Urinary Incontinence
Willows is one of Europe’s leading small animal referral centres. Our state-of-the-art hospital is led by internationally renowned Specialists, committed to providing the highest standards of veterinary care.
Our Soft Tissue Specialists have extensive experience in the treatment and management of patient’s urinary incontinence.
Our team of Surgeons are supported by our multi-disciplinary team of Specialists across a number of disciplines including; Anaesthesia, Diagnostic Imaging and Emergency and Critical Care. Willows also has a large dedicated team of Vets, Nurses and clinical support staff available 24 hours a day, every day of the year to provide the best possible care for your pet.
Why Should I Bring my Pet to Willows for Treatment Urinary Incontinence?
What is Urinary Incontinence?
Urinary incontinence is the passive involuntary leakage of urine via the urethra occurring mainly when a dog is most relaxed i.e. lying down. There are a number of types of urine leakage that will explored before reaching the diagnosis of passive involuntary incontinence including:
- Overflow incontinence; when the bladder is so full that the valve mechanisms cannot prevent leakage
- Urge incontinence; urinary tract infection/irritation, inflammation of the bladder, prostate or vagina, and growths can all stimulate increased frequency of urination
- Increased water intake (polydipsia); related to increased urination
- Anatomical abnormalities; abnormal development of the urinary tract can predispose a dog to urine leakage, the most common form of which is incorrect placement of the ureters (ectopic ureter). Ectopic ureters usually open further downstream than normal, commonly resulting in incontinence.
Approximately 80% of mature dogs referred for investigation of urinary incontinence are diagnosed with urethral sphincter mechanism incompetence (USMI) – failure of the ‘valve’ of the bladder neck and urethra to prevent urine leakage. USMI can be congenital (present at birth) or acquired and can occur together with ectopic ureters, with the result that cases with ectopic ureters (which are present from birth) can sometimes present later in life as the valve mechanism also gradually ‘gives up’.
What Animals are Most Commonly Affected by Urinary Incontinence?
Urinary incontinence is most common in middle aged to older medium large female dogs, although male dogs can be affected. A higher number of cases are seen in Doberman Pinscher, Old English Sheep Dog and Springer Spaniel. Cats are rarely presented for incontinence.
Neutered (spayed) bitches are more likely to become incontinent, and those that do often do so within one or two years of surgery. The timing of a neutering in relation to the bitch’s first season is thought to have an impact the development of incontinence, however there is limited evidence to support this.
Most surgeons prefer to neuter female dogs after one or two seasons, particularly in breeds with a predisposition for incontinence. This potential benefit does however needs to be weighed up against the risks of unwanted puppies and mammary tumour development, which are reduced by earlier neutering.
How is Urinary Incontinence Diagnosed?
Logical and careful investigation will maximise the chances of accurate diagnosis and successful treatment.
Whilst the majority of dogs who develop incontinence in later life suffer from USMI, it is important to rule out any factors that may contribute to incontinence before considering treatment for USMI. The diagnosis and treatment of any coexisting abnormality may significantly increase the likelihood of successful treatment of or even completely avoid the need for specific treatment for USMI.
Investigation of the entire urinary tract is extremely important as there are no specific tests available to diagnosis USMI, therefore a diagnosis must be reached by ruling out all other possible causes of incontinence.
A typical investigation for incontinence will include some or all of the following tests:
- Blood tests; to test for evidence of kidney function or electrolyte abnormality
- Urine analysis;bladder infections are common in incontinent patients and can cause complications if not diagnosed and treated before surgery
- Ultrasound scan; to examine the kidneys and bladder for abnormalities and for evidence of where the ureters, enter into the bladder
- Intravenous Urogram (IVU); a dye which shows up on X-rays is injected into the bloodstream and followed into the kidneys, ureters and bladder. This is useful to detect abnormalities of the ureters, including ectopic ureters
- Double contrast cystogram; air and dye are injected up the urethra into the bladder. This is useful for examining the position of the bladder neck and when looking for bladder wall abnormalities or evidence of bladder stones
- Retrograde studies; dye is injected into the vagina, the urethra and bladder to examine the anatomy of the vagina and possibly reveal ectopic ureters not seen in the IVU
- Cystoscopy; a small camera can be placed in the bladder neck via the urethra in medium and large breed dogs. This technique is very useful in ruling out ectopic ureters
In the event that a urine infection is diagnosed, this will require antibiotic treatment for four to six weeks. A negative culture result following the end of antibiotic treatment will also be required prior to surgery.
What Treatments are Available for Urinary Incontinence?
Medical: Where USMI is the only or major cause of urine leakage a good response can be achieved through medical therapy. Some will become continent and some will be greatly improved, although some will remain incontinent. The drug therapy requires daily administering and will fail to work as soon as treatment is stopped. A minority of dogs can experience behavioural changes on some medications. Some medications can be given together, improving their effect.
Surgical: Surgery for uncomplicated USMI is reserved for dogs where medical treatment is unsuccessful, or continuous therapy proves impractical. There are a number of techniques available to increase the resistance to leakage of uring, all of which have very similar success rates.
- Urethropexy (males and females);The urethra is surgically fixed in a position to improve continence
- Colposuspension (females only);The vagina, associated urethra and bladder neck, are surgically held in a position to improve continence
- Collagen injections; into the bladder neck via a camera placed in the urethra (males require a modification of this technique). Injections need to be repeated after two to three years
- Prostatopexy (males only); the prostate gland is used as an anchoring point to improve the positioning of the urethra and bladder neck.
What can I Expect if my Pet is Treated for Urinary Incontinence?
Research suggests that the outlook following surgery is the same regardless of the technique used:
- 50% -60% become continent
- 30% – 40% are improved but require some supplemental medication to remain continent
- 10% – 20% do not benefit from surgery
Complications of the different surgical procedures are similar regardless of technique used. These include infection, urine retention and continued incontinence. The choice of surgical technique used will be tailored to the individual pet and based on the evidence gained during the investigation and the discussions between the veterinary surgeon and the owner.
The experience of our Soft Tissue Specialists indicates that at Willows we can be a little more positive than the above figures suggest, and offer continence for to 75% – 80% of cases following surgical treatment for USMI.
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Soft Tissue Surgery
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