The short-term clinical efficacy of amitriptyline in the management of idiopathic feline lower urinary tract disease: a controlled clinical study.

In a controlled study, the effects of amitriptyline compared with that of a placebo in cats suffering from idiopathic Feline Lower Urinary Tract Disease (FLUTD) have been investigated. Thirty-six animals were selected by veterinary practitioners and treated with a placebo or 10mg amitriptyline once daily. All animals received concomitant antibiotic treatment. A total of 24 cats were included in the final assessment of the results. The severity of symptoms before and after treatment were compared between groups and showed no significant difference. Results indicated that the 7-day course of 10mg amitriptyline was not effective in the treatment of idiopathic FLUTD. Thus, it is considered not to be beneficial as a short-term therapy where the therapeutic results depend on peripheral effects of the drug. Long-term effects may be expected 4 or more weeks after the start of therapy and need to be further investigated.

Comparison of the efficacy of two anti-uric acid diets in dalmatian dogs.

Commercial anti-uric acid diets for dogs may contain insufficient protein to sustain growth and lactation. In order to investigate the efficacy of an experimental purine-free diet moderately low in protein, its effect on urinary uric acid excretion was compared with that of a commercial dog food and a commercial low-protein anti-uric acid diet. The experimental diet, commercial dog food and commercial anti-uric acid diet contained 10.0, 12.8 and 5.0 g crude protein/MJ metabolizable energy, respectively. Twelve Dalmatian dogs were subjected to a 3 x 3 Latin square study. Although the plasma uric acid concentration was significantly lower when the dogs were fed either the commercial anti-uric diet (18.7 +/- 6.0 mumol/l, mean +/- SD, n = 12) or the experimental diet (19.2 +/- 8.3 mumol/l), when compared to the commercial dog food (29.2 +/- 11.1 mumol/l), no significant decrease of uric acid concentration in urine collected before the morning meal was seen. The average concentration of urinary uric acid was 60 mumol/l. There was a significant increase in the urea:creatinine ratio in urine when the dogs were fed the experimental diet compared to the commercial anti-uric acid diet, confirming that the experimental diet contained more protein. The experimental diet lowered plasma uric acid and was relatively high in protein and thus may be suitable for use in growing and lactating dogs to prevent ammonium urate urolithiasis.

Clinical and radiographic findings compared with urodynamic findings in neutered female dogs with refractory urinary incontinence.

Possible correlations were investigated between the clinical and urodynamic findings in 77 neutered female dogs with urinary incontinence refractory to standard medical management. The clinical data used in the analysis were age, bodyweight, breed, the characteristics of the dribbling of urine and whether it developed before or after neutering, the type of response to previous treatments, signs of polyuria/polydipsia, and the results of urinalysis and culture. In 50 of the dogs, a standardised contrast radiographic examination was made to locate the neck of the bladder and to assess the morphology of the bladder. These findings were analysed for their correlation with the results of multichannel urethral pressure profilometry and diuresis cysto-urethrometry. Logistic regression analysis revealed that neither the clinical nor the radiographic findings could predict any of the abnormal urodynamic findings. Functional abnormalities of the bladder, such as a low compliance, detrusor instability, or a low bladder capacity may therefore be particularly difficult to detect in dogs with urinary incontinence.

Functional anatomy and neural regulation of the lower urinary tract in female dogs: a review.

A review of the literature of the functional anatomy and neural regulation of the lower urinary tract is presented. The two main functions of the lower urinary tract are the storage and the periodic elimination of urine. The smooth muscle of the bladder exhibits intermittent contractions as the bladder adapts its capacity to increasing volumes and it exhibits sustained contractions associated with relaxation of the external sphincter to effect micturition. During storage, tension receptors in the bladder wall initiate external sphincter contraction (somatic), internal sphincter contraction (sympathetic), detrusor inhibition, and parasympathetic ganglion inhibition (sympathetic). The storage phase can be switched to the micturition phase either voluntarily or involuntarily. Neuroanatomical and electrophysiological studies reveal that medial and lateral cell groups in the dorsolateral pons may be regarded as micturition and storage control centres, respectively.

Idiopathic detrusor-urethral dyssynergia in dogs: a retrospective analysis of 22 cases.

