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A 10-month-old female neutered domestic shorthair cat presented with a history of urinary incontinence and recurrent bacterial cystitis since 2 months of age. Physical examination was unremarkable other than vulval hypoplasia. Genitourinary dysplasia was diagnosed following a physical examination, CT imaging and retrograde positive contrast urethrocystography. Attempted medical management of the urinary incontinence was unsuccessful. Surgical treatment consisted of cystourethroplasty combined with artificial urethral sphincter placement, resulting in marked improvement of urinary continence. Following multiple adjustments of the artificial urethral sphincter near-total continence was achieved, which was maintained at 10 months post-surgery., (© 2024 British Small Animal Veterinary Association.)

There is growing evidence supporting clinically important associations between age at neutering in bitches and subsequent urinary incontinence (UI), although much of this evidence to date is considered weak. Target trial emulation is an innovative approach in causal inference that has gained substantial attention in recent years, aiming to simulate a hypothetical randomised controlled trial by leveraging observational data. Using anonymised veterinary clinical data from the VetCompass Programme, this study applied the target trial emulation framework to determine whether later-age neutering (≥ 7 to ≤ 18 months) causes decreased odds of early-onset UI (diagnosed < 8.5 years) compared to early-age neutering (3 to < 7 months). The study included bitches in the VetCompass database born from January 1, 2010, to December 31, 2012, and neutered between 3 and 18 months old. Bitches were retrospectively confirmed from the electronic health records as neutered early or later. The primary outcome was a diagnosis of early-onset UI. Informed from a directed acyclic graph, data on the following covariates were extracted: breed, insurance status, co-morbidities and veterinary group. Inverse probability of treatment weighting was used to adjust for confounding, with inverse probability of censoring weighting accounting for censored bitches. The emulated trial included 612 early-age neutered bitches and 888 later-age neutered bitches. A pooled logistic regression outcome model identified bitches neutered later at 0.80 times the odds (95% CI 0.54 to 0.97) of early-onset UI compared with bitches neutered early. The findings show that later-age neutering causes reduced odds of early-onset UI diagnosis compared with early-age neutering. Decision-making on the age of neutering should be carefully considered, with preference given to delaying neutering until after 7 months of age unless other major reasons justify earlier surgery. The study is one of the first to demonstrate successful application of the target trial framework to veterinary observational data., Competing Interests: The authors have declared no competing interests exist., (Copyright: © 2024 Pegram et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Urinary incontinence (UI) is a disorder of micturition that can occur in dogs of any age, sex, and breed depending on the underlying cause and time of onset. Diagnosis and treatment for various causes of UI in dogs have been described by multiple comprehensive single author review articles, but large prospective clinical trials comparing treatment outcomes in veterinary medicine are lacking. The objectives of this consensus statement therefore are to provide guidelines on both recommended diagnostic testing and treatment for various causes of UI in dogs. Specifically, pathophysiology directly related to the canine urinary system will be reviewed and diagnostic and therapeutic challenges will be addressed. A panel of 12 experts in the field (8 small animal internists [L. Adams, J. Bartges, A. Berent, J. Byron, J. Foster, A. Kendall, S. Vaden, J. Westropp], 2 neurologists [J. Coates, N. Olby], 1 radiologist [G. Oetelaar], and 1 surgeon [C. Adin]) was formed to assess and summarize evidence in the peer-reviewed literature and to complement it with consensus recommendations using the Delphi method. Some statements were not voted on by all panelists. This consensus statement aims to provide guidance for management of both male and female dogs with underlying storage or voiding disorders resulting in UI., (© 2024 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Urinary incontinence due to urethral sphincter mechanism incompetence (USMI) affects up to 20% of bitches that undergo spaying surgery. Amitriptyline is a tricyclic antidepressant whose urinary retention is a reported side effect. This study aimed to assess the efficacy and safety of amitriptyline when compared to estriol orally. Fifteen bitches with a clinical diagnosis of post-spaying UI were evaluated during 60 days in a non-blinded randomized clinical trial. All patients were enrolled after clinical evaluation consisting of anamnesis, physical examination, and complementary exams (complete blood count, biochemical parameters, urinalysis, and abdominal ultrasound). The amitriptyline (AMT) group consisted of 8 bitches, which received the initial dose of 1 mg/kg every 12 h, whereas the estriol (EST) group consisted of 7 bitches which were initially treated with 1 mg/animal every 24 h. Patients underwent clinical evaluation at 7 days, and then at 21 and 60 days of treatment to assess safety and efficacy, as well as adjustments of dose when necessary. A urinary incontinence scale was used to assess the level of incontinence and therapeutic response to treatment. During the period of the study, estriol was fully effective in 71% of cases and amitriptyline in 62%. Both drugs proved safe in the medical treatment of USMI, with adverse effects such as somnolence (AMT, n = 5/8) and male attraction (EST, n = 1/7). The results support the amitriptyline recommendation as a substitute for estriol in USMI treatment., Competing Interests: Declaration of Competing Interest A.G.P. has given lectures for MSD Animal Health Brazil and was sponsored in international congresses participation by MSD. The authors alone are responsible for the content and writing of this paper. Publication: Jesus et al. Applying children's enuresis treatment with amitriptyline for canine post-spaying urinary incontinence: A pilot estriol-controlled randomized clinical trial. The Author A.G.P. has given lectures for the MSD Brazil and was sponsored in international congresses participation by MSD. The other Authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Describe the management of incontinence with several therapies, culminating with the apparently successful treatment utilizing artificial sphincter placement following an inadvertent prostatectomy., Animal: 5-month-old 7.5-kg male neutered Miniature Schnauzer., Clinical Presentation, Progression, and Procedures: The patient was referred for dysuria and persistent stranguria following an iatrogenic total prostatectomy and urethrectomy. An extra pelvic urethral anastomosis was performed, followed by hospitalization for 2 weeks with a urinary catheter. The patient was further investigated for persistent stranguria, and a contrast urethrogram revealed a urethral stricture at the anastomosis site, which was treated with fluoroscopic balloon dilation. The stranguria resolved, but an acute nocturnal grade 3 passive urinary incontinence occurred, which was nonresponsive to medical management of phenylpropanolamine hydrochloride and estriol. An artificial urethral sphincter was placed, leading to continence after 5 top-ups to a total volume of 0.9 mL. The patient remained continent for 5.5 weeks before abrupt incontinence recurred, which was resolved by another 0.1-mL top-up. No further signs of incontinence occurred in the 11 months following., Treatment and Outcome: The placement of an artificial urethral sphincter successfully managed urinary incontinence in this patient. Continence was achieved with no significant complications other than a transient loss of continence. Long-term follow-up 14 months after sphincter placement revealed that the patient had remained continent since the final sphincter top-up. The owner reported a significant improvement in the patient's quality of life following successful incontinence management., Clinical Relevance: This case highlighted the benefits of placing an artificial urethral sphincter in managing urinary incontinence after select cases of prostatectomy in dogs that are unresponsive to medical management.

