Colposuspension for Treatment of Female Dogs With Refractory ::::Ji

Colposuspension for Treatment of Female Dogs With Refractory ::::Ji

"';""'';::td:l"tli
Evaluation of a Transpelvic Sling Procedure With and Without
in incontinent
failure in inco
th.u."Bladd
Colposuspension
for Treatmentof FemaleDogs With Refractory::::Ji,:T,t
IJrethral Sphincter Mechanism Incompetence
RAFAEL F. NICKEL, DVM,Dr.Med.vct.,
Diplomare
ecvs, URSEL WIEGAND, DVM, Dr.Med.Vcr.,
and W.E. VAN DEN BROM, pr,o
Objective-To evaluatea sling procedureusing a polyesterribbonpassedthroughthe obturatol
tbramen,aroundthe urethra,and fixed outsidethe pelvis for the treatmentof female dogs with
rel'ractoryurethralsphincterrnechanismincompetence
(USMI).
Animals-26 f'emaledogs with USMI that had not improvedwith medicalmanagemeut.
Methods-All dogs underwenta transpelvicsling procedure,
and in 13, with a radiographic
diagnosisof a pelvic bladder,additionalcolposuspension
was perfbrmed.Multichannelurethlal
prcssureprofilornetry(UPP) and diuresiscy.stourethrometry
(LiCM) were performedin all dogs
belbrc and in sevenclogs2 to 14 n.ronths
afier surgery.Long-termresultsoisurgery anclrnedical
therapywere deterrnincd.
Results-13 dogs (50a/;1,6of thesewithout additionalcolposuspension,
were continentafter
s u r g e r y a n d r e r n a i n e d c o n t i n e n t d u r i n g a f o l l o w - u p pl 2e troi o3d6omf o n t h s ( m e a n
l 9, r n o n t l r s ) .
Seven,threeof which haclcolposuspension,
hadimprovedmarkedly.Fourof thesedogsbecame
continentwith additionalrnedicaltherapy.Five dogsdid not improve,and threeof thesewcrc
eventuallyeuthanatizecl.
In one dog, the sling was removedafter5 daysbecauseo1'persistent
stranguriit.
Surgeryand rnedicaltherapytogetherresultedin continence
in l7 dogs(650lo)
during
periodof 6 to 36 months(rnean,22 months).Postoperative
a firllow-r,rp
dysuriaor stntngrilil
occurredin six dogs, and four o1'theseunderwenta colposuspension
procedure.Two dogs
developeda fistula, 2 ancl3 years afier surgery.Preoperatively,
decreasedurethral resistance
was stlggested
by the findingsol'UPP and UCM in 25 dogs,andan abnormallyhigh cornpliiince
was firundin 3, detrusorinstabilityin 2, and a low thresholdpressure
in I dog. There was no
apparentcorrelittionbetweenthesefindingsand the outcomeof surgery.Urethralclosureprcssuresmeasuredafiel surgery were signiliiantly increasedbut were still lower than the nonnal
r i r n g ei n u l l d r r g sw i l h p c r s i s t e notr r e c u r r e ni tn c o n t i n e n c e .
Conclusions-A transpelvicsling procedure,
with or withoutadditionalcolposuspension,
carr
be uscfirl in the rnanagement
of dogs with refiactoryurinaryincontinence.
The procedureis not
beneficialil'it doesnot increascurethralpressure
closeto, or within,the normalrange.
@Copyright 1998bv The Americun Collegeof'VeterinorySurgeons
endoscoPic b:
arere
dures
use of sling
encouraging
slin
prepubic
.rioi
to other 1
endoscoPic i
gen.t-n ln adt
postopelatlv
when COmp
niques.T-e't3
To reduc,
I
cations ano
the miduret
developed.
with regard
thral press
female dog
uate a ffan
colposuspe
tory to me
I
J*"nlVurinarY rnc
Alldogsh
failed to :
only if tht
tory, conl
ffact' resu
trY (UPP)
low-up ti
Preop
ough me
OF urethral sphincter mechanism
T'TREATMENT
I incompetence (USMI) in female dogs presents
a great challenge. When medical therapies fail to
resolve the incontinence, surgical intervention may
be beneficial. Various surgical and endoscopic tech-
the larger case studies with long-term fbllow-up,
however, the cure rate was not higher than -537o,and
g%oto13%oofthepatientsfailedtorespondatall.se
ln a review of the iurgical management of USMI, it
is suggestedthat bladder dysfunction, such as detru-
and.cultl
niquesfor the treatmentof USMI in female dogs
havebeenreportedin the veterinaryliterature.r8In
,o, i*tubility, could be responsiblefbr treatmenr
failure in somepatients.e
This has been described
IL:1.7
lilliil;
:'"Ml
to exclu
tract su
From the Department of Clinical Sciencesof Compar.rionAnimals, University of Utrecht, Utrecht, The Netherlands.
Address reprint requeststo Mrs. Anke Henny, Yalelaan 8, 3508 TD Utrecht, The Netherlands.
