ACVIM consensus statement on diagnosis and management of urinary incontinence in dogs

Abstract

Urinary incontinence (UI) is a disorder of micturition that can occur in dogs of any age, sex, and breed depending on the underlying cause and time of onset. Diagnosis and treatment for various causes of UI in dogs have been described by multiple comprehensive single author review articles, but large prospective clinical trials comparing treatment outcomes in veterinary medicine are lacking. The objectives of this consensus statement therefore are to provide guidelines on both recommended diagnostic testing and treatment for various causes of UI in dogs. Specifically, pathophysiology directly related to the canine urinary system will be reviewed and diagnostic and therapeutic challenges will be addressed. A panel of 12 experts in the field (8 small animal internists [L. Adams, J. Bartges, A. Berent, J. Byron, J. Foster, A. Kendall, S. Vaden, J. Westropp], 2 neurologists [J. Coates, N. Olby], 1 radiologist [G. Oetelaar], and 1 surgeon [C. Adin]) was formed to assess and summarize evidence in the peer-reviewed literature and to complement it with consensus recommendations using the Delphi method. Some statements were not voted on by all panelists. This consensus statement aims to provide guidance for management of both male and female dogs with underlying storage or voiding disorders resulting in UI.

Keywords: canine; incontinence; urinary.

FIGURE 1

Diagram depicting location of smooth and striated muscle in the male and female bladder and urethra. Source: Image by Tim Vojt, MA. Used with permission from The Ohio State University.

FIGURE 2

Afferent and efferent bladder innervation and signal pathways. Ach‐n, acetylcholine nicotinic receptor; Ach‐m, acetylcholine muscarinic receptor; α: alpha‐adrenergic receptors; β, beta‐adrenergic receptors. (+) denotes stimulation of muscular contraction, and (−) denotes inhibition of muscular contraction. L_1‐4 refers to lumbar spinal cord segments 1 to 4. S_1‐3 refers to sacral spinal cord segments 1 to 3. Source: Image adopted Veterinary Clinics: Small Animal Practice, Volume 45, Issue 4, p. 769‐782. Used with permission from author.

FIGURE 3

Common causes of urinary incontinence in dogs. Refer to Table 1 for a complete list of differentials.

FIGURE 4

Visual aid for diagnosis and management of urinary incontinence in female dogs based on initial pattern recognition. Image adopted from the International Continence Society (ICS). Please note that the diagnosis and management should be tailored to the individual dog and the presumed diagnoses listed are not an exhaustive list.

FIGURE 5

Visual aid for diagnosis and management of urinary incontinence in male dogs based on initial pattern recognition. Image adopted from the International Continence Society (ICS). Please note that pattern recognition is less reliable in male dogs, the diagnosis and management should be tailored to the individual dog, and the presumed diagnoses listed are not an exhaustive list.

FIGURE 6

Recommended initial diagnostic steps for storage and voiding disorders. ABUC, aerobic bacterial urine culture.

FIGURE 7

Doppler color flow indicating urine jets from right (A) and left (B) ureteral vesicular junctions (UVJ) using 2D B‐mode ultrasound. LE, left; RT, right.

FIGURE 8

Cystoscopic image of vestibulovaginal band or vestibulovaginal septal remnant (VVSR) before and after transection. Please note the position and confirmation of the external urethral orifice before and after transection.

FIGURE 9

Flow diagram depicting diagnostic steps for urinary incontinence due to a disorder in urine storage. Please note, that dogs presenting with urinary incontinence since birth should be investigated for ectopic ureters (EU) prior to following this flow diagram. The ⊕ symbol refers to positive growth on ABUC. ABUC, aerobic bacterial urine culture; LUT, lower urinary tract; PU/PD, polyuria/polydipsia; PVRV, post void residual volume; UI, urinary incontinence; USG, urine specific gravity.

FIGURE 10

Flow diagram depicting diagnostic steps for urinary incontinence due to a disorder in voiding. Please note that the diagnostic options for an increased postvoid residual volume should be tailored to the individual dog and pattern recognition. ABUC, aerobic bacterial urine culture; UI, urinary incontinence.