Urinary incontinence in the spayed bitch
Svensson Emma Camilla
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Acquired urinary incontinence affects as many as 5-20% of spayed bitches, which is a sub-stantially larger percentage than what is seen in intact bitches or male dogs; both intact and neutered (FORSEE et al., 2013; ARNOLD, 1997). In particularly large dogs and dogs of cer-tain breeds are predisposed to the condition (VERONESI et al., 2009; HOLT and THRUS-FIELD, 1993). The etiology of spay incontinence appears to be multifactorial. The research focused for a long time on estrogen deficiency, since the medication with estrogens aided many patients. Since then, further investigations have elucidated possible effects of other hormonal factors such as GnRH and gonadotropins on the pathophysiology of the lower uro-genital tract (REICHLER et al., 2004; REICHLER et al., 2006a). Receptors of GnRH, LH and FSH has been detected in the lower urogenital tract, leading researchers to believe that the hormones fulfill a previously unknown physiological function in the region (PONGLOWHA-PAN et al., 2007). Differences in collagen versus muscle mass has been noted when compar-ing intact and neutered dogs as well as between male and female animals (PONGLOWHA-PAN et al., 2008). Bitches suffering from urethral sphincter mechanism incompetence (US-MI) are more likely to have a caudally located bladder neck and a shorter urethra than intact female dogs (GREGORY, 1994; GREGORY et al., 1992). The urethral pressure is shown to decrease during the first year after spaying and a shorter distance of the urethra fulfills its sphincter function, demonstrated by a decreased functional profile length (FPL) (REICHLER et al., 2004; GREGORY, 1994). USMI has been referred to as physiological incontinence and is commonly diagnosed by excluding other conditions causing incontinence. Even though more advanced technique in the form of urethral pressure profilometry is available, it is not a necessity for the average practitioner. The first line of therapy consists of alpha-adrenergic agonists and in particular, phenylpropanolamine (PPA), but some dogs benefit from a combi-nation of PPA and estriol or estriol alone, in cases where the adverse effects of PPA renders the drug unsuitable (ARNOLD et al., 2009; KANCA et al., 2012). PPA is traditionally admin-istered two to three times per day but once per day treatments have shown great success in contemporary studies (CLAEYS et al., 2011). Surgical therapy should only be considered when medicinal therapy fails. The two forms of therapy can also be combined with success when neither of the methods can achieve sufficient results on its own (RAWLINGS et al., 2001). Most surgical techniques produce an initial improvement in the patient but the conti-nence scores typically decrease over time (WHITE, 2001).