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38 Cards in this Set

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Urinary incontinence problems?

-- leaking urine


-- inc. in frequency


-- unfruitful efforts to urinate

Pudendal n. innervates ______ sphincter.

-- external sphincter

Parasympathetic br. innervates ______ sphincter.

-- internal sphincter

Two phases of micturition?

-- storage phase


>> sympathetic input to sphincters >> closed




-- voiding phase


>> parasympathetic input


>> detrusor m. contracts


>> sphincters relax

Animal attempts to void, indicating?

-- normal bladder innervation and sensation


>> can detect that it's full

If animal attempts to void but cannot?

-- likely obstructed

If animal does not attempt to void?

-- innervation problem

If animal attempts to void but is unable to void completely?

-- partial function


-- obstruction


-- sphincter dysfunction

Animal has to go (frequency/urgency) all the time?

-- hyperfunction


>> hypersensitivity of the bladder


>> inflammation most common cause


>> infection in dogs, idiopathic cystitis in cats

Animal leaks urine?

-- weak sphincter


-- anatomical defect

Animal leaks only with full bladder?

-- paradoxical (obstructive) incontinence

Sphincter function: stops suddenly?

-- sphincter timing problem


-- obstruction

Neurological lesion between brainstem to L7?

Upper motor neuron bladder


-- detrusor areflexia (atonic bladder)


-- sphincter hypertonus


>> no attempt to void


>> no voiding


>> lg. amount residual urine


>> difficult to express


Neurological lesion of sacrum?

Lower Motor Neuron Bladder


-- detrusor areflexia + sphincter areflexia


>> no attempt to void


>> no voiding (may leak)


>> large to moderate amount residual urine


>> easy to express

Neurological lesion of pudendal n.?

-- decreased sphincter tone


>> voiding normal
(leakage with stress, full bladder)


>> no residual urine


>> easy to express


>> perineal reflex may be absent

Causes of normal voiding + incontinence?

-- leaking when bladder is full


-- sphincter incompetence


>> urethral sphincter mechanism incompetence


>> UTI


>> pudendal lesion


-- anatomical defects
>> sphincter by-pass: ctopic ureters

What are ectopic ureters? Signs?

-- one or both ureters bypass the sphincter


-- normal urination


-- constant leaking


-- leaking during stress


-- important Ddx in young animals

Diagnosis of ectopic ureters?

-- intravenous pyelogram w/ CT


-- cystoscopy


-- CT

Treatment of ectopic ureters?

-- surgery


-- laser ablation

Three reasons for sphincter incompetence?

-- urethral sphincter mechanism incompetence


-- UTI


-- pudendal lesion

What is urethral sphincter mechanism incompetence (USMI)?

-- middle-aged, spayed females


-- incontinence with full bladder


>> leak at night or when relaxed


>> hours after voiding


>> can be precipitated by PU/PD

Diagnosis of USMI?

-- history and clinical signs


-- rule out UTI
-- urethral pressure profile

Treatment of USMI? Watch for?

-- phenylpropanolamine, BID or TID


>> watch for hypertension


-- dethylestilbestrol (DES)


>> watch for bone marrow suppression)


-- imipramine


>> use in conjunction with other drugs

Bone marrow suppression from DES: when do you know there is a problem?

-- monitor CBC


-- don't ignore any cytopenia in dogs on DES


>> starts with neutropenia (stop drug now!)


>> second, lose platelets


>> third, lose RBCs (too late!)

Surgical treatment of USMI?

-- colosuspension (pull bladder forward, stretch urethra)


-- cystourethropexy


-- bladder or urethral slings


-- periurethral collagen injection


-- hydraulic occluder

Causes of urge incontinence (normal voiding + incontinence + inc. frequency)?

-- inflammation of urinary bladder


-- UTI and stones


-- sensation of fullness at low volumes


-- urgency

Treatment of urge incontinence?

-- propantheline


-- oxybutynin


-- RO inflammation, infection, stone

Most common cause of dog that attempts to void and stops suddenly?

-- stones in male dogs

Another cause of dog that attempts to void and stops suddenly?

-- reflex dyssnergia


>> bladder and sphincters are not coordinated

What is paradoxical obstruction?

-- obstruction causes leaking with full bladder


>> treat underlying problem


>> urethral stones


>> prostatitis, urethritis, neoplasia (TCC)

No attempts to void, leaks constantly?

-- empty bladder >> anatomical defect


-- full bladder >> paradoxical (obstruction) or detrusor arreflexia

Detrusor arreflexia (hypotonic bladder) can be caused by?

-- normal or inc. sphincter tone (UMN bladder)


-- decreased sphincter tone (LMN bladder)


-- overdistention




>> should have other neuro signs, like paresis

How does overdistension cause detrusor arreflexia?

-- separation of tight junctions causes atony


>> can also be caused by inflammation, edema


>> act immediately to prevent permanent damage!


>> avoid manual expression

Overdistension treatment?

-- keep bladder empty for 7 days


>> place urinary catheter


>> allow tight junctions to be repaired




-- bethanecol to inc. contractility

Most common cause of urinary incontinence in young dogs?

-- ectopic ureters

Most common cause of urinary incontinence in a spayed female dog?

-- USMI, UTI

Most common cause of urinary incontinence in a male dog?

-- UTI

Obstruction can cause?

--paradoxical incontinence


-- can lead to atonic bladder