Objective: To identify predictive factors for postoperative continence in female Golden Retrievers following cystoscopic-guided laser ablation of intramural ectopic ureters (CLA-EU)., Animals: 41 client-owned female entire Golden Retrievers with uni- or bilateral intramural ectopic ureter(s) were retrospectively enrolled., Methods: Patients were diagnosed with ectopic ureters with a combination of ultrasonography and cystoscopy. CLA-EU was performed for all dogs so that each ureteral opening was considered to be in an appropriate position by a single operator. All dogs had short-term follow-up 4 weeks and long-term follow up > 10 weeks after the procedure via telephone, which included urinary continence scoring. Clinical factors and ultrasonographic and cystoscopic findings from initial presentation were evaluated to identify predictive factors for postoperative continence., Results: Short-term urinary continence was achieved in 46.3% of dogs with no additional medical therapies. Presence of historical urinary tract infections prior to CLA-EU (OR, 0.130; 95% CI, 0.020 to 0.621; P = .018) was negatively correlated and ureteral dilatation (OR, 34.260; 95% CI, 1.813 to 2,143; P = .043) was positively correlated with likelihood of urinary continence. Long-term urinary continence was achieved in 63.4% of dogs, and presence of historical urinary tract infections was negatively prognostic (OR, 0.173; 95% CI, 0.023 to 0.856; P = .048)., Clinical Relevance: Female Golden Retrievers undergoing CLA-EU have similar outcomes to those reported for other mixed-breed cohorts with > 30% of dogs failing to regain urinary continence. Historical urinary tract infections were significantly associated with both short- and long-term urinary continence in our population.

Ureteral ectopia is rare and requires surgical treatment after a thorough diagnostic workup. Open surgical techniques for repositioning ectopic ureters have been known for many years and are well described in the literature. However, to the best of our knowledge, no laparoscopic method of correcting this pathology has been described, which, in our opinion, would benefit the animal in terms of the healing process and overall clinical outcomes. This study aimed to evaluate the possibility of laparoscopic treatment of ureteral ectopia, which causes urinary incontinence in dogs. All of the operated ten dogs presented in this study were client-owned females with symptoms of urinary incontinence due to a unilateral intramural ectopic ureter. A three-trocar laparoscopic technique was used to perform the ureteroneocystostomy of the ectopic ureter. In this article, clinicopathological data, imaging features, procedural findings, complications, and short- and long-term outcomes are presented. The procedure was feasible in all cases. No major postoperative complications were observed. Among the minor complications, slight hematuria was observed in three dogs, which resolved spontaneously. In the period of at least one year after surgery, no negative impact of the procedure was observed. Seven of the ten operated dogs regained urinary continence. The remaining three dogs required additional surgery (urethral bulking) because of a lack of improvement after adjuvant pharmacological treatment. Overall, good-to-excellent long-term outcomes can be achieved; however, dogs that remain incontinent after laparoscopic ureteroneocystostomy may require additional treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Prządka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

A 9 mo old male Labrador retriever presented for investigation into persistent urinary incontinence. Abdominal ultrasound and retrograde urethrocystogram with computed tomography documented a uterus masculinus (UM), which was confirmed on histopathology after surgical removal. A connection between the UM and the urethra was present, documented by positive contrast retrograde urethrocystography and confirmed with surgery. Typically, in the literature, UM are blind ending, and there are only a few case reports that demonstrate an assumed connection. This case has demonstrated a patent connection between the UM and the urethra, which should be considered a differential diagnosis for persistent urinary incontinence and urinary tract infection in juvenile male dogs., (© 2023 by American Animal Hospital Association.)

Background: An ectopic ureter is a congenital malformation characterized by caudal displacement of one or both ureteral orifices and is the most common cause of urinary incontinence in young dogs. Complete resolution of incontinence after surgery has been reported in 25-82% of dogs. The aim of this study was to identify preoperative prognostic factors for continence after surgical treatment of dogs with an ectopic ureter. Dogs were included if surgical correction of an ectopic ureter was performed and at least 1 year follow-up was available., Results: Fifty-one dogs met the inclusion criteria. The ectopic ureters were either intramural (91%) or extramural (9%). The ectopic ureters were bilateral in 49% of cases. Overall median follow-up time after surgery was 6.5 years (range 1-13 years). Surgical correction alone resolved urinary incontinence in 47% of cases. Low grade pre-operative incontinence, male sex and pre-operative presence of ureteral or renal pyelum dilation were significantly associated with urinary continence after surgery., Conclusions: Dogs with severe preoperative incontinence were less likely to become completely continent after surgery, whereas male sex and preoperative dilation of the ureter or renal pyelum were positive prognostic indicators for continence. These results may assist in predicting outcome after surgical correction of ectopic ureters and suggest assessment of pre-operative urethral pressure profiling in future studies., (© 2022. The Author(s).)

