Managing Urinary Incontinence in Female Dogs

Urinary sphincter mechanism incompetence is a common cause of urinary incontinence in adult female dogs. Medical management options include sympathomimetic or parasympathomimetic drugs and estrogen, but these are not curative. When medical treatment fails, surgery may be indicated. In colposuspension, the lateral vaginal walls are anchored to the prepubic tendon, shifting the bladder cranially such that any rise in intra-abdominal pressure compresses the urethra and the bladder, which decreases the tendency for leakage. Urethropexy repositions the bladder more cranially by anchoring the urethra to the prepubic tendon. Reported success rates for these procedures are 53% and 56%, respectively. Complications include urinary retention, dysuria, and anuria, sometimes requiring surgical revision. 

This article describes a new combined urethropexy–colposuspension (CUC) technique. Using a caudal midline approach, the bladder is exteriorized and tractioned cranially. Urethropexy is performed using a simple interrupted 2-0 polypropylene suture anchored around the prepubic tendon and passed through the urethral wall. A second suture is anchored in the caudal linea alba just cranial to the pubic brim. Colposuspension is then performed using bilateral 2-0 poly-propylene mattress sutures. Owner perceptions of long-term outcomes were measured using a standardized grading system. The authors reported a 70% success rate in treating the clinical signs of incontinence and conclude that CUC is a relatively simple procedure that can be more effective than either urethropexy or colposuspension alone.

Commentary

This summary article is based on one of the author’s published retrospective series of 30 dogs.¹ A Foley catheter was left in place for 36 hours with 10% of dogs needing diazepam to help with dysuria after catheter removal. With a mean follow-up of 36 months, this technique appears to have improved the results of this disease, though owners still need to be warned that medication may still be necessary. The key to the surgical technique seems to be putting just the right amount of tension on the urethra while avoiding overtensioning, which leads to dysuria.—Jonathan Miller, DVM, MS, DACVS