Urinary incontinence in a male dog

Re: Urinary incontinence in a male dog

Anthony Todd — Mon, 23 Jun 2014 16:56:23 GMT

[quote user="Thomas Johnson"]I have never had a failure with Propalin, Incurin, or a combination of the two. But just because you and I have been fortunate enough not to see one of the more unusual cases that doesn't respond to medical therapy, we should be aware that there are many reported cases where medical management doesn't completely resolve the problem.[/quote]

I must admit I have absolutely no data to back up, actually [!], anything I state 'cos it's all based on unreliable [probably] recollections of a few successes and/or failures which would distort any opinion probably.

The other thing too is that the bitch I treated for incontinence "successfully" actually never came back 'cos the owner was totally unhappy with me etc. yet i may put that down as a glowing success.

In this day of data-mining it should be so easy to pick up a large number of "leaky" dogs and easily show how many responded to this or that.

The only people that seem to do it [blocked cats anyway] are universities or second opinion centres who only see the last resort cases.

I'd love to be able to collect data from some of the busy SA practices [if there are any now...] so that we'd know that drug X for condition Y is hopeless, based on 126 cases etc. etc.

The NHS has this glorious opportunity to get a vast amount of therapeutic data but they'll blow it 'cos of "data protection".

More's the pity.

Re: Urinary incontinence in a male dog

Thomas Johnson — Mon, 23 Jun 2014 09:16:29 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]Though Incurin is licensed, cheaper, and works on the same receptors.[/quote]

Will it match my 100% success with stilboestrol?

[/quote]

I have never had a failure with Propalin, Incurin, or a combination of the two. But just because you and I have been fortunate enough not to see one of the more unusual cases that doesn't respond to medical therapy, we should be aware that there are many reported cases where medical management doesn't completely resolve the problem.

And the £77 for 28 stilboestrol tablets was the list price from our wholesaler for the human generic product, though I'm sure you can get it a bit cheaper elsewhere.

Re: Urinary incontinence in a male dog

Anthony Todd — Sat, 21 Jun 2014 18:57:19 GMT

[quote user="Thomas Johnson"]Though Incurin is licensed, cheaper, and works on the same receptors.[/quote]

Will it match my 100% success with stilboestrol?

Re: Urinary incontinence in a male dog

Anthony Todd — Sat, 21 Jun 2014 18:55:24 GMT

[quote user="Thomas Johnson"]There is no veterinary licensed stilboestrol,[/quote]

I can only state again that, in a spayed incontinent bitch, I never had a failure with stilboestrol whereas propalin did fail.

If there is no vet licenced stilboestrol then you can use the cheaper generic human tabs, or aren't there any now.

Does the VMD serve any useful purpose to the public or animals or does it only benefit the drug manufacturers?

Is there just one example of the VMD preventing anything bad happening to animals ?

Re: Urinary incontinence in a male dog

Thomas Johnson — Sat, 21 Jun 2014 11:00:05 GMT

[quote user="Anthony Todd"]

Jeepers, sorry, didn't know. We used to buy 1000 5mg for a few pounds! Anyone remember APS?

These look cheaper but you'll probably go to jail...

http://www.petceutics.com.au/stilboestrol-tablets.html

Mind you, I'm ashamed to admit, it was the generic human drug, fine for use in that species but may be lethal in dogs without the exhaustive testing so necessary for the safety of animals now.

[/quote]

There is no veterinary licensed stilboestrol, you could still use it via the cascade after you'd tried Propalin and Incurin. Though Incurin is licensed, cheaper, and works on the same receptors.

Re: Urinary incontinence in a male dog

Anthony Todd — Sat, 21 Jun 2014 09:55:07 GMT

[quote user="Thomas Johnson"]stilboestrol recently? £77 + VAT from our wholesaler[/quote]

Jeepers, sorry, didn't know. We used to buy 1000 5mg for a few pounds! Anyone remember APS?

These look cheaper but you'll probably go to jail...

http://www.petceutics.com.au/stilboestrol-tablets.html

Mind you, I'm ashamed to admit, it was the generic human drug, fine for use in that species but may be lethal in dogs without the exhaustive testing so necessary for the safety of animals now.

Animals and ourselves are so lucky we have the vital protection of the VMD.......

Re: Urinary incontinence in a male dog

Thomas Johnson — Sat, 21 Jun 2014 09:36:38 GMT

[quote user="Anthony Todd"]

[quote user="Ian Battersby"]We have used AUS in a few complicated female incontinent patients that have failed other techniques[/quote]

Is HRT tried first in all cases? [I mean in spayed bitches]

I don't think we ever had it fail in a spayed bitch which was continent before spaying. Iused to put cases that failed on propalin back on stilboestrol.....

Why are the simple, cheap, effective things changed to a less reliable and always more expensive treatment or procedure these days?

Another res star I expect...

[/quote]

Have you seen the price of stilboestrol recently? £77 + VAT from our wholesaler for 28 1mg tablets! And I can't imagine anyone is considering surgical intervention without trying medical therapy first.

