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Urinary Incontinence Surgery for Dogs

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Dog Urinary Incontinence

Urinary incontinence surgery for dogs is something dog owners may wish to consider for their leaky dogs. Many dog owners are reluctant to provide prescription medications for their dog's incontinence. This is often due to the fear of side effects or they are just uncomfortable with the chronic use of medications. Dog owners may therefore hope for a permanent solution that would address the underlying problem directly. Urinary incontinence surgery for dogs is available but it's not always a good long-term solution as one may hope.

A Matter of Lack of Tone 

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Dog urinary incontinence may triggered by various causes. Dogs may develop it secondary to underlying causes such as diabetes, kidney disease, cushing's Disease or thyroid conditions which cause increased drinking and increased urination making it difficult for the dog to "hold it."

In some cases, intervertebral disc diseases, tumors in the spinal cord, or degeneration of the nerves may be the culprit. Most of these forms of incontinence therefore develop secondary to other conditions and require having the underlying cause addressed in order for the incontinence to reduce.

In many middle-aged and senior dogs though, urinary incontinence is caused though by a condition that is known as "Urethral Sphincter Mechanism Incompetence" (USMI). It is basically a loss of tone of the dog's urethral sphincter. This is mostly a diagnosis of exclusion, after other important potential causes have been ruled out.

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Affected dogs are often large spayed female dog breeds such as Rottweilers, Dobermans and Old English sheepdogs. Dogs who are obese or dogs with a docked or bobbed tail are more predisposed. Owners often notice that the leakage occurs when the dog is relaxed as when the dog is resting or sleeping.

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Traditional Treatment for Dog Incontinence 

If your dog has urinary incontinence, traditional treatment involves the use of drugs that address the leaking. The medications used are mainly two types: Proin (phenolpropanolamine) and estrogen/estrogen-based products.

Proin, also known as PPA, is a stimulant medication that was once used in human medicine but it was pulled off pharmacy shelves in 2000 because it was found to cause high blood pressure and strokes in people. Now, dogs do not suffer from high blood pressure and strokes to the extent people do, therefore its current use in veterinary medicine.

Proin side effects in dogs though may cause lowered appetite, restlessness and higher heart rates considering that this drug is a stimulant. This drug may be contraindicated in dogs with cardiac issues and routine blood pressure checks every six months to a year may be necessary.

Estrogen has been used to treat urinary incontinence in female dogs for several years. Estrogen fell out of favor because of its side effects such as bone marrow suppression, aplastic anemia and risks for mammary cancer. However, new drugs nowadays contain lower levels of estrogen or contain estrogen like- products which, yes, significantly lower the risks for side effects, but this comes at a price: it's often a less effective choice compared to Proin.

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Male neutered dogs who leak may too benefit from hormones, in this case testosterone, but even this hormone has been linked with problems such as the onset of prostatic hypertrophy. The side effects and lower effectiveness is why hormones remain a second choice for many vets.

Medications for treating urinary incontinence in dogs are only a management plan. They fail to permanently address the underlying cause of the incontinence which is, as already described, decreased urethral sphincter tone.

Urinary Incontinence Surgery for Dogs

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Decreased sphincter tone in dogs can be problematic. Left untreated, complications include irritated skin from contact with urine to annoying urinary tract infections and even ulcers due to scalding.

Usually, surgical intervention is considered only when the dog proves to be unresponsive to medical treatment or if the affected dog for some reason cannot take the drugs described above.

The goal of urinary incontinence surgery for dogs is t correct the underlying issue through surgical intervention. This can be accomplished in different ways.

Colposuspension is the most popular type of urinary incontinence surgery for dogs. A study conducted in 2001 found that 86 percent of dog owners were pleased with the outcome of the surgery. According to the study, out of 22 dogs 12 attained complete urinary control two months after surgery while 3 had attained it 1 year after surgery.Other surgical options include cystopexy, urethropexy (often performed along with cystopexy) and deferentopexy for male dogs.

While success rates for urinary incontinence surgery for dogs may seem good from looking at studies, something to consider is its long-term efficacy. In the long-term results were sometimes not as promising.

Collagen injections into the tissue surrounding the urethra may help, but this as well isn't a permanent fix and can be costly. According to veterinarian Dr. Kara, these injections would need to be repeated as they are on average effective for about 17 months. In the case the urinary incontinence is caused by arthritis of the spine, acupuncture and chiropractic manipulation may help older dogs.

Recently there has been growing interest in the use of artificial urethral sphincters. In a pilot study, 3 of 4 dogs with hydraulic urethral sphincter implantation showed improved continence scores for 2 years after surgery, which seems quite promising.

"Overall, surgical treatment options appear to have good short-term efficacy but poor long-term results with restoration of continence in only 14 to 56 percent of patients."~ Heather S. Hadley

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References:

  • J Am Vet Med Assoc. 2001 Sep 15;219(6):770-5.Evaluation of colposuspension for treatment of incontinence in spayed female dogs. Rawlings C1, Barsanti JA, Mahaffey MB, Bement S.
  • White RN. Urethropexy for the management of urethral sphincter mechanism incompetence. J Sm Anim Prac 2001;42:481-486
  • DVM360: Ameliorating our incompetence with urinary incontinence: Artificial urethral sphincters
  • Rose SA, Adin CA, Ellison GW, et al. Long-term efficacy of a percutaneously adjustable hydraulic urethral sphincter for treatment of urinary incontinence in four dogs. Vet Surg2009;38:747-753.
  • Vet Surg. 2009 Aug;38(6):747-53. doi: 10.1111/j.1532-950X.2009.00560.x.Long-term efficacy of a percutaneously adjustable hydraulic urethral sphincter for treatment of urinary incontinence in four dogs.

    Rose SA1, Adin CA, Ellison GW, Sereda CW, Archer LL

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