Urinary incontinence caused by increased urethral closure pressure Mechanical causes for urinary retention include urethroliths, bladder

and/or urethral neoplasia, proliferative urethritis, urethral strictures, urethral foreign bodies, urethral plugs in cats, prostatic diseases (abscess, paraprostatic cyst, benign prostatic hypertrophy), and extraluminal compressions. Functional obstructions can be seen with suprasacral or brainstem disease (upper motor neuron bladders), urethral spasms that usually occur secondary to urethritis or a mechanical obstruction, idiopathic detrusor-urethral dyssynergia, and administration of -AR agonists. Bladder dysfunction can lead to detrusor atony and secondary overflow incontinence. The diagnosis of overflow incontinence is made based on history, thorough physical and neurologic examination, and complete imaging of the urinary tract. Most dogs will have a history of intermittent to persistent stranguria prior to the UI. Plain radiographs, cystourethrograms, and cystoscopy can all be beneficial to evaluate the patient for mechanical obstructions. An enema should be performed prior to radiographic studies in order to fully evaluate the distal urethra. Cystoscopy is useful to evaluate the urethral mucosa, obtain samples for biopsy and culture, and aid in placement of urethral stents if needed. If no mechanical obstructions are present, urodynamic studies may help provide insight for functional obstructions. Treatment for mechanical obstructions is to either remove the obstruction if possible or treat the lesion pharmacologically. Alpha-1 adrenoceptor antagonists (phenoxybenzamine, prazosin) can be used to help relax the internal urethral sphincter. In some cases, such as reflex dyssynergia, a skeletal muscle relaxant such as valium is also beneficial. Once these drugs have taken effect, or a urinary catheter is in place, parasympathomimetics can be started. Bethanechol, a muscarinic agent, helps to restore bladder tone and facilitate bladder emptying. In severe cases, a tube cystotomy or urethral stent may be needed for urine evacuation. Urinary incontinence caused by detrusor instability An overactive bladder occasionally results in UI, although more commonly patients have pollakiuria. Most often animals with detrusor hyperreflexia have an underlying cystitis caused by bacteria, cystic calculi, neoplasia, Reprinted in IVIS with the permission of the Congress Organizers Close this window to return to IVIS

Proceedings of the 33rd World Small Animal Veterinary Congress 2008 - Dublin, Ireland Medicine 18 WSAVA / FECAVA Programme 2008 | 411 WSAVA / FECAVA World Small Animal Congress polyps, or drugs. Occasionally, idiopathic detrusor hyperreflexia can occur and medical management can be beneficial in controlling clinical signs. Oxybutinin, tolterodine and some newer anticholinergics as well as tricyclic antidepressants (imipramine, clomipramine) have anticholinergic properties which can be considered for treatment of patients suspected of having detrusor hyperreflexia. References 1. de Groat WC, Booth AM, Yshimura N. Neurophysiology of Micturition and its Modification in Animal Models of Human Disease. In: C.A. M, ed. Nervous Control of the Urogenital System. The Autonomic Nervous System. Chur, Harwood; 1993,:227 -290. 2. Blok BF, Holstege G. The central nervous system control of micturition in cats and humans. Behav Brain Res 1998;92:119 -125. 3. Lautzenhiser SJ, Bjorling DE. Urinary incontinence in a dog with an ectopic ureterocele. J Am Anim Hosp Assoc 2002;38:29-32. 4. Cannizzo KL, McLoughlin MA, Mattoon JS, et al. Evaluation of transurethral cystoscopy and excretory urography for diagnosis of ectopic ureters in female dogs: 25 cases (1992-2000). J Am Vet Med Assoc 2003;223:475-481. 5. Samii VF, McLoughlin MA, Mattoon JS, et al. Digital fluoroscopic excretory urography, digital fluoroscopic urethrography, helical computed tomography, and cystoscopy in 24 dogs with suspected ureteral ectopia. J Vet Intern Med 2004;18:271-281. 6. Berent A, Mayhew P. Cystoscopic-guided laser ablation of ectopic rueters in 12 dogs. JVIM 2007;21:600, abstract #101. 7. Reichler IM, Pfeiffer E, Piche CA, et al. Changes in plasma gonadotropin concentrations and urethral closure pressure in the bitch during the 12 months following ovariectomy. Theriogenology 2004;62:1391-1402. 8. Hamaide AJ, Verstegen JP, Snaps FR, et al. Influence of the estrous cycle on urodynamic and morphometric measurements of the lower portion of the urogenital tract in dogs. Am J Vet Res 2005;66:1075-1083. 9. Hamaide AJ, Grand JG, Farnir F, et al. Urodynamic and morphologic changes in the lower portion of the urogenital tract after administration of estriol alone and in combination with phenylpropanolamine in sexually intact and spayed female dogs. Am J Vet Res 2006;67:901-908. 10. Augsburger HR, Cruz-Orive LM. Influence of ovariectomy on the canine striated external urethral sphincter (M. urethralis): a stereological analysis of slow and fast twitch fibres. Urol Res 1998;26:417-422.

11. Byron JK, March PA, Chew DJ, et al. Effect of phenylpropanolamine and pseudoephedrine on the urethral pressure profile and continence scores of incontinent female dogs. J Vet Intern Med 2007;21:47-53. 12. Carofiglio F, Hamaide AJ, Farnir F, et al. Evaluation of the urodynamic and hemodynamic effects of orally administered phenylpropanolamine and ephedrine in female dogs. Am J Vet Res 2006;67:723-730. 13. Reichler IM, Jochle W, Piche CA, et al. Effect of a long acting GnRH analogue or placebo on plasma LH/FSH, urethral pressure profiles and clinical signs of urinary incontinence due to sphincter mechanism incompetence in bitches