Changes

==Introduction==

==Introduction==

This is the a common cause of '''urinary incontinence in dogs''', especially '''neutered bitches''', although castrated male dogs and entire animals can also be affected.

This is a common cause of '''urinary incontinence in dogs''', especially '''neutered bitches''', although castrated male dogs and entire animals can also be affected.

SMI is most commonly seen as an acquired condition, but may also be seen as a congenital problem in young animals.

SMI is most commonly seen as an acquired condition, but may also be seen as a congenital problem in young animals.

'''<u>Congenital SMI</u>''' may occur in conjunction with anatomical defects such as [[Ureteral Ectopia|ureteral ectopia]] and [[Intersex|intersexuality]]. It occurs most commonly in '''large-breed bitches'''. The urethra may be abnormally short of absent, but often no abnormalities are detected apart from a caudally-positioned bladder.  

'''<u>Congenital SMI</u>''' may occur in conjunction with anatomical defects such as [[Ureteral Ectopia|ureteral ectopia]] and [[Intersex|intersexuality]]. It occurs most commonly in '''large-breed bitches'''. The urethra may be abnormally short or absent, but often no abnormalities are detected apart from a caudally positioned bladder.  

50% of congenital SMI bitches become continent '''following their first oestrus'''.

50% of congenital SMI bitches become continent '''following their first oestrus'''.

==Clinical Signs==

==Clinical Signs==

The presenting signs is usually '''passive urinary incontinence''' when the animal is recumbent.

The presenting sign is usually '''passive urinary incontinence''' when the animal is recumbent. Typically, the animal '''urinates normally''' between episodes of leakage. The incontinence '''varies in severity''' and can improve or get progressively worse over time.

 

Typically, the animal '''urinates normally''' between episodes of leakage.

 

The incontinence '''varies in severity''' and can improve or get progressively worse over time.

==Diagnosis==

==Diagnosis==

Diagnosis is usually based on the '''exclusion of all other likely causes''' (urinary tract infection, ectopic ureters, neoplasia) and the presence of a '''caudal bladder neck''' on radiography.

Diagnosis is usually based on the '''exclusion of all other likely causes''' (urinary tract infection, ectopic ureters, neoplasia) and the presence of a '''caudal bladder neck''' on radiography.

A '''positive response to treatment''' may be the only diagnosis possible if finance preclude further testing.

A '''positive response to treatment''' may be the only diagnosis possible if finances preclude further testing.

==Treatment==

==Treatment==

There are numerous '''surgical treatments''' available, and involve:

There are numerous '''surgical treatments''' available, and involve:

:increasing urethral resistance: peri-urethral surgical '''slings''', '''artificial sphincters''', intra-urethral bulking agents

*increasing urethral resistance: peri-urethral surgical '''slings''', '''artificial sphincters''', intra-urethral bulking agents

:increasing urethral length: bladder neck reconstruction techniques

*increasing urethral length: bladder neck reconstruction techniques

:relocating the bladder to an intraabdominal position: '''colposuspension'''

*relocating the bladder to an intraabdominal position: '''colposuspension'''

'''Colposuspension''' carries the lowest complication rate, and the technique is as follows: via a caudal midline laparotomy, using the vagina as a sling, the bladder neck is brought cranially and kept in the intra-abdominal position by sutures placed from the pre-pubic tendon to the lateral walls of the vagina.

'''Colposuspension''' carries the lowest complication rate, and the technique is as follows: via a caudal midline laparotomy, using the vagina as a sling, the bladder neck is brought cranially and kept in the intra-abdominal position by sutures placed from the pre-pubic tendon to the lateral walls of the vagina.

Gregory, S. (2010) '''Urinary Incontinence''' ''RVC student notes''

Gregory, S. (2010) '''Urinary Incontinence''' ''RVC student notes''

[[Category:To Do - Helen]]

 

[[Category:To Do - Review]]

[[Category:Urological Diseases - Dog]]

[[Category:Lower Urinary Tract - Pathology]]

[[Category:Expert Review - Small Animal]]