Sablotni Aguilera, Alexander Paul

Universitat Autònoma de Barcelona. Facultat de Veterinària

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Artificial urethral sphincter Vaginal transobturator tapeAcquired urinary incontinence in adult bitch. Surgical options.Alexander Paul Sablotni Aguilera - Final Project in Veterinary Medicine Degree 2017 – Autonomous University of BarcelonaIntroductionUrinary incontinence (UI) occurs when the voluntary control of the bladder and urethral sphincters disappears, resulting in a constant or frequentinvoluntary loss of urine during storage. In adult bitches, the main cause (in 85% of the cases) is the urethral sphincter mechanism incompetence(USMI), acquired especially post neutering, and ectopic ureter (UE). Others less frequent would be detrusor instability, neurogenic incompetence,intersexuality, bladder neoplasia, ureterovaginal fistula, vaginal neoplasia and vesiculo-vaginal fistula.There is a lot of controversy about the pathophysiology but sure is that there are multiple factors that can predispose to acquired UI in adultbitches, such as adult weight, age of neutering, and the breeds (medium to large) among others. The first episodes of acquired UI may appearbetween 2 and 5 years post-sterilizeObjectives• Define the surgical options for the treatment of acquired UI in adult bitches.• Compare the success rate of each surgical techniques.• Determine the advantages and disadvantages of each surgical techniques.Surgical techniquePaper DataAuthor Yearnº of casesPostoperative success rate (%)Average follow-up period (months)ColposuspensionHolt et al. 1990 15053 (excellent)33,637 (improved)Marchevsky et al.1999 6040 (excellent)-42 (improved with medicine)Rawlings et al. 2001 23 55 (excellent) 7Urethropexy R. White 2001 10056 (excellent) 35,427 (improved) 40,1Cystourethropexy Massat et al. 1993 1020 (excellent)-40 (improved)UretroplastyBushby and Hankes1980 1 100% 1,5Urethropexi & colposuspensionMartinoli et al. 2014 30 70% 39,5 Colposuspension &uretroplastyMuir et al. 1994 540% (excellent)-60% (recurred)Teflon Arnold et al. 1989 22 77% (excellent) -Glutaraldehyde cross-linked collagenArnold et al. 1996 32 53% (excellent with surgery only) 22Collagen Barth et al. 2005 4068% (injection)1718% (injection+ medicine)Bovine cross-linked collagenByron et al. 2011 31 +/- 65% 16,4Artificial urethral sphincterAdin et al. 20046 (cadaver)100%**tested to see how the device worked. Rose et al. 2009 4 100% 26 - 30P. Delisser et al. 2012 11 36,4% 13,73Currao et al. 2013 1856% (excellent)3267% (improved)Reeves et al. 201327 (18 USMI)92,50% (excellent) 12,5Vaginal transobturator tapeNickel et al. 1998 2625% (7 with Colpo.) 19 25% (6 without Colpo.)15,4% (4 with medicine) 22Claeys et al. 2010 7 87,50% 11,3Deschamps and Roux 2015 12 92% 41(Wilson 2016)TreatmentMedical1.Phenylpropanolamine hydrochloride 2. Diethylstilbestrol Surgical techniques1. Realization of pexias2. Injection of substances3. Placement of devicesColposuspension Urethropexy USMI before injection After injection(Berent 2016) (Berent 2016) (Rawlings 2002)(McLoughlin y Chew 2009)Cystourethropexy Uretroplasty(Massat et al., 1993) (McLoughlin y Chew 2009)(Claeys et al. 2010)Conclusions1. Among the existing surgical techniques for the treatment of acquired UI in adultbitches, colposuspension has been the most used in history. However,performed as the only technique, its success rate only slightly exceeds 50%.2. Although there are few comparative studies at present, urethropexy combinedwith colposuspension may be considered a good surgical protocol, since it hasbeen shown to increase the success rate up to 70%.3. Regarding the most innovative techniques, both periurethral collagen injectionand AUS placement, provide success rates similar to the combination ofcolposuspension and urethropexy, but are less invasive and offer betterpostoperative techniques. The main problem is the economic cost.4. TVT can be considered a good alternative to previous techniques, since inaddition to demonstrating equal or higher success rates, it is an economical andfaster surgical technique to do.5. The main drawback of all surgical techniques for the treatment of acquired UI isits poor long-term efficacy.

Acquired urinary incontinence in adult bitch. Surgical options

https://ddd.uab.cat/pub/tfg/2017/179953/TFG_asablotniaguilera_poster.pdf

Acquired urinary incontinence in adult bitch. Surgical options

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