Medical and surgical management of urinary incontinence

image of Medical and surgical management of urinary incontinence
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Micturition is the physiological process of storage and voiding of urine. Disorders of micturition interfere with these normal processes and can often to urinary incontinence or the inability to voluntarily control the flow of urine through the urethra. This chapter focuses on the medical, endoscopic and surgical management of urinary incontinence in small animal veterinary patients, with sections on aetiology of urinary incontinence; diagnostic approach to urinary incontinence; and treatment strategies for urinary incontinence.

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30.2 Fluoroscopic image of a female dog taken during a retrograde vaginovestibulogram showing an extramural ectopic ureter. (Courtesy of Dr Carrie Palm and Dr Bill Culp)
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30.3 Continence evaluation sheet.
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30.5 Endoscopic images taken during the injection of bulking agents in a female dog with USMI in dorsal recumbency. (a) The injection needle is passed through the working channel of the endoscope and pierces the urethral mucosa. (b) Infusion of the bulking material into the submucosal layer, creating a bleb. (c) After the bleb is formed, the needle is removed and the urethral lumen begins to coaptate.
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30.6 Endoscopic images of a female dog taken during cystoscopic-guided laser ablation of a right intramural ectopic ureter. The dog is in dorsal recumbency. (a) Urethral lumen (black arrow) showing the intramural ectopic ureteral opening in the mid-urethra (yellow arrow). (b) A urethral catheter (white arrow) and a laser fibre (red arrow) have been inserted into the lumen of the ectopic ureter (yellow arrow) prior to laser ablation. (c) Laser ablation being performed. The ureteral tissue (yellow arrow) is being cut with the laser (red arrow) towards the urethral lumen and trigone (black arrow). (d) The trigone of the bladder following laser ablation showing the new ureteral opening (yellow arrow) and the left normal ureteral opening (blue arrow).
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30.7 Fluoroscopic images of a female dog taken during CLA-EU of an intramural ectopic ureter. (a) Ventrodorsal view showing a ureteral catheter (black arrow) over a guidewire (white arrow) in the right ureter. The intramural tunnel is visible (yellow arrows). The cystoscope (red arrow) is at the level of the trigone and contrast medium is present in the urinary bladder (UB). (b) Lateral view showing the intramural tunnel (yellow arrows) of the ureter, the catheter (black arrow) and the cystoscope (red arrow). The ectopic ureteral opening (red arrow) (c) before and (d) after CLA-EU. Blue arrow = ureteral orifice; white arrow = guidewire; yellow arrow = ureteral catheter.
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30.8 CLA-EU in a male dog with ureteral junction stenosis using a perineal approach. The dog is in dorsal recumbency. (a) Endoscopic image of the right ureteral opening in the proximal urethra. (b) Fluoroscopic image showing the cystoscope at the opening of the ureter. (c) Endoscopic and (d) fluoroscopic images showing placement of the ureteral catheter through the stenotic ureteral opening. (e) Endoscopic image showing ablation of the stenotic tissue with the laser (green) cutting the tissue over the ureteral catheter (orange). (f) Endoscopic image showing that at completion of the laser ablation the ureteral opening is now seen to be an appropriate size and is no longer stenotic.
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30.9 Endoscopic images of a dog with a persistent paramesonephric remnant (PPMR) during laser ablation of the remnant. The dog is in dorsal recumbency. (a) Laser fibre at the band of tissue with a catheter is one compartment of the vagina. (b) Charring of the tissue during laser ablation. (c) An open vaginal opening following laser ablation.
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30.10 Fluroroscopic image of a urethral stent in the proximal urethra of a male dog that has DUD.
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30.11 Hydraulic occluder placement in a female dog with USMI. (a) The silicone ring prior to implantation into the patient with permanent suture material placed through the islets of the device. (b) The occluder is placed around the lumen of the urethra, approximately 1.5 cm caudal to the trigone. (c) The ring is placed around the proximal urethra and the tubing exiting the body wall is attached to the access port. Note the black Huber needle being used to flush the device with saline.
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30.12 Neoureterostomy in a female dog with unilateral ureteral ectopia and severe hydroureter. (a) A neoureterostomy has been created (the Poole suction tip is located in the stoma). The more distal intramural tunnel (large red rubber catheter) has been partially dissected prior to excision. The smaller red rubber catheter is positioned in the contralateral normally positioned ureterovesicular junction. (b) After excision of the intramural ectopic ureteral segment, the mucosa has been sutured in a simple interrupted fashion to re-establish continuity of the bladder mucosa and the site of the neoureterostomy can be clearly seen.
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30.13 Ureteroneocystostomy in a dog with extramural ectopic ureters. (a) The distal aspect of the ureter has been ligated and sectioned and is being pulled through a tunnel created in the dorsal aspect of the bladder wall in preparation for ureteroneocystostomy. (b) The completed ureteroneocystostomy has been completed by placement of fine gauge absorbable sutures in a simple interrupted pattern to appose ureteral to bladder mucosa. (c) The completed ureteroneocystostomy can be seen from the external surface of the bladder after closure of the cystotomy incision
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