagnostic work‐up including urinalysis should always be repeated. As results of urinalysis did not correlate well with results of bacterial culture, a urine culture is recommended (Comer and Ling 1981). Cystocentesis is the preferred method of urine collection (Bartges 2004). Equivocal results of quantitative cultures of urine samples obtained during midstream voiding or by catheterization require repeat collection by cystocentesis (Comer and Ling 1981).

Medical treatment of urinary incontinence in the bitch

“…So far, no consensus has been reached about the link between the age of the dog at spaying and the concurrent risk of USMI (Arnold et al, 1989;Arnold, 1997;Thrusfield et al, 1998;Stöcklin-Gautschi et al, 2001;de Bleser et al, 2011;Beauvais et al, 2012;Forsee et al, 2013;Reichler and Hubler, 2014). In earlier studies, an increased risk of developing incontinence has been mentioned when spaying was performed before three months of age (Thrusfield et al, 1998;Stöcklin-Gautschi et al, 2001), or when dogs have had their first oestrus (Arnold et al, 1989).…”

Bir Dişi Golden Retrieverda Ektopik Üreter Operasyonu Sonrası Kalıcı Üriner İnkontinensin Tedavisinde Deslorelin Asetatın Etkisi

“…GnRH analogues are especially suitable for patients showing serious side effects after therapy with alpha adrenergic agonists or if alpha-adrenergic agonists are contraindicated. So far, there have been no reports on side effects after the use of GnRH analogues in ovariectomized bitches [13] . In the literature, GnRH depot analogue was reported to have restored incontinence only in castrated male dog [17] and cat [18] .…”

“…The success rate varies from 86% to 97% for phenylpropanolamine and 74-93% for ephedrine. But the use of alpha-adrenergic agonists is contraindicated in diseases where an increase in blood pressure should be avoided, as in most kidney diseases, heart problems or glaucoma [13,14] . The subcutaneous application of GnRH depot analogues (Deslorelinacetate 4.7 mg/dog) increases bladder compliance and is successful as a single therapy in approximately 50% of bitches with UI.…”

“…Unfortunately phenylpropanolamine is not completely effective in the treatment USMI [11,12] . Recently gonadotropin-releasing hormone (GnRH) analogues were shown to improve continence in ovariectomized female dogs [1,13,14] .…”

Kastration der Hündin – neue und alte Erkenntnisse zu Vor- und Nachteilen

“…Harninkontinenz wird mit einer Inzidenz von 5-20 % als eine der häufigsten Nebenwirkungen der Kastration beschrieben (93,121 Ein kausaler Zusammenhang zwischen Kastration und dem Auftreten von Harninkontinenz wurde bereits vor über einem halben Jahrhundert beschrieben (54) und 20 Jahre später erstmals statistisch belegt (120). Im Jahr 2012 wurde die wissenschaftliche Evidenz des Zusammenhangs zwischen Kastration oder Kastrationsalter und Harninkontinenzrisiko untersucht und abschließend als schwach bezeichnet (9).…”