Background: Cystourethroscopy and vaginoscopy (uroendoscopy) is often used in the diagnostic evaluation of dogs with lower urinary tract disorders (LUTD)., Objective/hypothesis: To evaluate if uroendoscopy is warranted in dogs with various LUTD, the agreement between uroendoscopic and ultrasonographic diagnoses were compared. Dogs with recurrent urinary tract infections (rUTI) will have the highest diagnostic agreement between uroendoscopy and ultrasonography (US) compared to dogs presenting for other LUTD., Animals: Two hundred thirty-seven dogs presenting between 2014 and 2019 with lower urinary tract signs (LUTS) that had US within 60 days preceding uroendoscopy., Methods: Retrospective study. Dogs were categorized by primary indication for ultrasound. Pertinent uroendoscopic findings were recorded and agreements (κ analysis) between the final uroendoscopic diagnosis were compared with the final ultrasonographic diagnosis., Results: Pertinent uroendoscopic findings were recorded for 69/237 (29%) cases. For dogs presenting primarily for urinary incontinence (UI), agreement between uroendoscopy and US was 71% (46/65; κ = 0.47, 95% CI 0.28-0.66), for dogs with stranguria, 58% (29/50; κ = 0.47, 95% CI 0.31-0.62) and for dogs with rUTI the agreement was substantial at 87% (26/30; κ = 0.70, 95% CI 0.43-0.98). Urethral strictures were the majority (14/21; 67%) of pertinent uroendoscopic findings for dogs with stranguria, of which 12 were male dogs., Conclusions and Clinical Importance: Agreement between uroendoscopy and US was moderate for all dogs. Based on these data, recommendation for uroendoscopy should be tailored to individual clinical presentation and signalment; transabdominal US is not the preferred modality for urethral lesions., (© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Background: Urethral sphincter mechanism incompetence (USMI) is a common problem in female dogs, but some dogs fail to achieve continence with standard treatment. Urethral submucosal injection of autologous skeletal muscle progenitor cells (skMPCs) previously has been shown to restore urethral function in a canine model of USMI., Hypothesis/objective: To determine if urethral submucosal injection of skMPC alters continence in dogs with USMI that had previously failed standard medical management. We hypothesized that the injections would lead to improved continence., Animals: Fifteen client-owned dogs with USMI that had failed standard medical management., Methods: Dogs were prospectively enrolled into a single-armed clinical trial. Once enrolled, a triceps muscle of each dog was biopsied; the tissue specimens were digested, cultured, and expanded to 100 million cells before injection into the urethral submucosa using a surgical approach. Continence was assessed at baseline and 3, 6, 12, and 24 months post-injection using continence scores and urethral pressure profilometry., Results: Median continence scores increased significantly from baseline at 3, 6, 12, and 24 months. Increases were seen in 14 of 15 dogs with 7, 6 or 1 dog achieving scores of 5, 4 or 3, respectively. Additional medication was required to achieve continence in all but 2 dogs., Conclusions and Clinical Importance: Urethral submucosal injection of skMPC can be used adjunctively to improve continence in dogs with difficult to manage USMI. The procedure is labor intensive but well tolerated; most dogs will require continued medication to remain continent., (© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Objectives: To assess the recovery of urinary continence, faecal continence and tail function in ambulatory dogs with caudal lumbar intervertebral disc extrusion and to explore clinical factors that may be associated with recovery., Materials and Methods: Medical records from January 2010 to December 2020 were searched to identify ambulatory dogs undergoing surgical treatment for a caudal lumbar intervertebral disc extrusion causing urinary incontinence, faecal incontinence and/or tail dysfunction. Signalment, history, presenting clinical signs, neurological examination findings, diagnostic test results, treatment and outcome were recorded for all dogs., Results: Eighteen dogs with caudal lumbar intervertebral disc extrusion causing tail dysfunction, urinary and/or faecal incontinence were included. Urinary continence was recovered in 12 (86%) of 14 affected dogs, faecal continence recovered in nine (90%) of 10 affected dogs and tail function recovered in 13 (87%) of 15 affected dogs. Loss of tail nociception was recorded in three dogs on presentation; two made a full recovery and one showed mild persistent tail paresis., Clinical Significance: The prognosis for functional recovery of urinary continence, faecal continence and tail function in ambulatory dogs with caudal lumbar intervertebral disc extrusion following surgical treatment is good. Larger studies are needed to identify prognostic factors associated with failure of recovery., (© 2022 The Authors. Journal of Small Animal Practice published by John Wiley & Sons Ltd on behalf of British Small Animal Veterinary Association.)

Introduction: The Entlebucher Mountain Dog is predisposed to ureteral ectopia and associated diseases of the urinary tract as well as the kidneys, which can have severe to lethal consequences. Due to the clustered occurrence of clinical signs in 11 % of Entlebucher Mountain dogs in the absence of a genetic test for ureteral ectopia, screening was introduced in 2008 to allow phenotype-based breeding selection. The ureteral orifices of the dogs are visualized by ultrasound and existing urinary retention or urinary incontinence is documented. The diagnostic findings were evaluated centrally with assignment to one of five phenotypes depending on the localization of the ureteral orifices and the renal and ureteral shape. Breeding approval and mating restrictions are the responsibility of the respective breeding associations and predominantly Entlebucher Mountain Dogs with extravesical ectopic ureters and/or clinical signs were excluded from breeding. The effect of phenotype-based selective mating on the incidence of ureteral ectopia and its clinical signs, as well as possible factors influencing the expression of the phenotype, were determined in the birth cohorts after the introduction of screening. Analysis of the data set of 1456 phenotyped Entlebucher Mountain Dogs showed, that at 11 % versus 5 %, males were more frequently assigned to the extravesical phenotype than females. The effect of phenotype-based breeding selection was examined in a subpopulation consisting of phenotyped parents and their offspring (n = 876). The prevalence of the extravesical phenotype decreased from 24 % in the 2005 to 2007 birth cohorts to 1,4 % in the 2015 to 2017 birth cohorts. Since 2015 almost no Entlebucher Mountain Dogs with incontinence, hydroureter or hydronephrosis have been recorded. It was feared that the additional selection measures to control ureteral ectopia in the small Entlebucher Mountain Dog population would intensify the inbreeding increase. However, this has so far remained absent. Therefore, as long as no genetic test is available, it is recommended to continue phenotype-based breeding selection with exclusion of dogs with extravesical ureteral ectopia and/or hydroureter/hydronephrosis/urinary incontinence, while keeping an eye on the development of the inbreeding coefficient.

Objectives: The objective of this retrospective study was to describe the feline population presented for urinary incontinence at a veterinary teaching hospital between 2009 and 2019, with a particular focus on cats with a non-neurologic underlying cause., Methods: The medical records of cats diagnosed with urinary incontinence were retrospectively evaluated. Signalment, clinical presentation, results of diagnostic tests, diagnosis of the underlying cause and treatments were recorded. When information was available, outcome was recorded and follow-ups divided into three time frames (0-1 week, 1 week to 3 months and >3 months)., Results: Thirty-five cats were presented with urinary incontinence. Of these, 18 cats with complete medical records presented urinary incontinence of non-neurologic origin. The most common clinical signs at presentation were urine leakage while resting (12/18), urine-soiled perineum (8/18), urine dribbling (8/18) and no spontaneous micturition (5/18). The most common underlying cause was urethral obstruction (67%; 12/18), with a majority due to urethral strictures (58%; 7/12). Other causes were suspected inflammation (2/12), neoplasia (1/12), urolithiasis (1/12) and foreign body (1/12). In 8/10 cats in which it was performed, cystoscopy and contrast cystourethrography were the methods that led to the diagnosis. Twelve cats with urethral obstruction underwent interventional procedures, resulting in complete resolution of incontinence in 7/12 and improvement in 1/12. Urinary tract infection was a common complication after 3 months (4/18)., Conclusions and Relevance: When incontinence of non-neurologic origin is suspected in a cat, urethral obstruction should be considered. Advanced imaging studies (cystoscopy and contrast studies) are useful for diagnosis. A good prognosis was reported in cats undergoing interventional procedures with no long-term treatment.

Objective: To assess the outcome and safety of surgically placed artificial urethral sphincters in male dogs with urethral sphincter mechanism incompetence., Materials and Methods: We included dogs with urethral sphincter mechanism incompetence treated by placing an artificial urethral sphincter from January 1, 2010 to December 31, 2017. The continence score (scale 1 to 5, with 5 indicating complete continence) was evaluated before and after implantation. Follow-up information was obtained from the institution's medical records (short-term up to 12 months) and questionnaires were completed by telephone (long-term ≥12 months) for evaluation., Results: Medical therapy was unsuccessful in 18 dogs and unknown in one dog before the artificial urethral sphincter placement. Short-term continence improved in 16 of the 19 (84%) dogs. Four patients were lost to follow-up. Nine of 15 (60%) dogs showed long-term continence improvement, eight of 15 (53%) remained completely continent. The median follow-up was 1785 (range 2 to 3234) days. The complication rate was 56% (9/16). Minor complications, including haematoma, stranguria/temporary dyssynergia and mild inflammation at the port, were reported in four of 16 (25%) dogs. Five of 16 (31%) experienced major complications, including stranguria/mechanical urethral obstruction, persistent dyssynergia, fistula at the port and port rotation., Clinical Significance: Artificial urethral sphincter placement is a valid option for treating incontinent male dogs that show an insufficient response or become refractory to medical or other prior surgical management. A high-complication rate is associated with this procedure., (© 2022 British Small Animal Veterinary Association.)

