Colposuspension for urinary incontinence

Introduction

• A surgical approach to the management of acquired urinary incontinence associated with urethral sphincter mechanism incompetence (USMI) in female dogs.

Uses

• Acquired urinary incontinence, especially in spayed bitches, that is not responsive to medical therapy, or in situations where the owner rejects medical management.
• The precise etiology of this disorder is not understood fully:
  • Acquired incontinence may be associated with hormonal consequences of ovariohysterectomy and the presence of a 'pelvic bladder'.
  • Obesity also contributes to the condition.
  
  In animals with a long history of incontinence, which may be of a variable nature, congenital causes such as ectopic ureter should also be considered.

Advantages

• Surgery, when successful, precludes the need for on-going medical management of the condition.
• Colposuspension has been reported to produce continence in 53% of dogs suffering from confirmed USMI.
• Complications associated with procedure are rare.

Disadvantages

• No surgical technique has been shown to be uniformly effective in curing acquired USMI.

Preparation

• 15 min.

Requirements

Materials required

Minimum equipment

• Standard surgical pack.

Ideal equipment

• Balfour retractors or a surgical assistant.
• Vaginoscope.

Minimum consumables

• Monofilament non-absorbable suture, size 0 or 1.
• Urethral catheter.

Ideal consumables

• Foley catheter.

Sequelae

Prognosis

• The procedure has been reported as curing incontinence in 53% of patients.
• Other patients may have incontinence improved by surgery and require a lower dose of medical treatment than before surgery.

Reasons for treatment failure

• Incorrect diagnosis - cause of incontinence remains, eg ectopic ureter.

Sources

Publications

• Recent references from PubMed.
• Nickel R F, Wiegund U & van der Brom W E (1998) Evaluation of a transpelvic sling procedure with and without colposuspension for treatment of female dogs with refractory urethral sphincter mechanism incontinence. Vet Surg 27 , 94-104.
• Gookin J L, Stone E A & Sharp N J (1996) Urinary incontinence in dogs and cats. Part II; diagnosis and management. Comp Cont Ed Pract Vet 18 , 525-540.
• Holt P E (1990) Long-term evaluation of colposuspension in the treatment of urinary incontinence due to incompetence of the urethral sphincter mechanism. Vet Rec 127 , 537.
• Holt P E (1985) Urinary incontinence in the bitch due to sphincter mechanism incompetence: surgical treatment. JSAP 26 , 237.