Results of a retrospective study of 22 dogs with signs of dysuria and/or stranguria in which a diagnosis of idiopathic detrusor-urethral dyssynergia was made are presented. The diagnosis was based on the exclusion of detectable pathological conditions which could also cause urine outflow obstruction. The affected cases were 22 middle-aged male dogs (mean age 4.9 years) of large and giant breeds (mean bodyweight 36.7 kg). Nine dogs had had periodic clinical signs for longer than one year, one for seven months and eight for two to five weeks, while in four dogs signs had begun four to five days before referral. All dogs received the alpha-sympatholytic agent prazosin as an initial treatment and in 11 it remained the only therapy. There was a good effect in seven and a moderate response in the other four dogs. In one dog, prazosin was ineffective and was replaced by diazepam, which markedly reduced the signs. Three other dogs required frequent catheterisation and antibiotics were administered. These dogs responded favourably. Another three dogs with evidence of impaired bladder contractility were also treated with the parasympathomimetic agent carbachol. One did not improve and was euthanased. Four dogs developed bladder paralysis and severe infectious cystitis. Only one of these could be managed satisfactorily by long-term administration of prazosin, carbachol and antibiotics, and the others had to be euthanased.

Evaluation of a transpelvic sling procedure with and without colposuspension for treatment of female dogs with refractory urethral sphincter mechanism incompetence.

OBJECTIVE: To evaluate a sling procedure using a polyester ribbon passed through the obturator foramen, around the urethra, and fixed outside the pelvis for the treatment of female dogs with refractory urethral sphincter mechanism incompetence (USMI). ANIMALS: 26 female dogs with USMI that had not improved with medical management. METHODS: All dogs underwent a transpelvic sling procedure, and in 13, with a radiographic diagnosis of a pelvic bladder, additional colposuspension was performed. Multichannel urethral pressure profilometry (UPP) and diuresis cystourethrometry (UCM) were performed in all dogs before and in seven dogs 2 to 14 months after surgery. Long-term results of surgery and medical therapy were determined. RESULTS: 13 dogs (50%), 6 of these without additional colposuspension, were continent after surgery and remained continent during a follow-up period of 12 to 36 months (mean, 19 months). Seven, three of which had colposuspension, had improved markedly. Four of these dogs became continent with additional medical therapy. Five dogs did not improve, and three of these were eventually euthanatized. In one dog, the sling was removed after 5 days because of persistent stranguria. Surgery and medical therapy together resulted in continence in 17 dogs (65%) during a follow-up period of 6 to 36 months (mean, 22 months). Postoperative dysuria or stranguria occurred in six dogs, and four of these underwent a colposuspension procedure. Two dogs developed a fistula, 2 and 3 years after surgery. Preoperatively, decreased urethral resistance was suggested by the findings of UPP and UCM in 25 dogs, and an abnormally high compliance was found in 3, detrusor instability in 2, and a low threshold pressure in 1 dog. There was no apparent correlation between these findings and the outcome of surgery. Urethral closure pressures measured after surgery were significantly increased but were still lower than the normal range in all dogs with persistent or recurrent incontinence. CONCLUSIONS: A transpelvic sling procedure, with or without additional colposuspension, can be useful in the management of dogs with refractory urinary incontinence. The procedure is not beneficial if it does not increase urethral pressure close to, or within, the normal range.

Xanthinuria in a family of Cavalier King Charles spaniels.

Xanthine calculi were found in a 7-month-old male Cavalier King Charles spaniel with urethral obstruction and renal insufficiency. Because the only two other reported cases of naturally occurring xanthine urolithiasis concerned a Cavalier King Charles and a King Charles spaniel the urine of the littermates and parents of the patient were also examined for xanthinuria. Semi-quantitative analysis revealed high urine concentrations of hypoxanthine and xanthine in the patient and his female littermate. Quantitative analysis by high-pressure liquid chromatography (HPLC) of the urine samples from the family of this Cavalier King Charles spaniel and nine control dogs revealed that hypoxanthine and xanthine excretion was 30 and 60 times higher in the affected patient and the female littermate than in the others dogs. The pattern of xanthinuria, which is caused by a deficiency of the enzyme xanthine oxidase, in the relation diagram of this family of Cavalier King Charles Spaniels was consistent with an autosomal recessive mode of inheritance.

Simultaneous diuresis cysto-urethrometry and multi-channel urethral pressure profilometry in female dogs with refractory urinary incontinence.

