Sally – urinary incontinence

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Sally, a much loved family pet, developed the condition of urinary incontinence at 4 years of age in 2006. The incontinent episodes would occur mainly at night after Sally had been lying down but could also occur intermittently during the day time.

A thorough diagnostic investigation was performed incorporating urine analysis, ultrasonography and radiography with the use of contrast dye to highlight the anatomy of her bladder and associated structures. The tests revealed that Sally had an elongated bladder outline and the bladder neck was located within the pelvis rather than the more normal position of being in the abdomen. This is a common cause of incontinence in bitches referred to as acquired urethral sphincter mechanism incompetence  (AUSMI). This condition means that the bladder neck / urethral tone is no longer capable of restraining the urine collecting in the bladder and subsequently, urine leaks out in an uncontrolled manner, often whilst the dog is lying down.

Initial medical treatment with Propalin ( phenylpropanolamine) was successful, but soon there was evidence of incontinent episodes again. Another oestrogen medication called Incurin was trialled but again Sally experienced episodes of urine leakage. The combination of these two medications was given but still, there was minimal improvement.

In 2008, the next sensible step was to consider surgery and a urethropexy procedure was performed. This aim of this surgery is to fix the urethra in a more forward / abdominal position and hence increase the muscular tone of the urethra and bladder neck, hopefully giving urinary continence or at least reducing the level of incontinence. Sally was completely free of urinary accidents for 7 days, but sadly the incontinence returned after a sudden, unexpected episode of exertion. Disruption of the fixation sutures was suspected, so a second urethropexy was performed. There was some initial improvement but again despite a restricted exercise regime post operatively, the urinary accidents returned to the same frequency as prior to the surgeries.
Sally’s veterinarian at Village Vets worked tirelessly to research other medical options for Sally, but a year later in 2009, further referral was sought. At this time, one of the only other options was to consider a different surgical procedure called a Colposuspension, which aims to achieve similar goals to the urethropexy surgery but utilising the redundant vaginal tissue. Sally did very well for 7 days, no urinary accidents then day by day the wet beds started to occur again – the incontinence had returned.
More medication was trialled – this time imipramine followed by Enurace (ephedrine) – there was some improvement. But was there anything else that could be done……..
From  January 2010, Northwest surgeons were able to offer the treatment of urethral collagen injections by a specialised endoscope. The collagen blebs are injected directly into the urethra without the need for a surgical approach. The aim of the collagen is to act as a bulking agent around the urethra and cause some resistance to urine outflow, hence resolving or at least improving the episodes of urinary incontinence. The patients have a short anaesthesia, a pain free recovery and once they have demonstrated a good urinary flow after the procedure, they are ready for home. Sally is the first patient at Northwest Surgeons to receive urethral collagen injections for urinary incontinence. It is early days for Sally, but nearing 3 months after the collagen delivery with no additional medication, the urinary accidents are infrequent giving a more manageable situation for her caring , devoted owners.

Our thanks to veterinary surgeon Alan Humphreys of Village Vets, Woolton, Liverpool for referring Sally to Northwest Surgeons.