Background: Urethral obstruction secondary to artificial urethral sphincter (AUS) implantation is a recognized complication in dogs. However, urethral obstruction secondary to AUS-associated capsule formation has been described rarely., Hypothesis: Describe clinical and diagnostic findings, management, and outcome in 6 dogs with urethral obstruction secondary to AUS-associated capsule formation., Animals: Six client-owned dogs., Methods: Retrospective study. Medical records between January 1, 2010, and June 30, 2021, were reviewed to identify dogs with urethral obstruction associated with the AUS device., Results: The AUS device was implanted a median of 884 days (range, 20-2457 days) before presentation for urethral obstruction. Median age at time of urethral obstruction was 4.7 years (range, 3.1-8.7 years). Clinical signs at the time of urethral obstruction were stranguria (n = 4), pollakiuria (3), weak urine stream (2), and worsened urinary incontinence (1). In all dogs, the urethra was noted to be stenotic during urethroscopy and positive contrast cystourethrography. All dogs underwent surgery, and a fibrous capsule associated with the AUS was found to be causing urethral stenosis. Resolution of urethral obstruction occurred in all dogs after transection or removal of the capsule. Positive bacterial cultures were obtained from the capsule, AUS, or both in all dogs. Recurrence of urethral obstruction had not occurred in any dog at the time of follow-up., Conclusions and Clinical Importance: Urethral obstruction secondary to capsule formation is an uncommon but clinically important complication associated with use of the AUS. Continued investigation is needed to evaluate this complication more thoroughly, and its possible association with infection., (© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Objective: To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic-guided laser ablation (CLA) in female dogs., Study Design: Retrospective study from 2011 to 2018., Animals: Twenty-five female dogs., Methods: Data collected included signalment, clinicopathologic data, procedural data, complications, and short-term and long-term outcomes. Complications were graded as minor or major if a surgical revision was required. Continence status was scored subjectively (1 = completely incontinent to 10 = fully continent)., Results: Fifteen dogs had bilateral EU and 24 had intramural EU (iEU). Open surgical correction included 13 neoureterostomies, 2 neocystoureterostomies, and a combination of these in 2 dogs. Eight dogs underwent CLA. Eighteen dogs experienced minor complications (72%), and 2 experienced major complications (8%). One-month postoperative continence was achieved in 20/25 (80%) dogs (median score of 10). Incontinence recurred at a median time of 24.9 months in 5 dogs but responded to medical treatment. Overall, dogs remained continent for 66 months (median) and 22/25 (88%) dogs achieved continence with adjunction of medical/surgical treatment in incontinent ones. Fewer minor complications and postoperative recurrences of incontinence were documented after CLA than neoureterostomy (P < .01 and P < .05)., Conclusion: Ectopic ureter correction by open surgery or CLA resulted in a subjectively good prognosis, most dogs reaching continence within a month of surgery, although incontinence occasionally recurred in the long term. CLA was associated with fewer complications and incontinence recurrences than neoureterostomy., Clinical Significance: Cystoscopic-guided laser ablation should be preferred to correct iEU to prevent short-term complications and the recurrence of incontinence. Further studies should investigate the cause of postoperative recurrence of urinary incontinence., (© 2022 American College of Veterinary Surgeons.)

Ultrasonography is a widely available diagnostic modality for the identification of dogs with suspected ureteral ectopia; however published studies detailing its sensitivity and specificity are currently lacking. The aim of this retrospective, descriptive, diagnostic accuracy study was to evaluate the sensitivity and specificity of ultrasonography for the diagnosis of ureteral ectopia in incontinent dogs presenting to a referral institution, using cystoscopy as the gold standard. Medical records of urinary incontinent dogs presenting to a single institution (n = 38) were retrospectively reviewed for the presence of ureteric insertion abnormalities and concurrent urinary tract abnormalities. Ultrasonographic findings were compared with those from cystoscopic examination to determine diagnostic accuracy. The relationship between the presence of concurrent urinary tract abnormalities and ureteral ectopia was assessed using an independent samples t-test and Mann-Whitney test. Statistical significance was set at P ≤ 0.05. Ultrasonography had a sensitivity of 93.5%, specificity of 100%, and diagnostic accuracy of 95% when identifying dogs with ureteral ectopia. When classifying individual ureters as ectopic or non-ectopic, sensitivity was 87.8% and specificity was 86.7%. Dogs with ureteral ectopia had significantly more concurrent urinary tract abnormalities on ultrasound than unaffected dogs (P = 0.004). Ectopic ureters were associated with significantly more concurrent ipsilateral upper urinary tract ultrasonographic abnormalities than unaffected ureters (P < 0.001). Ultrasonography performed by an experienced ultrasonographer is a sensitive and specific screening tool for canine ureteral ectopia, which eliminates the need for heavy sedation, general anesthesia, and advanced imaging, although it should not be relied upon as the sole diagnostic modality for the assessment of individual ureters., (© 2022 The Authors. Veterinary Radiology & Ultrasound published by Wiley Periodicals LLC on behalf of American College of Veterinary Radiology.)

