Urethropexy urinary incontinence pelvic bladder (4)
Urethropexy urinary incontinence pelvic bladder (21)
Freya Jordan 2

URINARY -

URETHROPEXY

Urethropexy is a surgical procedure used to manage urinary incontinence in female dogs, where medical management has failed or long term medical management is not desired.   

Urinary incontinence may occur at any age, although commonly will occur in young, large breed, desexed females, with incontinence most frequently occuring as leaking at night or with excitement.  Leakage is thought to occur due to an inability of the muscles to hold the urine (urethral sphincter mechanism incompetence, USMI).  Desexing is thought to increase the risk of incontinence due to the role of hormones on the urethral muscles, but the timing of desexing has not been shown to be a factor to date.

Diagnosis is based on the age, breed, and xray studies.  For xray studies to be of use in the diagnosis of urethral sphincter mechanism incompetence, a contrast dye has to be used at the time to highlight the bladder anatomy.

Urethropexy aims to cure the incontinence by increasing the pull and tone of the urethral muscles, by using sutures to stretch-out the urinary tract and increase the force required by the patient to urinate.  The prognosis for resolution or improvement of the urinary incontinence overall is good.  Approximately 60% of patients will have resolution of the incontinence, with an improvement of continence reported in a further 20%.  Further improvement in continence may occur with a second surgery.  The effects of surgery may decrease, and return of the incontinence may occur over time in some patients.  

Occasionally a combination of surgeries (colposuspension), or placement of an artificial sphincter (AUS port) may be used.

Complications such as swelling, infection, straining to urinate or inability to urinate, may occur in the post-surgery period in 10-15% of cases.  Management is usually medical with antibiotics or analgesia and anti-inflammatories, however in patients who are unable to urinate removal of the suture may be required.