Re: Urinary incontinence in a male dog

John Flynn — Sat, 21 Jun 2014 09:08:44 GMT

[quote user="Evelyn Barbour-Hill"]AUS is................?[/quote]

"Artificial Urinary Sphincter", an experimental treatment for urinary incontinence in pets, hence being described as a "last-resort" when all else has failed.

Having said that, I'm not totally sure that this will necessarily improve the welfare of the patient and is warranted other than from an owner convenience stand-point (which always makes me a little uncomfortable for any surgical procedure, including the pre-pubertal spaying when the only reason presented is "because I don't want the mess of her bleeding" that may have led to the incontinence in the first place)? What do others think? Do you consider urinary incontinence to be a welfare problem in these patients having this procedure performed?

[quote user="Anthony Todd"]

Is HRT tried first in all cases? [I mean in spayed bitches]

I don't think we ever had it fail in a spayed bitch which was continent before spaying. Iused to put cases that failed on propalin back on stilboestrol.....

[/quote]

Firstly, I rule out UTI's or PUPD, then I tend to use either phenylpropanolamine or estriol first line, and switch to the other second-line if no success, third-line I use both together, fourth-line I throw in a deslorelin-implant (with no case successes as yet) as well, and fifth-line I offer colposuspension/urethropexy, sixth-line would probably be rehoming to a home where the incontinence isn't an issue - I've come close, but not had to euthanase one of these yet.

Of course if the bitch hadn't been spayed in the first place...

Do others consider stilboestrol more effective than estriol also? If one has failed is it worth trying the other?

Re: Urinary incontinence in a male dog

Anthony Todd — Sat, 21 Jun 2014 00:15:22 GMT

[quote user="Ian Battersby"]We have used AUS in a few complicated female incontinent patients that have failed other techniques[/quote]

Is HRT tried first in all cases? [I mean in spayed bitches]

I don't think we ever had it fail in a spayed bitch which was continent before spaying. I used to put cases that failed on propalin back on stilboestrol.....

Why are the simple, cheap, effective things changed to a less reliable and always more expensive treatment or procedure these days?

Another res star I expect...

Re: Urinary incontinence in a male dog

Evelyn Barbour-Hill — Fri, 20 Jun 2014 21:11:50 GMT

AUS is................?

Re: Urinary incontinence in a male dog

Ian Battersby — Fri, 20 Jun 2014 09:42:46 GMT

We have used AUS in a few complicated female incontinent patients that have failed other techniques, but we tend to use them as last treatment as we are still awaiting long term follow up data on how the devices are tolerated.

In males we haven't used AUS ( aware of non published reports), our preference is to use bulking agents in the prostatic urethra which are delivered using cystocopy. We have used collagen and silicone based products for this. we also use bulking agents in females as well

Re: Urinary incontinence in a male dog

Martin Atkinson — Wed, 18 Jun 2014 09:51:20 GMT

[quote user="Kirsten Simpson"]

Would having had a prostatic abscess in the past make him more prone to more if he got testosterone though? (Honestly, I can't remember if it is). Will chat to O just now and give her options.

[/quote]Interesting question given that I now an now aware that prostatic tumours are more likely in castrated dogs as they are not testosterone dependent . Don't know about prostatic cysts/abscesses though.

Re: Urinary incontinence in a male dog

Anthony Todd — Tue, 17 Jun 2014 20:48:15 GMT

[quote user="bob lehner"]Indeed - comes to most of us eventually...[/quote]

Not being personal, but do they use testosterone in male [human] incontinence?

[forewarned is forearmed...]

Re: Urinary incontinence in a male dog

Kirsten Simpson — Tue, 17 Jun 2014 17:42:38 GMT

Would having had a prostatic abscess in the past make him more prone to more if he got testosterone though? (Honestly, I can't remember if it is). Will chat to O just now and give her options.

Re: Urinary incontinence in a male dog

Anthony Todd — Tue, 17 Jun 2014 17:13:28 GMT

Used to be able to get testosterone tabs but castrated dogs were rare. Incontinent bitches responded brilliantly to stilboestrol tabs but you had to use minimal doses or they came on heat, of course.

Re: Urinary incontinence in a male dog

Eamon McAllister — Tue, 17 Jun 2014 16:39:12 GMT

I find that Sustanon 250 works well in leaky old castrated dog provided there are no other health issues. It comes in 1ml ampoules so I give 1ml per dog and repeat when necessary. I have known it to work for 6 or 8 weeks or more.

Re: Urinary incontinence in a male dog

Kirsten Simpson — Tue, 17 Jun 2014 15:14:39 GMT

Hijacking a thread, sorry!

Anything new on this though? Have a 12yr 5mo MN dog, castrated 4 years ago along with a nasty ruptured prostatic abscess that almost killed him. Initially was dribbling few drops when climbing up onto furniture, not happening when lying relaxing. Not all the time. When out is U+ otherwise normally. Does has arthritis and the owner gives meloxicam. Took full bloods and nothing apart from sl raised ALKP (but lab says most likely from NSAID use). Was going to try on Propalin. Anything better? Did dipstick/CG in house and all 100% normal. Could it be nerve damage from prostate op or too late for that? To do with his arthritis and weakening legs + muscles?