Urinary incontinence results from disorders of the lower urinary tract or neurologic diseases either of the nerve supply to the bladder/urethra or within the central nervous system. Congenital causes include patent urachus and ectopic ureter. Coordination of lower urinary tract function involves the interaction of both the sympathetic and parasympathetic system as well as somatic branches of the central nervous system. Well-recognized causes of incontinence include equine herpes virus 1 myeloencephalopathy, polyneuritis equi (neuritis of the cauda equina), and sacral/coccygeal trauma. Idiopathic bladder paralysis is characterized by bladder paralysis and sabulous cystitis in the absence of overt neurologic deficits., Competing Interests: Disclosure No commercial or financial conflicts of interest. No funding., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Prostatic cancer is uncommon in dogs. Dogs with prostatic carcinoma have been reported to have a poor prognosis. Information regarding prognosis with various surgery options as well as prognosis with surgical vs. medical treatment is lacking. This retrospective study compares the outcomes of medical management to surgical treatment in dogs with prostatic adenocarcinoma and assesses the surgical outcomes of patients who underwent total prostatectomy (TP) and prostatocystectomy (TPC). The medical records of 41 dogs with prostatic adenocarcinoma, between February 2008 and June 2019, were reviewed for information on signalment, clinical signs in the initial evaluation, preoperative diagnostic imaging findings, treatment type (non-surgical or surgical), surgery type, postoperative complications, adjunctive medical therapy, and survival time. The dogs were divided into non-surgical (n = 12) or surgical (n = 29) groups. The surgical group was subdivided into the TP (n = 20) and TPC (n = 9) subgroups., Results: Age was not significantly different between the surgical (median 13.1 years [8.4-15.4] years) and the non-surgical groups (median 10.8 [7.7-15.3] years). Body weight (BW) was also not significantly different between the surgical (median 6.8 kg [2.4-34.5 kg]) and non-surgical groups (median 6.4 kg [3.7-9.12 kg]). The overall median survival time (MST) from the initial evaluation was significantly longer in the surgical than in the non-surgical group (337 vs. 90.5 days). The postoperative MST was significantly longer in the TP group than in the TPC subgroup (510 vs. 83 days). As TPC was performed in cases of tumor progression, its postoperative complications were severe, resulting in a shorter MST. Ten (50%) and 6 patients (30%) in the TP subgroup postoperatively showed mild and severe urinary incontinence, respectively, whereas all patients in TPC subgroup did show severe incontinence., Conclusion: Results of the study suggest that surgical treatment of prostatic carcinoma results in longer survival times over medical management alone. In particular, TP might be recommended for improving survival time and quality of life in canine prostatic adenocarcinoma that does not infiltrate the bladder. Early detection is key for a survival advantage with surgical treatment., (© 2022. The Author(s).)

Background: In humans, multiple researchers have not only determined that there is a relationship between urinary incontinence (UI) and lower back pain (LBP), but that by treating the LBP, clinicians are able to improve or resolve the UI. Up until now, no equivalent canine research has investigated whether treatment of LBP can improve the clinical signs of acquired, non-neurologic UI in dogs., Aim: To determine if a relationship exists between LBP and urethral sphincter mechanism incompetence (USMI) in dogs., Methods: Review of medical records of all patients that presented to Points East West Veterinary Services with a history of naturally occurring acquired UI from May 2013 to December 2019. Thirty-nine patients treated for LBP using combined acupuncture and manual therapy, and 33/39 patients that also received concurrent photobiomodulation (PBM) therapy, qualified for this study., Results: Treated patients showed a statistically significant reduction in both the frequency ( p < 0.01) and volume ( p < 0.01) of UI episodes. Treatment responses ranged from no improvement, to complete resolution of the USMI clinical signs., Conclusion: The reduction of USMI clinical signs following LBP treatment suggests a relationship between these two conditions. Combined acupuncture, manual therapy, with or without PBM was shown to be an effective treatment for USMI. By corollary, USMI incontinence should be considered a potential pain symptom., Competing Interests: The authors declare that there is no conflict of interest.

An 8 mo old male Doberman pinscher was referred for investigation of persistent urinary incontinence. Physical examination revealed urine leakage and abnormal external genitalia. A computed tomography scan identified a large fluid-filled cavity extending from the caudoventral abdomen displacing the colon and urinary bladder. No retained testicles were identified. A retrograde urethrogram study found a linear communication, cranial to the pubic brim between the urethra to the fluid-filled cavity (fistula). Exploratory celiotomy was performed, and an entire female reproductive tract with a blind-ending vagina and a urethrovaginal fistula was found. En bloc gonad hysterectomy was performed, the fistula was transected, and a careful urethral reconstruction was performed. The urinary incontinence resolved immediately after surgery, and no complications were reported. Mild urinary incontinence recurred 4 days following patient discharge, and a urine bacterial culture was positive for Klebsiella spp. An antibiotic course was prescribed, and the incontinence fully resolved. Congenital urogenital abnormalities should always be considered in young animals presenting with urinary incontinence. Here, a young female pseudohermaphrodite dog with a naturally occurring congenital urethrovaginal fistula is described. Exploratory surgery was required for definitive diagnosis and surgical intervention yielded a good medium-term outcome with resolution of clinical signs., (© 2021 by American Animal Hospital Association.)

The objective of this study was to describe the clinical findings, medical management, and outcomes of horses with sabulous cystitis, and to describe a high flow bladder lavage procedure in horses that are standing or under general anesthesia. The medical records of 13 horses diagnosed with sabulous cystitis via cystoscopy between 2013 and 2020 were reviewed. Geldings (92%) and Warmbloods (46%) were overrepresented. The most common presenting complaint was urinary incontinence (69%). Complete blood cell count, serum biochemistry profile and urine cytology results were non-specific. Six (46%) horses had various degrees of erosion, ulceration, and hemorrhage of the bladder mucosa. All horses were treated with bladder lavage either with standing sedation ( n = 12) or general anesthesia ( n = 2), as well as antimicrobials (54%), anti-inflammatory drugs (62%), bethanechol (15%), and phenazopyridine (15%). Most horses (85%) were discharged from the hospital, but only a small percentage (23%) was reported as having no urinary abnormalities on follow-up communication. Key clinical message: Copious bladder lavage with a high flow rate system could mitigate the acute clinical signs and improve the quality of life of horses with sabulous cystitis, but the prognosis for return to previous level of athletic performance and long-term survival is guarded., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Case Description: An 8-month-old 41.2-kg (90.6-lb) sexually intact male Dogue de Bordeaux with urinary incontinence and signs of nausea was referred for further evaluation and treatment of bilateral hydronephrosis, hydroureter, and ectopic ureters., Clinical Findings: Clinicopathologic analyses revealed urine specific gravity and serum concentrations of urea nitrogen and creatinine within reference limits. Abdominal ultrasonography and CT revealed unilateral abdominal cryptorchidism, ureters that bilaterally passed dorsal to and appeared compressed by the external iliac arteries (retroiliac ureters), and bilateral hydronephrosis, hydroureter, and ectopic ureters. On CT, minimal uptake of contrast medium by the right kidney indicated either a lack of renal function or ureteral obstruction., Treatment and Outcome: The dog underwent exploratory laparotomy, right ureteronephrectomy, left neoureterocystostomy, bilateral castration, and incisional gastropexy without complication and was discharged 2 days postoperatively. Eleven days after surgery, the dog had improved but continued urinary incontinence, improved left hydronephrosis and hydroureter, and serum concentrations of urea nitrogen and creatinine within reference limits. At 24 months after surgery, the dog was reportedly clinically normal, other than having persistent urinary incontinence., Clinical Relevance: To our knowledge, this was the first report of a dog with retroiliac ureters and compression-induced ureteral obstruction with secondary hydroureter and hydronephrosis. Retroiliac ureters should be considered as a differential diagnosis in young dogs with ureteral obstruction. Our findings indicated that a good outcome was possible for a dog with retroiliac ureters treated surgically; however, the presence of additional congenital anomalies should be considered and may alter the prognosis in dogs with retroiliac ureters.