OBJECTIVE: To assess urethral closure and bladder storage function in female dogs with refractory urinary incontinence by use of simultaneous diuresis cysto-urethrometry (UCM) and multi-channel urethral pressure profilometry (UPP). ANIMALS: 53 female dogs of various breeds with a history of 'non-neurogenic,' acquired urinary incontinence unresponsive to standard conservative treatment. PROCEDURE: UPP and UCM were performed on dogs sedated with xylazine, using a flexible polyvinylchloride multi-channel catheter connected to a perfusion system. Urine production was determined by use of radionucleotide dilution analysis. Values of reproducible urodynamic variables obtained previously in clinically normal dogs were compared with findings in the incontinent dogs. Cutoff values with the highest predictive values of urodynamic variables were determined and selected for functional classification. RESULTS: Except for threshold volume, median values of all urodynamic variables were significantly different between continent and incontinent dogs. Urethral pressure values, their relative variation, bladder threshold pressure, and prevalence of detrusor contractions were significantly lower than values in normal dogs, but compliance was higher. Forty-one dogs had urodynamic findings suggestive of poor urethral closure function assessed by UCM, but 10 of these had normal closure pressure values during UPP. Abnormal bladder storage function was interpreted from the findings of 19 dogs. Low capacity was found in 3, low threshold pressure in 15, and high compliance in 9 dogs. Seven of the dogs with abnormal bladder storage function had normal urethral closure function assessed by UPP and UCM. Five dogs had no abnormal findings, and 1 continent dog was abnormal by our classification. CONCLUSIONS: Abnormal bladder storage function was suggested in a considerable number of dogs with refractory urinary incontinence.

Comparison of long-term effects of ovariectomy versus ovariohysterectomy in bitches.

Although ovariectomy is less invasive and less time-consuming than ovariohysterectomy, most surgical textbooks recommend ovariohysterectomy for routine neutering of bitches. This advice is probably based on concerns about the development of uterine disease after ovariectomy. However, there is no evidence that conditions such as cystic endometrial hyperplasia (CEH)-endometritis develop in the ovariectomized bitch, unless progestagens are administered. The purpose of this study was therefore to compare the long-term effects of ovariectomy and ovariohysterectomy, including the incidence of urinary incontinence. Questionnaires were sent to 264 owners of bitches, in which ovariectomy (126) or ovariohysterectomy (138) had been performed as a routine neutering procedure 8-11 years earlier. Complete data were available for 69 bitches of the ovariectomy group and for 66 bitches from the ovariohysterectomy group. There were no indications that endometritis had developed in bitches of the ovariectomy group. None of the bitches was sexually attractive to male dogs after neutering. The occurrence of a clear to white vaginal discharge was reported in two bitches of each group, but none of these four bitches appeared to be ill during the periods when the discharge was present. Furthermore, with the exception of urinary incontinence, no problems were reported that could be related to the surgical neutering. Six of the ovariectomized bitches and nine of the ovariohysterectomized bitches eventually developed urinary incontinence. Of these 15 bitches (11%), 12 weighed more than 20 kg. Bouvier des Flandres bitches were at a higher risk of developing urinary incontinence than were those of the other breeds. The possibility that the urinary incontinence was due at least in part to other conditions must be considered, since eight of the bitches were 9 years or older before urinary incontinence occurred and seven of the incontinent bitches also had polyuria or polydipsia. There were no significant differences in the incidence of urogenital problems listed above between the bitches of the ovariectomy and ovariohysterectomy group. It is hypothesized that a uterine disease such as CEH-endometritis cannot develop after complete ovariectomy, unless progestagens are administered. The results of this study indicate that ovariectomy does not increase the risk of CEH-endometritis or other complications in comparison with ovariohysterectomy. It is concluded that there is no indication for removing the uterus during routine neutering in healthy bitches. On the contrary, ovariectomy should be considered the procedure of choice.

Simultaneous diuresis cysto-urethrometry and multichannel urethral pressure profilometry in continent female dogs.

OBJECTIVE: To study a combined urodynamic technique for assessment of urethral closure and bladder storage function in female dogs. ANIMALS: 20 healthy, adult, sexually intact female dogs of various breeds. PROCEDURE: Urethral pressure profilometry and continuous urethral pressure registration during high-diuresis cystometry (cysto-urethrometry) were studied in dogs sedated with xylazine. Pressures were measured, using a flexible polyvinylchloride multichannel catheter connected to a perfusion system. Urine production and volume were determined by radionucleotide dilution analysis of urine samples. Urethral pressure profilometry was performed first, followed by cystourethrometry. Maximal urethral pressure and maximal urethral closure pressure of consecutive profiles and their mean values were determined. Closure pressure at its highest and lowest level and at micturition threshold and absolute and relative magnitude of urethral pressure variation were determined in the high-pressure zone of the urethra while the bladder filled, enforced by diuresis. Bladder pressure and volume at the micturition threshold and static compliance also were determined. RESULTS: Differences in mean and variance between variables listed were not significant. Urethral closure pressure varied from 5 to 67 cm of H2O during bladder storage. So-called unstable detrusor contractions were observed in 6 dogs. CONCLUSIONS: Several variables for the assessment of the dynamics of urethral closure and bladder storage function obtained by the technique reported here are reproducible. Values from this study are considered reference values for further studies. CLINICAL RELEVANCE: The reported technique can be helpful in the investigation of complicated urinary incontinence in female dogs.