Re: Urinary incontinence in a male dog

Jenny Smith — Sat, 01 Mar 2014 00:56:07 GMT

I remember seeing a few referred cases of older (5y+) incontinent male dogs - investigations confirmed ectopic ureters and they were taken to surgery. My 6yo boxer has started to become a little leaky, not quite at the threshold for me to start investigations but definitely getting there

Jenny

Re: Urinary incontinence in a male dog

Rob Davis — Fri, 28 Feb 2014 15:37:35 GMT

[quote user="John Flynn"]Testosterone?[/quote]

I have used testosterone (durateston) injections in an elderly inconinent castrated miniature poodle. Propalin alone worked initially then not so well. Started testosterone injections and worked brilliantly, though only for about 2 weeks at a time. As soon as he started leaking again we repeated the injection. I spoke to Intervet about it as I was concerned about using it as frequently as this, but they seemed happy as long as he wasn't developing any aggression etc. The only side effect was that he was constantly trying to hump his owner's leg! I used the testosterone injections for nearly three years before euthanasing him for an unrelated issue at the grand old age of 15.

Re: Urinary incontinence in a male dog

Tim Charlesworth — Fri, 28 Feb 2014 12:16:29 GMT

[quote user="John Flynn"]

On the ethics note, what are folks thoughts on surgical interventions for urinary incontinence in general? I'm always a little uncomfortable that this is verging on a surgical mutilation as the bitch is rarely suffering in either welfare or health for the problem (assuming good husbandry); indeed it seems like a surgery of convenience due to a complication resulting from what is often also a previous surgery of convenience (having my bitch spayed so she doesn't come into season and bleed...). I see certain similarities to debarking, which I've never done (though often wonder if I should have in limited circumstances).

I'm also interested whether other specialist surgeons get results in the dizzy heights of success from combined colposuspension/urethropexy as reported by Dick White and colleagues, as I find 50:50 at best in medically-unresponsive bitches... I suspect there may be a few minor technical points that could vastly increase my success rate. (Martinoli et al, 2013, Veterinary Surgery, DOI:10.1111/j.1532-950X.2013.12084.x)

"Given the overall improvement rate (combined excellent and good outcomes) of 96% and the absence of any major complications, consideration might be given to use of CUC as an alternative to medical management for dogs with USMI." [30 bitches, 21 completely resolved, 8 significantly improved]

[/quote]

I really don't think that there are any ethical concerns about operating on dogs who are incontinent. Some owners prefer a surgical procedure over a potential lifetime of medication. The 2 most commonly performed surgeries (urethropexy and colposuspension) are relatively quick procedures with most dogs discharged the day after surgery. Success rates are usually quoted as being 60-70% "dry" long term whichever technique is used but you need to remember that these are mainly dogs who have "failed" medical management and a proportion of these dogs may have otherwise been PTS'd. The Martinolli paper is interesting in that they are reporting 95% excellent/good at 3 years which is better than either colpo or urethropexy alone. I think it's too soon to know if other people get the same long term outcome simply because this has only very recently been reported (I've now done 2 combined surgeries and they're both dry at 6 wks postop but too soon to draw any meaningful conclusions..).

Nothing wrong with medical tx and this will prob always remain the first choice tx but I have no qualms about recommending/performing surgical interventions when needed.

Re: Urinary incontinence in a male dog

bob lehner — Fri, 28 Feb 2014 11:47:56 GMT

[quote user="Linda Filshie"]My old boy was leaky from middle age onwards [/quote]

Indeed - comes to most of us eventually...

Re: Urinary incontinence in a male dog

John Flynn — Fri, 28 Feb 2014 10:05:37 GMT

Testosterone?

I must confess I'm not sure I've ever seen a case that I was truly convinced was SMI in a male dog.

Of the last few I can think of that came my way already on phenylpropanalamine (PPE), there was an alternative explanation found in each case.

My favourite one was PUPD with a neck mass (presumed functional mobile thyroid carcinoma) and the "incontinence" resolved magically on removal without any further PPE...

Re: Urinary incontinence in a male dog

Martin Atkinson — Fri, 28 Feb 2014 09:27:16 GMT

[quote user="Tim Charlesworth"]

Surgeon's are starting to play with AUS (artificial urinary sphincter) systems - an implantable, pressure adjustable cuff that is sutured around the proximal urethra. They are still in early days wrt long term follow up but some people are reporting good results and they may be worth considering in a male dog due to the lack of effective medical options

[/quote]Wow. That's the best thing about this forum the accumulated experience of ages and some cutting edge stuff like this. Keep us posted, albeit it sounds a bit impractical not to say expensive for the average case.

Re: Urinary incontinence in a male dog

Tim Charlesworth — Fri, 28 Feb 2014 09:18:04 GMT

Re: Urinary incontinence in a male dog

Rob Loxley — Thu, 27 Feb 2014 23:35:06 GMT

Propalin, Enurace, occasionally tried Incurin, but the response rates are lower than in bitches