Urethral sphincter mechanism incompetence (USMI) is a common cause of urinary incontinence in dogs. Although estrogen is often prescribed for the medical therapy of USMI for spayed female dogs, they are known to have limited effectiveness and potential adverse effects. In castrated male dogs with USMI, testosterone reagents have been attempted besides estrogen. In this study, the effect of testosterone drugs, mainly methyltestosterone, on spayed female dogs with USMI was retrospectively evaluated. Ten spayed female dogs with USMI were included. Diagnosis of USMI was based on the results of the dogs' medical history, clinical signs, and no abnormalities in physical examinations, urinalysis, ultrasonography, X-ray imaging, and neurological examinations. Methyltestosterone was administered at doses of 0.32-1.27 mg/kg BW p.o. semel in die (sid.) to twice a week. Nine of the ten dogs had good or excellent responses 2 to 4 weeks after the start of treatment. The minimum effective dose was 0.32 mg/kg/day. Although no severe adverse symptoms occurred in any dog, a mild increase in alanine aminotransferase was temporally observed at doses of 1.0 and 1.1 mg/kg/day in the two dogs. After dose reduction or withdrawal, two of eight dogs had recurrence of urinary incontinence. Resumption of testosterone treatment clearly improved the symptoms in the two dogs. These results indicate that testosterone reagents might be an option for treating USMI in spayed female dogs as well.

Background: Bulking agent implantation is a minimally invasive intervention for the management of urethral sphincter mechanism incompetence (USMI)., Hypothesis/objectives: To evaluate the efficacy and safety of the novel bulking agent VetFoam for the management of urinary incontinence in female dogs diagnosed with USMI., Animals: Fifteen client-owned female dogs., Methods: Prospective study. Female dogs diagnosed with USMI, refractory, or unamenable to medical treatment were included. VetFoam was injected under endoscopic guidance into the urethral submucosa. Continence score was evaluated before and after the procedure and monthly thereafter., Results: Twenty-two injection procedures were performed in 15 dogs (5 dogs underwent >1 procedure). Median age of all dogs at the time of the procedure was 111 months (range, 18-180). Median continence score significantly increased after, compared with before bulking agent injection (1.5; range, 1.0-3.5 versus 4.0; range, 1.5-5 respectively; P < .001; effect size, 2.6). Continence was achieved in 13/15 (87%) dogs after the first procedure and in 7/7 (100%) repeated procedures. Overall, 20/22 (91%) procedures resulted in high (≥4) continence scores at time of first follow-up. Mean duration of continence was 11.1 months (SD, 10.7) after the first injection. One dog (7%) developed self-limiting stranguria, pollakiuria, and tenesmus while no other apparent adverse effects were recognized in the other dogs., Conclusions and Clinical Importance: VetFoam is an apparently safe, effective novel bulking agent, which can be used as an alternative for the management of USMI., (© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.)

Objective: To compare the prevalence rates and severity of acquired urinary incontinence (AUI) between dogs spayed with laparoscopic and open laparotomy approaches., Study Design: Retrospective matched-pair cohort study., Animals: In total, 1285 privately owned dogs spayed >5 years previously were included in the study., Methods: Laparoscopically spayed dogs were matched with dogs spayed by traditional laparotomy. Matching variables were breed, bodyweight, age at spaying, time of spaying in relation to the onset of puberty, time interval since spaying, and age. In 400 matched-paired dogs, the outcome of AUI was assessed by using an owner questionnaire. A conditional logistic regression for matched pairs was performed on the data of 308 dogs., Results: Among 308 dogs, 30 and 29 dogs spayed by laparotomy and laparoscopy, respectively, were affected by AUI. The identified risk factors for AUI were age and time interval since spaying. The surgical approach (laparoscopy or laparotomy) was neither revealed as a risk factor nor did it influence the severity of AUI., Conclusion: The risk of AUI after spaying is not influenced by the surgical approach, (laparoscopy or laparotomy). Nearly every fifth dog spayed by laparotomy or by laparoscopy was affected by AUI. A relatively longer time interval since spaying and increased age of the dog increased the risk for AUI., Clinical Significance: Owners of dogs with a predisposition for AUI must be counseled about this risk when they present their dogs for spaying, regardless of surgical approach chosen., (© 2019 The American College of Veterinary Surgeons.)

Background: In contrast to dogs, the causes and outcomes of urinary incontinence (UI) in cats are largely unknown., Objectives: To determine the causes, identify comorbid conditions, and assess outcomes of cats with micturition disorders presenting as UI., Animals: Forty-five cats with UI., Methods: Retrospective study. Medical records of cats presented from January 2006 to December 2017 were searched using 45 keywords related to UI. History, presenting complaint, and physical examination findings were used to confirm a diagnosis. Cases were categorized based on functional and anatomic localizations., Results: Forty-five cats met inclusion criteria. Spinal cord disease was the most common cause of UI (n = 18), followed by urethral (n = 17), bladder (n = 9), and ureteral (n = 1) disorders. Proportions of voiding and storage phase disorders were similar (53% and 47%, respectively). However, voiding-phase disorders were observed more frequently in males and younger-aged cats (P < .03). Urinary tract infection was detected in 11 of 28 (39%) cats. Outcomes were available in 38/45 cases; 16 cats (42%) regained continence, 3 (8%) improved with treatment, and 19 (50%) remained incontinent or were euthanized. Multiple variable logistic regressions indicated that spinal cord disease was significantly more likely to be associated with poor outcomes compared to bladder or urethral disorders (P < .04)., Conclusions and Clinical Importance: Urinary incontinence in cats was associated with a variety of congenital and acquired disorders that affected both phases of micturition with similar frequency. Incontinent cats with spinal cord disorders were common and warrant a more guarded prognosis than do cats with bladder or urethral disorders., (© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Objectives: To investigate association between neutering and early-onset urinary incontinence in bitches under primary veterinary care in the UK., Materials and Methods: A retrospective cohort study of bitches within VetCompass born between January 1, 2010 and December 31, 2012 that were followed until March 31, 2018. The clinical records were automatically searched and manually validated for incontinence cases. Incidence risk and rate over the study period were calculated. Cox regression modelling separately evaluated the hazard of urinary incontinence and association with neutering: (1) from the date of birth for all bitches, both neutered and entire; and, (2) from the date of neutering for the neutered subset. Other variables considered included breed, bodyweight and veterinary practice group., Results: Overall, 492 bitches were identified with early-onset urinary incontinence from a total of 72,971 included in the study period. Incidence risk was 0.68% (95% confidence intervals 0.62 to 0.74), while incidence rate increased with age. After accounting for confounding factors, increased hazard of early-onset urinary incontinence was identified in: (1) neutered bitches, with the effect increasing with age; and, (2) bitches neutered before 6 months, within the first 2 years following neutering. In both models, increased hazard was additionally associated with increasing bodyweight and breed., Clinical Significance: Neutering itself and early-age neutering (<6 months) are major risk factors for early-onset urinary incontinence. These results should be taken into account in making evidence-based recommendations on neutering and its timing., (© 2019 The Authors Journal of Small Animal Practice published by John Wiley & Sons Ltd on behalf of British Small Animal Veterinary Association.)

