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Diagnostic approach to the incontinent patient

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Abstract

Urinary incontinence is a common problem in small animal veterinary practice. Careful attention to the history and physical examination, and a systematic approach to diagnostic planning, will ensure that unusual or uncommon disorders will not be missed. In this chapter, a basic diagnostic algorithm is presented for the assessment of male dogs and bitches with urinary incontinence as well as more detailed information on diagnostic imaging and the used of advanced diagnostic techniques.

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/content/chapter/10.22233/9781910443354.chap9

Figures

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9.1 Diagnostic algorithm for male dogs with urinary incontinence. CTEU = computed tomographic excretory urogram; PU/PD = polyuria/polydipsia; USMI = urethral sphincter mechanism incompetence; UTI = urinary tract infection. (© Julie Byron)
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9.2 Diagnostic algorithm for bitches with urinary incontinence. BP = blood pressure; CBC = complete blood count; Conj. = conjugated; CTEU = computed tomographic excretory urogram; DES = diethystilboestrol; OHE = ovariohysterectomy; PPA = phenylpropanolamine; PU/PD = polyuria/polydipsia; Tx = therapy; U/A = urinalysis; U/S = ultrasonography; USMI = urethral sphincter mechanism incompetence; UTI = urinary tract infection. (© Julie Byron)
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9.3 Juvenile or ‘hooded’ vulva. (a) This 8-year-old neutered female mixed-breed dog had a 3-year history of urinary incontinence due to urethral sphincter mechanism incompetence (USMI) and recurrent urinary tract infections. (b)There is evidence of perivulvar dermatitis when the perineal folds are retracted. The relationship between a ‘hooded’ vulva and USMI in neutered bitches is unclear.
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9.5 Normal contrast cystourethrogram in a male dog. This 8-year-old male neutered Golden Retriever was evaluated for difficulty urinating and was diagnosed with functional urethral obstruction.
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9.6 Normal contrast vaginourethrogram in a 13-year-old neutered female Samoyed with urethral sphincter mechanism incompetence. Radiopaque suture material is secondary to previous overiohysterectomy.
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9.7 Abnormal contrast vaginourethrogram in a 1-year-old neutered female Dobermann with urinary incontinence since weaning. Note the hypoplastic urethra, pelvic bladder position and narrow vagina. The bladder capacity in this dog is also subjectively reduced. (© Julie Byron)
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9.8 Computed tomographic excretory urogram of ureteral ectopia in a 3-year-old neutered female Miniature Pinscher with urinary incontinence since weaning. (a) Sagittal plane of the abdomen. Note the contrast enhancement of the ureters caudal to the neck of the bladder (arrowed). The bladder is filling with contrast as it flows retrograde from the ectopic openings. (b) Transverse plane of the abdomen at the level of the proximal urethra. Both ectopic ureters (white arrows) are clearly visible as well as the urethra (black arrow), with a small amount of contrast in the lumen. (© Julie Byron)
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9.9 Cystoscopic view of an ectopic ureter in a 1-year-old neutered female Labrador Retriever with a history of urinary incontinence prior to neutering. The left ureter (arrowed) terminated in the middle third of the urethra and the right ureter terminated at the bladder neck. Laser tissue ablation was used to open the ureters at the level of the trigone. (© Julie Byron)

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