@Copyright 1998 by The American College of Veterinary Surgeons
0161 -3499198127
02-0002$3 'oolo
94
A Sh
in all d
pelvicl
diagnor
96
TRANSPELVIC SLING FOR URINARY INCONTINENCE
Table 1. Signalment,Clinical Signs,History, and Resultsof PreviousConservativeTreatmentsin 26 FemaleDogs With RefractoryUrethral
SphincterMechanismIncompetence
Dog
No.
I
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
l7
18
19
20
2l
22
23
24
25
26
Age
(y)
Boxer
Doberman
Bouvier
DomesticShepherd
BeardedCollie
CanadianShepherd
Boxer
Doberman
Irish Setter
Bouvier
Doberman
Bobtail
Appenzeller
SwissLaufhund
DomesticShepherd
Bouvier
Boxer
Mastiff
Rottweiler
Rottweiler
Boxer
Doberman
Boxer
Doberman
Doberman
Irish Setter
5
7
3
7
5
10
3
4
7
2
3
5
6
7
6
3
3
5
2
6
4
8
6
BW
(ke)
Urine LeakageDuring
23
34
45
24
22
34
23
2'7
35
33
37
28
4l
28
22
35
27
50
M
31
20
39
29
37
36
27
recumb.
recumb.,excite.
recumb.,bark., postmict.
cont.
recum.
recumb.,postmict.
cont.
cont.
recumb.,postmict.
recumb.
recumb.,standingup
recumb.
cont.
cont.
cont.
cont.
recumb.,standingup
cont.
recumb.
recumb.,standingup
cont.
recumb.,standingup
recumb.
recumb.
cont.
recumb.,standingup
SignsStarted
(mo) Ago
12
16
6
2
48
24
36
96
15
24
22
10
3
12
48
6
3
4
6
48
Onset After
Spaying
(mo)
J
J
1
24
16
no
l0
9
20
5
30
no
1A
34
AA
48
30
z
I
no
30
6
38
J
34
6
Previous
Treatments
eph., imi.
eph.
eph., imi.
eph.
eph.
eph.
eph., imi., DES
eph.
phenylprop., es.
eph., ecp.
eph., es., prop.
eph.
eph.
eph.
eph., DES
eph., ethinyles.
eph.
eph.
eph.
eph.
eph.
eph., imi.
eph.
eph., imi.
eph., DES
eph., imi.
Responseto
Therapy
none
temp.
none
none
temp.
none
temp.
temp.
none
none
terhp.
temp.
none
temp.
temp.
none
temp.
none
none
rcmp.
none
temp.
temp.
none
temp.
no
Abbreviations:BW, body weight; recumb.,in recumbency;excite.,when excited;postmict.,after micturition;cont.,continuously;eph.,ephedrine
(1-3 mg/kg q 8 h); imi., imipramine(1-3 mglkg q 8 h); phenylprop.,phenylpropanolamine
(0.5-1.5mglkg q 8 h); prop., propantheline(1 mg/kg q
8 h); DES, diethylstilbestrol(1 mg/dog q 24 h); es., estriol (l-2 mgldog q 24 h): ethinyles.,ethinylestradiol(0.5-1 mg/dog q 24 h); ecp.,
estriolcypromate;
temp.,temporary.
with some slack remainingand when the cathetercould
be withdrawn without difficulty. The ribbon was then
suturedtogetheraround and on top of the ligaclip (Fig
3) using 2-0 polypropylenesuturematerial(Prolene;Ethicon, Hamburg,Germany)and the remaindercut off and
removed.
In dogs also undergoing colposuspension,two 2-0
polypropylenesutureswere placedlateral to the urethra
and through the vagina on each Side,as describedby
Holt,3while the vaginawas graspedand pulled cranially.
The polypropylenesutureswere tied aroundthe inguinal
ligamentsand the final position checkedby digital palpation. The adductormuscleswere reapposedwith single
intemrptedsuturesof 2-0 polydiaxanone(PDS; Ethicon,
Hamburg,Germany).The incisionsin the abdominalwall,
subcutis,and skin were closedin a routine fashion.
After recovery,the dogs were hospitalizedfor at least
48 hours. Buprenorphine(Temgesic; Schering-Plough,
Amstelveen,the Netherlands)was administeredsubcutaneouslyat a doseof lO p,gkg body weight every 8 hours
afterthesurgicalprocefor 24hoursto provideanalgesia
dure.
Analysisof Results
Short-term follow-up and complications. A physical
examination was performed 24 hours after surgery, and
the micturition pattern was observed. When signs of dysuria or stranguria occurred, the bladder was palpated and
residual urine volume was assessed,and the urine was
removed by catheterization.
Long-term follow-up and complications. Information was obtained by telephone follow-up from both the
owner and the referring veterinarian. The results of the
surgical procedures were assessedby the owner and classified as follows:
1. Continent (complete continence or only rare occasions of minor urine leakage)
2. Improved (acceptable to the owner without further