Background: Urinary (UI) and fecal (FI) incontinence occur in up to 7.5% and 32% of dogs, respectively, after thoracolumbar acute noncompressive nucleus pulposus extrusion (ANNPE)., Hypotheses/objectives: To investigate clinical, diagnostic, and therapeutic predictors of UI and FI in dogs with ANNPE affecting the T3-L3 spinal cord segments., Animals: Hundred and eighty-seven dogs with T3-L3 ANNPE diagnosed based on clinical and MRI findings., Methods: Multicenter retrospective study. Data were obtained from medical records and telephone questionnaires and analyzed by logistic regression., Results: UI and FI were reported in 17 (9.1%) and 44 (23.5%) dogs, respectively. Paraplegic dogs were 3 times (95% CI = 1.25, 10.87) more likely to develop UI (P = .018) and 4 times (95% CI = 1.94, 12.56) more likely to develop FI (P = .001) compared to nonparaplegic dogs. Dogs with an intramedullary hyperintensity greater than 40% of the cross-sectional area of the spinal cord at the same level on transverse T2-weighted MRI images were 4 times more likely to develop UI (95% CI = 1.04, 21.72; P = .045) and FI (95% CI = 1.56, 10.39; P = .004) compared to dogs with smaller lesions. FI was 3 times (95% CI = 1.41, 7.93) more likely in dogs that were not treated with nonsteroidal anti-inflammatory drugs (NSAIDs) after diagnosis compared to dogs administered NSAIDs (P = .006) and 2 times (95% CI = 1.12, 5.98) more likely in dogs presented with clinical signs compatible with spinal shock compared to dogs without (P = .026)., Conclusion and Clinical Importance: The identification of clinical, diagnostic, and therapeutic predictors of UI and FI in dogs with T3-L3 ANNPE can help to approach these autonomic dysfunctions occurring after spinal cord injury., (© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Case Description: A 5-year-old spayed female Maltese mixed-breed dog was referred for evaluation because of severe urinary incontinence refractory to medical management., Clinical Findings: Physical examination revealed constant dribbling of urine and urine scalding. Culture of a urine sample yielded methicillin-resistant Staphylococcus pseudintermedius and Proteus mirabilis . Abdominal ultrasonographic examination revealed absence of the left kidney, a small, nondistended urinary bladder, and diffuse hepatopathy. Urinary incontinence persisted despite appropriate antimicrobial treatment. Cystourethroscopy and vaginoscopy were subsequently performed and revealed a hypoplastic bladder and a vesicovaginal fistula with urinary leakage through the vaginal diverticulum; no left ureterovesicular junction was identified, consistent with suspected left renal aplasia., Treatment and Outcome: Exploratory laparotomy was performed, and the cranial aspect of the vagina was circumferentially ligated immediately caudal to the fistula. The urinary incontinence resolved immediately after surgery, and lower urinary tract signs improved over the next 2 weeks. Moderate urinary incontinence recurred approximately 6 months later, and a urinary tract infection with Escherichia coli was subsequently identified and treated; clinical signs resolved ≤ 48 hours after treatment was initiated., Clinical Relevance: To the author's knowledge, vesicovaginal fistulas in dogs have not been previously described and should be considered a differential diagnosis for persistent urinary incontinence and recurrent urinary tract infections in female dogs. Vaginoscopy in addition to cystourethroscopy was required to identify the abnormality in this patient. Because multiple concurrent anomalies can be present, both procedures should be performed in female dogs with these clinical signs, even if an abnormality is identified cystoscopically.

Objectives: To evaluate associations between spaying and urinary incontinence in bitches under primary veterinary care in the UK., Materials and Methods: A case-control study was nested within the study population of 333,910 bitches, which included all bitches within the VetCompass database with an electronic patient record in 2016 or in both 2015 and 2017. The electronic records were searched automatically for urinary incontinence cases, which were manually reviewed for inclusion. All non-cases were included as controls. Additional demographic and clinical information was extracted on cases and controls., Results: The study included 427 incident cases and 1708 controls that were presented between November 1, 2014 and October 31, 2017. Prior spaying was associated with increased odds of urinary incontinence (odds ratio: 3.01; 95% CIs: 2.23 to 4.05). Increased odds of urinary incontinence were additionally associated with increasing age and increasing bodyweight. Age at spay was not associated with urinary incontinence., Clinical Significance: The findings support spaying as a major risk factor associated with urinary incontinence, but age at spay appears to be of less clinical importance. These results will help assist clinicians in making evidence-based recommendations on spaying while taking other considerations for urinary incontinence into account., (© 2019 The Authors Journal of Small Animal Practice published by John Wiley & Sons Ltd on behalf of British Small Animal Veterinary Association.)

Objective: To describe the clinical presentation, magnetic resonance imaging features, and outcome of cats treated with hemilaminectomy for intervertebral disc extrusion (IVDE)., Study Design: Short case series., Animals: Six cats., Methods: Medical records were reviewed for signalment, onset, duration, and severity of clinical signs, magnetic resonance imaging features, surgical findings, and clinical outcome with a minimum postoperative follow-up of 4 weeks., Results: Our population included 6 cats with a median age of 8.6 years, consisting predominantly of males (n = 5) and purebred cats (n = 4). An acute onset and short duration of progressive clinical signs of myelopathy was the most common presentation; spinal hyperesthesia was present in 3 cats. A large volume of extradural material was identified by MRI within the lumbar vertebral column of each cat, causing marked spinal cord compression. The most common sites affected were L2-L3 (n = 2) and L6-L7 (n = 2). Follow-up after hemilaminectomy was available in 5 cats: 4 had normal voluntary motor function, and 1 had recurrence of acute paraplegia, compromised nociception, and an extensive T2w hyperintense intramedullary lesion according to MRI. All 4 cats with preoperative urinary incontinence remained incontinent for at least 1 week despite good voluntary motor function of pelvic limbs., Conclusion: Intervertebral disc extrusion was diagnosed by MRI in all 6 cats, most commonly at L2-3 and L6-7. Hemilaminectomy resulted in a good to excellent outcome in 4 of 5 cats., Clinical Significance: Feline IVDE can be diagnosed by MRI and carry a good prognosis after surgical decompression, although urinary continence may be delayed despite good pelvic limb voluntary motor function., (© 2019 The American College of Veterinary Surgeons.)

