Incontinent male puppy

RE: Incontinent male puppy

gerard mclauchlan — Wed, 26 Oct 2016 17:21:59 GMT

If only we could take every case that contacts us for this but unfortunately not possible

RE: Incontinent male puppy

Anthony Todd — Wed, 26 Oct 2016 17:16:54 GMT

[quote user="gerard mclauchlan"]financially unable[/quote]

Sounds like a good case for a university to take, as a teaching experience?? All sorts of learning spin-offs?

Sometimes, back in the day, the old guard at the Beaumont, would take these sort of cases on???

RE: Incontinent male puppy

Anthony Todd — Wed, 26 Oct 2016 17:10:23 GMT

[quote user="Andrew Kent"]Having had a mildly incontinent dog myself I certainly feel for the owners of dogs like this![/quote]

or "being mildly incontinent myself etc.etc."

Couldn't resist, sorry.

signed: A Dinovet

RE: Incontinent male puppy

gerard mclauchlan — Wed, 26 Oct 2016 12:26:37 GMT

Hi,

Yup anything <8kg can't be done with rigid perineal approach so would require surgical reimplantation. In terms of ureteronephrectomy I personally wouldn't as we don't know if there is still some remaining function to that side and with the other kidney looking a bit odd on ultrasound I worry about developing an azotaemia (have you checked sdma?). I guess its weighing up incontinence vs risk of unmasking azotaemia. I have seen these congenital abnormalities in male dogs >7years of age and while over time renal function will no doubt become progressively compromised it is often slowly progressive as it is a partial rather than complete outflow obstruction. I would only remove if the incontinence is too much for the owners and they are financially unable to afford reimplantation and are aware of the possible further loss of overall renal function.

Ger

RE: Incontinent male puppy

Andrew Kent — Wed, 26 Oct 2016 11:41:45 GMT

Hi Ashlea,

The size of this dog will make any treatment more challenging as it is too small currently for flexible cystoscopy and probably too small for a perineal approach for rigid cystoscopy. That means some kind of surgical approach to the abdomen would likely be needed. Although would be interested to hear if Gerard thinks otherwise?

There are various other centres who have an interest in these kind of problems, depending where you are you could try Laura Owen at Cambridge Vet School or Ian Battersby at Davies. Might be able to come up with some more names if we know where you are.

But I guess firstly they need to decide if they are willing to go for referral and are likely to be looking at spending at least a few thousand for that - but without intervention they will see progressive decline in the function of the obstructed kidney and ongoing incontinence.

The other option is ureteronephrectomy which could perhaps be performed there? I wouldn't suggest it fist line because the kidney is potentially salvageable but it has to be a consideration. You would need to be certain that the other ureter is orthotopic and obviously there is concern about the other kidney potentially being dysplastic but this is the option that some people would go for in this case and could be the most cost effective. Or would you be able to offer surgical ureteral reimplantation there?

Andy

RE: Incontinent male puppy

Ashlea — Wed, 26 Oct 2016 10:59:50 GMT

Thank you Andrew and Gerard, it's good to know that the appearance of the kidney on ultrasound doesn't necessarily mean it can't be saved. I might pm you both with the ultrasound pictures if that's ok, I'm a bit too embarrassed about my poor ultrasonography skills for a public airing! The dog in question is a 3.5kg border terrier (with what appears to be a 1.6cm diameter ureter...). Unfortunately we're a bit far away from Glasgow or Willows and the owners are now dithering about referral altogether.

RE: Incontinent male puppy

Andrew Kent — Tue, 25 Oct 2016 19:37:07 GMT

Hi Ashlea

Sounds a tricky one - would be great to see the ultrasound images if that's possible.

Agree with Gerard here that your imaging tells you there is an obstructive disease so IV contrast is unlikely to help you and indeed with the hydronephrosis there may well be minimal filtration from that side.

There are various options for treatment but, as Gerard mentions, an interventional approach (for example laser ablation if this is an ectopic with stenotic opening) may be the most cost effective. Some options can be dependent on size/breed of dog so would be useful to have that info if possible?

I'm not sure where you are in the country but we might be able to suggest somebody locally if you let us know which referral centres you are near.

Andy

RE: Incontinent male puppy

gerard mclauchlan — Tue, 25 Oct 2016 18:30:36 GMT

Hi Ashlea,

I would be very reluctant to give any of these cases contrast due to the potential nephrotoxicity - why take the risk when given the enlarged ureter and hydronephrosis there is clearly an obstruction that needs corrected ?

The appearance of the kidney isn't prognostic I have seen many cases of kidneys with little to no parenchyma present dramatically improve following correction of the obstruction. In cats the ultrasonographic appearance of a kidney has been shown to not be predictive of outcome. Possible it may also have renal dysplasia given the abnormal appearance of the other side but this is even more reason to try to correct the ectopic obstructed side. I have spent 12 months completing an Interventional Radiology Fellowship with Chick Weisse and Allyson Berent at the Animal Medical Centre in New York and have dealt with many of these cases - would be more than happy to see if the case if the clients fancy a trip to Glasgow.

If you want to chat further let me know

Ger

RE: Incontinent male puppy

Ashlea — Tue, 25 Oct 2016 18:10:01 GMT

Very interesting case, probably not so good for puppy though. On ultrasound he's got what looks like one massive ectopic ureter heading up to a kidney which has very little in the way of normal architecture. The other kidney didn't look so good either. His left kidney is pretty big, bloods ok but a there was a possible cast in his urine sample. I didn't get as far as contrast, the owners are keen to investigate but he's not insured for this so I think their money is best spent on referral. As an aside, what's the risk of causing renal failure from IV contrast studies?

RE: Incontinent male puppy

Andrew Kent — Tue, 25 Oct 2016 12:12:12 GMT

Having had a mildly incontinent dog myself I certainly feel for the owners of dogs like this!

The history is certainly suspicious that there is some structural abnormality of the urinary tract, the challenge in male dogs (especially small ones) is that they are often harder to diagnose than females where a simple combination of ultrasound and cystoscopy picks up most abnormalities.

We therefore often end up with more complex diagnostics (contrast imaging in particular CT) to get a clear picture of what is going on, plus the treatment is often more complex.

Do let us know what you find

Andy

RE: Incontinent male puppy

Ashlea — Tue, 25 Oct 2016 09:41:51 GMT

Thank you - have the puppy in today so will make sure I check the renal pelvis and ureters. The degree of incontinence with this pup is massive - he's trying to urinate outside and passing a little but he drips urine constantly - I can imagine what a mess he's leaving at home if the the state of my consult table is anything to go by!

RE: Incontinent male puppy

gerard mclauchlan — Thu, 20 Oct 2016 12:22:49 GMT

Certainly less common than females. Probably under-diagnosed as male dogs (in particular labs) can have ectopic ureters with a stenosis meaning they are often only minimally incontinent but on ultrasound have dilated ureters/renal pelvis. Ultimately needs imaging as you planned

Gerard