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Urinary incontinence
British Small Animal Veterinary Association , 287 (2015); https://doi.org/10.22233/9781910443248.15
/content/chapter/10.22233/9781910443248.chap15
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Urinary incontinence

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Abstract

The focus of this chapter is on animals in which urinary incontinence is the primary sign, although other urinary abnormalities may be present in some cases. Urinary incontinence is a common problem in dogs (around 5% of adult bitches; Forsee et al., 2013), with many affected animals managed medically in first-opinion practice, often after only minimal diagnostic investigations. This chapter looks at anatomy and physiology, investigation, differential diagnosis and different conditions. Practical tips are included. Colposuspension; Cystourethropexy; Prostatopexy; Vas deferensopexy; Urethral submucosal collagen injection; Ureteroneocystotomy; Ureteral reimplantation.

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Figures

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15.1
Innervation of the bladder and urethra. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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15.1 Innervation of the bladder and urethra. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.2
(a) Intra-abdominal bladder neck. Raised intra-abdominal pressure results in pressure on the bladder and proximal urethra (arrowed), favouring continence. (b) Intrapelvic bladder neck. Raised intra-abdominal pressure favours urine leakage (arrowed). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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15.2 (a) Intra-abdominal bladder neck. Raised intra-abdominal pressure results in pressure on the bladder and proximal urethra (arrowed), favouring continence. (b) Intrapelvic bladder neck. Raised intra-abdominal pressure favours urine leakage (arrowed). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.3
Retrograde vaginourethrogram of a bitch with a markedly intrapelvic bladder neck. © 2015 British Small Animal Veterinary Association
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15.3 Retrograde vaginourethrogram of a bitch with a markedly intrapelvic bladder neck.
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15.4
Artificial urethral sphincter. The cuff which is wrapped around the urethra is to the lower left and the port, which is placed subcutaneously, is to the upper left of the image. © 2015 British Small Animal Veterinary Association
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15.4 Artificial urethral sphincter. The cuff which is wrapped around the urethra is to the lower left and the port, which is placed subcutaneously, is to the upper left of the image.
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15.5
(a) Intramural ectopic ureter with a submuscosal tunnel opening in the urethra. (b) Extramural ectopic ureter. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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15.5 (a) Intramural ectopic ureter with a submuscosal tunnel opening in the urethra. (b) Extramural ectopic ureter. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.6
Urethroscopic image of an intramural ectopic ureter opening into the urethra. © 2015 British Small Animal Veterinary Association
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15.6 Urethroscopic image of an intramural ectopic ureter opening into the urethra.
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15.7
Retrograde vaginourethrogram demonstrating an intramural ectopic ureter (course indicated by and ) entering the urethra (indicated by *). The approximate point of entry is indicated by the black arrow. © 2015 British Small Animal Veterinary Association
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15.7 Retrograde vaginourethrogram demonstrating an intramural ectopic ureter (course indicated by and ) entering the urethra (indicated by *). The approximate point of entry is indicated by the black arrow.
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15.8
Large ectopic ureter opening into the urethra. A guidewire has been placed into the ureteral opening. (Reproduced from with permission from the publisher) © 2015 British Small Animal Veterinary Association
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15.8 Large ectopic ureter opening into the urethra. A guidewire has been placed into the ureteral opening. (Reproduced from with permission from the publisher)
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15.9
Laser resection of the ureteral opening back to the trigone. (Reproduced from with permission from the publisher) © 2015 British Small Animal Veterinary Association
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15.9 Laser resection of the ureteral opening back to the trigone. (Reproduced from with permission from the publisher)
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15.10
Retrograde vaginourethrogram showing urethral hypoplasia in a queen. © 2015 British Small Animal Veterinary Association
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15.10 Retrograde vaginourethrogram showing urethral hypoplasia in a queen.
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15.11
Bladder neck reconstruction for urethral hypoplasia. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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15.11 Bladder neck reconstruction for urethral hypoplasia. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.12
Retrograde vaginourethrogram illustrating urovagina. © 2015 British Small Animal Veterinary Association
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15.12 Retrograde vaginourethrogram illustrating urovagina.
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15.13
Ureteral vaginal fistulation in a cat. Combined intravenous urogram and retrograde vaginourethrogram showing the normal ureter entering the trigone (black arrow) and the other ureter () becoming tortuous and joining the vaginal stump (white arrow). The urethra is shown by the asterisk (*). © 2015 British Small Animal Veterinary Association
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15.13 Ureteral vaginal fistulation in a cat. Combined intravenous urogram and retrograde vaginourethrogram showing the normal ureter entering the trigone (black arrow) and the other ureter () becoming tortuous and joining the vaginal stump (white arrow). The urethra is shown by the asterisk (*).
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The external pudendal vessels and prepubic tendon should be identified prior to colposuspension (left side shown, caudal is top right and ventral top left of the image, prior to incising the linea alba).
The external pudendal vessels and prepubic tendon should be identified prior to colposuspension (left side shown, caudal is top right and ventral top left of the image, prior to incising the linea alba). © 2015 British Small Animal Veterinary Association
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Image of The external pudendal vessels and prepubic tendon should be identified prior to colposuspension (left side shown, caudal is top right and ventral top left of the image, prior to incising the linea alba).
The external pudendal vessels and prepubic tendon should be identified prior to colposuspension (left side shown, caudal is top right and ventral top left of the image, prior to incising the linea alba). The external pudendal vessels and prepubic tendon should be identified prior to colposuspension (left side shown, caudal is top right and ventral top left of the image, prior to incising the linea alba).
