Small Animal Abdominal and Metabolic Disorders Q&A 02

This question was provided by Manson Publishing as part of the OVAL Project. See more Small Animal Abdominal and Metabolic Disorders Q&A.

A two-year-old, neutered female Giant Schnauzer presented with urinary incontinence of several months’ duration. The dog leaked when recumbent and the severity of the incontinence varied. The dog was otherwise normal. She was spayed at 11 months old after her first season and was not incontinent as a puppy.

Question	Answer		Article
How would you investigate this dog?	Full clinical examination with specific reference to the urinary and nervous system. Urine collected by cystocentesis or catheterization for bacteriology and urinalysis. Blood for routine haematology and biochemistry. Plain radiographic (lateral and ventrodorsal) examination of the abdomen after suitable preparation (enemas should be given to remove faeces from the rectum). Intravenous urogram. Give 700 mg/kg iodine via the cephalic vein with ventrodorsal views taken at 0 and 5 minutes and lateral views of the abdomen and caudal abdomen taken at 10 and 15 minutes respectively. A small amount of air introduced into the bladder prior to injection of contrast improves visualization of the ureterovesical terminations. Retrograde vagino-urethrogram. Allows accurate determination of the position of the bladder neck and may confirm the presence and morphology of an ectopic ureter. Ultrasound examination of the bladder after residual air and contrast has been removed and the bladder moderately filled with sterile saline. This allows identification of ureterovesical junctions and visualization of ureteral jets from ureters entering the trigone normally. Alternatively, direct visualization of ureteral emptying with fluoroscopy. Urodynamic investigation. Stressed urethral pressure profilometry is a better predictor of continence than plain urethral pressure profilometry. Both techniques require expensive equipment and are dependent upon the technique used. Urethral pressure profilometry can provide additional useful information.		Link to Article
This radiograph was obtained. What is your main differential diagnosis?	In this case the history, lack of specific findings on clinical and radiographic examinations, and presence of an intrapelvic bladder neck on the radiograph were highly suggestive of urethral sphincter mechanism incompetence. The dog responded well to treatment with phenylpropanolamine and subsequent colposuspension. Other common causes of urinary incontinence were ruled out by the above investigation.		Link to Article