Urethral sphincter incompetence in an entire bitch

RE: Urethral sphincter incompetence in an entire bitch

Sammy82 — Tue, 10 May 2016 22:22:09 GMT

Not really helping the OP, but I am utterly confused by the anatomy here. Femoral artery I can kind of see how that's in the general mammary/groin area. But I do not understand how the pudendal nerve could have possibly been damaged. It runs from its origin well protected inside the pelvis and leaves the pelvis at the pubic arch, dorso-medial to the tuber ischiadicum. Unless the surgery extended dorsally to the vulva I can not see how the surgeon would have been anywhere near it. The pundendus nerve gives up branches to innervate the caudal mammary area too, but that's distal to to the sphincter branch so I don't think how this could affect the shpincter. Maybe the urination problem has nothing to do with the surgery after all?

RE: Urethral sphincter incompetence in an entire bitch

Andrew Kent — Tue, 10 May 2016 20:51:25 GMT

Hi Lara,

I agree with many of the thoughts here that I would want to exclude inflammatory lower urinary tract disease here but would also try to localise the incontinence more.

What is the bladder like on palpation? Full? Empty? Flaccid?

Can you express urine and if so is it easy or difficult?

If this seems to be related to reduced urethral tone then medical management (e.g. phenylpropanolamine) might help. But if this is related to altered detrussor function then other drugs may be more appropriate.

Andy

RE: Urethral sphincter incompetence in an entire bitch

Lara Brunori — Tue, 10 May 2016 17:31:50 GMT

[quote user="Tim Charlesworth"]

Hi Laura - please don't take offence but is there any chance of an anatomy mix-up here? The main artery that supplies the caudal mammary chain is the caudal superficial epigastric. This will always need to be ligated during a caudal mammary mass removal and if not, it can bleed like stink - is this the vessel that you mean? The femoral artery should have been well out of the way. Either way, the pudendal nerve should not have been "in the line of fire". What is the SG of the urine these days? I would be most suspicious of loss of concentrating ability rather than a structural/neurogenic case eg acute renal insult 2ndry to hypotension?

[/quote]

Hi Tim,

no offence at all, more than justified objection... unfortunately no mix-up... the surgeon digged quite a lot because of the mass had quite deep and wide attachments, so he ended up hitting the femoral artery

Regarding the UTI, you're right for completeness I'll do cystocentesis on Friday, under u/s guidance so I can also assess the bladder itself, but the history to me doesn't fit very well... the owner doesn't report any polydipsia and when she lies down she usually produces very large amounts.

RE: Urethral sphincter incompetence in an entire bitch

Tim Charlesworth — Tue, 10 May 2016 17:13:57 GMT

Having now reread the post I would add potential urinary tract inflammation eg cystitis/urethritis/vaginitis etc to the ddx list!

RE: Urethral sphincter incompetence in an entire bitch

Tim Charlesworth — Tue, 10 May 2016 17:11:04 GMT

[quote user="Hannah Wynne Richards"]

In that case, surely she would have been squatting frequently, and producing lakes not puddles each time? This leakage when lying down sounds more like a true sphincter incontinence.

Wynne

[/quote]

I don't think that the OP states whether or not she is producing puddles or whether there is any increased frequency of squatting? I agree that we would expect a dog who in effect was PUPD to squat and produce normal urine as well as overflow incontinence when recumbent. I think that basic urinalysis is always a good place to start with these ones though. If everything is OK then I would start wondering whether or not this was related to the original surgery or even the mass itself (eg regional lymph node mets etc) but I wouldn't want to miss a metabolic cause. USMI also wouldn't cause the dog to not urinate when it squats (which I think the OP says).

I'm going to have to reread the original post!

RE: Urethral sphincter incompetence in an entire bitch

Hannah Wynne Richards — Tue, 10 May 2016 16:18:25 GMT

In that case, surely she would have been squatting frequently, and producing lakes not puddles each time? This leakage when lying down sounds more like a true sphincter incontinence.

Wynne

RE: Urethral sphincter incompetence in an entire bitch

Tim Charlesworth — Tue, 10 May 2016 15:37:59 GMT

RE: Urethral sphincter incompetence in an entire bitch

Aine Seavers — Tue, 10 May 2016 09:57:39 GMT

try her on gabapentin-but start low dose 5mg/kg bid then up it slowly every day but if on for more than 4 days then regardless of if it worked or not-you need to phase them back off it not stop suddenly. I am not convinced it is pain- recumbancy pushes the bladder into a straight line to neck and so reveals incontinence- i would do a urine analysis on her and if gabapentin not sorting the issue then trial some incontinence meds- if her BP is not elevated then trial propalin. Weirdly we think Cerenia which is also anti sub p may help in these bladder pain cases- yours is an odd variant but could try it unless against the cascade.

RE: Urethral sphincter incompetence in an entire bitch

Hannah Wynne Richards — Tue, 10 May 2016 09:40:02 GMT

Your theory is probably right, or the nerve may even have been transected, or included in the ligature.

I can't think what to do at this stage.......hopeless I'm afraid.

I also can't believe anyone wouldn't give pain relief following this surgery

Wynne