Peritoneal larval cestodiasis caused by Mesocestoides spp. is a rare infection in dogs. A 6-year-old female dog was presented for veterinary care with urinary incontinence which started 1 year earlier. After performing hematology, ultrasound, and computerized tomography, an exploratory laparotomy revealed canine peritoneal larval cestodiasis (CPLC) with the presence of Mesocestoides vogae (syn. Mesocestoides corti) tetrathyridia confirmed by morphological identification and PCR and DNA sequencing. Parasitic cysts were found around the urinary bladder and appeared to inhibit its normal function. An initial treatment with 5 mg/kg praziquantel subcutaneously every 2 weeks for four treatments failed to alleviate the clinical signs, and only treatment with fenbendazole at 100 mg/kg P.O. twice daily for 28 days was associated with the disappearance of ascites and regaining of urinary control. This is the first report of CPLC associated with urinary incontinence in dogs and the first description of this cyclophyllidean cestode in dogs in Israel.

Untreated house soiling presents a severe risk to the human-animal bond. Despite being one of the most common behavior problems reported to veterinarians, a majority of veterinarians surveyed reported a lack of confidence in their ability to diagnose nonmedical inappropriate elimination. Successful resolution depends on an appropriate diagnosis, which is arrived at by a thorough medical and behavioral history, once medical problems have been ruled out. A systematic approach to collecting history, noting clinical signs and ruling out differentials, is most likely to yield positive results in the shortest time., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Incontinence is a frustrating condition for both pet owners and their veterinarians. Fortunately, most causes are easily diagnosed and most dogs respond to appropriate therapy. This article reviews normal urine storage and voiding, causes of incontinence, typical clinical presentation, diagnostics, and treatment., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the outcome of endoscopic injection of two different bulking agents, glutaraldehyde cross-linked collagen and dextranomer/hyaluronic acid copolymer into the urethral submucosa in female dogs with urinary incontinence caused by urethral sphincter mechanism incompetence., Materials and Methods: Retrospective review of records and follow-up communication with owners of dogs that received an endoscopically guided urethral bulking procedure. In each dog, either cross-linked collagen (2007 to 2011) or dextranomer/hyaluronic acid copolymer (2012 to 2015) was used. At least three injections were made in a circular arrangement in the midurethral region until the urethral lumen was closed., Results: Complete questionnaires were available from 50 of 100 pet owners. The mean interval between the treatment and interview was 67 (range: 57 to 114) months in the cross-linked collagen group and 19 (range: 2 to 48) months in the dextranomer/hyaluronic acid copolymer group. The mean duration of continence was 45∙8 months (range: 12 to 84 months) in the cross-linked collagen group and 20∙5 months (range: 12 to 48 months) in the dextranomer/hyaluronic acid copolymer group. The success rate at 6 months or more after the procedure was 71% after the injection of cross-linked collagen and 58% after injection of dextranomer/hyaluronic acid copolymer. One minor complication (transient haematuria) occurred in one dog. There were no major complications., Clinical Significance: Urethral injection of dextranomer/hyaluronic acid copolymer in bitches with urethral sphincter mechanism incompetence is a useful alternative to cross-linked collagen injection, which is no longer available in the European market. Dextranomer/hyaluronic acid copolymer injection is a minimally invasive alternative to surgical procedures and has a low complication rate., (© 2018 British Small Animal Veterinary Association.)

Objective: To estimate prevalence and identify demographic risk factors for urinary incontinence in male dogs., Methods and Methods: The study population included all dogs within the VetCompass database from September 1, 2009 to July 7, 2013. Electronic patient records were searched for urinary incontinence cases; demographic and clinical information were extracted and analysed., Results: Of 109,428 male dogs attending 119 clinics in England, there were an estimated 1027 dogs diagnosed with urinary incontinence, giving a prevalence of 0.94% (95% confidence interval: 0.88 to 1.00). Breeds with highest odds of incontinence in male dogs (compared with mixed breed dogs) included the bull mastiff (odds ratio: 17.21, 95% confidence interval: 6.65 to 44.56, case=5, non-case=314, P<0.001), Irish red setter (odds ratio: 12.79, 95% confidence interval: 4.83 to 33.84, case=5, non-case=142, P<0.001), fox terrier (odds ratio: 9.60, 95% confidence interval: 3.68 to 25.05, case=5, non-case=176, P < 0.001), bulldog (odds ratio: 5.72, 95% confidence interval: 2.24 to 14.59, case=5, non-case=929, P<0.001) and boxer (odds ratio: 3.65, 95% confidence interval: 1.84 to 7.25, case=10, non-case=1470, P<0.001). Increased odds of urinary incontinence were associated with greater age (age 9 to 12 years, odds ratio: 10.46, 95% confidence interval: 6.59 to 16.62, n=12,348, P<0.001) and being insured (odds ratio: 1.96, 95% confidence interval: 1.53 to 2.51, n=26,202, P<0.001). There was no association with castration or bodyweight using multi-variable analysis., Clinical Significance: The overall prevalence of urinary incontinence in male dogs is approximately 1%, which may be higher than expected given the sparsity of reports describing this problem. In contrast to bitches, neutering and bodyweight were not associated with greater odds of urinary incontinence, which is important when giving neutering advice., (© 2018 British Small Animal Veterinary Association.)

The two leading causes of urinary incontinence in dogs are ureteral ectopia in juveniles and urethral sphincter mechanism incompetence in adults. While the accuracy of diagnosis of ectopic ureters has improved due to increased use of CT and/or cystoscopy, the diagnosis of urethral sphincter mechanism incompetence largely remains one of exclusion. New treatment options have been developed for both conditions, which have reduced morbidity and mortality, although the rate of long-term urinary continence has not significantly improved for either and neither has our understanding of the pathophysiology behind these failures. This review provides updates on the management of both of these conditions, with discussion of controversial areas and thoughts for future directions., (© 2018 British Small Animal Veterinary Association.)

Objective: To evaluate the long-term efficacy of the transobturator vaginal tape inside out (TVT-O) in female dogs with urethral sphincter mechanism incompetence (USMI)., Study Design: Retrospective study., Animals: Incontinent spayed female dogs (n = 12)., Methods: TVT-O tape was inserted in 12 incontinent bitches diagnosed with USMI. Follow-up information was evaluated by a telephone questionnaire, and a continence score was attributed., Results: One year after surgery, 7 of 12 (58%) dogs were completely continent. Two dogs were removed from the long-term analysis (1 dead and 1 lost). At a median follow-up time of 85 months (range, 28-95), 4 of 10 dogs were completely continent without medical treatment. Incontinence recurred in 6 dogs at a median time of 2 months after surgery (range 1-20). Among these 6 dogs, 4 regained continence, and 2 had sporadic episodes of incontinence with additional medical treatment. No postoperative complications were encountered., Conclusion: TVT-O alone was successful in maintaining long-term continence in 40% of the dogs. Additional postoperative medical treatment was effective in restoring continence in another 40% of the dogs., Clinical Significance: TVT-O provides an alternative treatment of USMI in female dogs that is safe and less invasive than standard surgical techniques., (© 2018 The American College of Veterinary Surgeons.)