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Intraoperative photograph showing the vagina being grasped during colposuspension. Caudal is to the right of the image and the vagina has been grasped on either side of the urethra.
Intraoperative photograph showing the vagina being grasped during colposuspension. Caudal is to the right of the image and the vagina has been grasped on either side of the urethra. © 2015 British Small Animal Veterinary Association
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Image of Intraoperative photograph showing the vagina being grasped during colposuspension. Caudal is to the right of the image and the vagina has been grasped on either side of the urethra.
Intraoperative photograph showing the vagina being grasped during colposuspension. Caudal is to the right of the image and the vagina has been grasped on either side of the urethra. Intraoperative photograph showing the vagina being grasped during colposuspension. Caudal is to the right of the image and the vagina has been grasped on either side of the urethra.
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End result of colposuspension (transverse section; dorsal is at the top of image).
End result of colposuspension (transverse section; dorsal is at the top of image). © 2015 British Small Animal Veterinary Association
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Image of End result of colposuspension (transverse section; dorsal is at the top of image).
End result of colposuspension (transverse section; dorsal is at the top of image). End result of colposuspension (transverse section; dorsal is at the top of image).
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Cross-section showing a urethropexy suture (ventral is to the top and dorsal to the bottom of the image).
Cross-section showing a urethropexy suture (ventral is to the top and dorsal to the bottom of the image). © 2015 British Small Animal Veterinary Association
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Image of Cross-section showing a urethropexy suture (ventral is to the top and dorsal to the bottom of the image).
Cross-section showing a urethropexy suture (ventral is to the top and dorsal to the bottom of the image). Cross-section showing a urethropexy suture (ventral is to the top and dorsal to the bottom of the image).
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Suture placement in prostatopexy (for clarity, only one suture is shown on each side) (ventral is to the top and dorsal to the bottom of the image).
Suture placement in prostatopexy (for clarity, only one suture is shown on each side) (ventral is to the top and dorsal to the bottom of the image). © 2015 British Small Animal Veterinary Association
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Image of Suture placement in prostatopexy (for clarity, only one suture is shown on each side) (ventral is to the top and dorsal to the bottom of the image).
Suture placement in prostatopexy (for clarity, only one suture is shown on each side) (ventral is to the top and dorsal to the bottom of the image). Suture placement in prostatopexy (for clarity, only one suture is shown on each side) (ventral is to the top and dorsal to the bottom of the image).
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Ventral view of vas deferensopexy (cranial is to the top and caudal to the bottom of the image).
Ventral view of vas deferensopexy (cranial is to the top and caudal to the bottom of the image). © 2015 British Small Animal Veterinary Association
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Image of Ventral view of vas deferensopexy (cranial is to the top and caudal to the bottom of the image).
Ventral view of vas deferensopexy (cranial is to the top and caudal to the bottom of the image). Ventral view of vas deferensopexy (cranial is to the top and caudal to the bottom of the image).
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Injection apparatus for urethral collagen injection.
Injection apparatus for urethral collagen injection. © 2015 British Small Animal Veterinary Association
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Image of Injection apparatus for urethral collagen injection.
Injection apparatus for urethral collagen injection. Injection apparatus for urethral collagen injection.
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Result of submucosal injection in the urethra. This urethroscopic image shows the urethra closed by three submucosal mounds of collagen.
Result of submucosal injection in the urethra. This urethroscopic image shows the urethra closed by three submucosal mounds of collagen. © 2015 British Small Animal Veterinary Association
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Image of Result of submucosal injection in the urethra. This urethroscopic image shows the urethra closed by three submucosal mounds of collagen.
Result of submucosal injection in the urethra. This urethroscopic image shows the urethra closed by three submucosal mounds of collagen. Result of submucosal injection in the urethra. This urethroscopic image shows the urethra closed by three submucosal mounds of collagen.
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The ureter is stomatized into the bladder at the level of the trigone and ligated just distal to the stoma.
The ureter is stomatized into the bladder at the level of the trigone and ligated just distal to the stoma. © 2015 British Small Animal Veterinary Association
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Image of The ureter is stomatized into the bladder at the level of the trigone and ligated just distal to the stoma.
The ureter is stomatized into the bladder at the level of the trigone and ligated just distal to the stoma. The ureter is stomatized into the bladder at the level of the trigone and ligated just distal to the stoma.
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Transection of the distal ureter. (Redrawn after McLoughlin and Chew, 2000)
Transection of the distal ureter. (Redrawn after ) © 2015 British Small Animal Veterinary Association
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Image of Transection of the distal ureter. (Redrawn after McLoughlin and Chew, 2000)
Transection of the distal ureter. (Redrawn after McLoughlin and Chew, 2000) Transection of the distal ureter. (Redrawn after )
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Mosquito forceps are used to create a tunnel through the bladder. The stay suture in the end of the ureter is grasped and the ureter is drawn through the bladder wall into the lumen. (Redrawn after McLoughlin and Chew, 2000)
Mosquito forceps are used to create a tunnel through the bladder. The stay suture in the end of the ureter is grasped and the ureter is drawn through the bladder wall into the lumen. (Redrawn after ) © 2015 British Small Animal Veterinary Association
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Image of Mosquito forceps are used to create a tunnel through the bladder. The stay suture in the end of the ureter is grasped and the ureter is drawn through the bladder wall into the lumen. (Redrawn after McLoughlin and Chew, 2000)
Mosquito forceps are used to create a tunnel through the bladder. The stay suture in the end of the ureter is grasped and the ureter is drawn through the bladder wall into the lumen. (Redrawn after McLoughlin and Chew, 2000) Mosquito forceps are used to create a tunnel through the bladder. The stay suture in the end of the ureter is grasped and the ureter is drawn through the bladder wall into the lumen. (Redrawn after )
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