Case of the Month July 2014

Our case of the month for July 2014 is Flora an Italian Spinone puppy with a big personality and a rapidly growing body to go with it! At nearly 5 months of age most puppies have grasped house training and clearing up occasional accidents has become a distant memory. However Flora appeared to be going in the other direction. Out on her walks and in the garden Flora had been spending pennies like any other female dog but when relaxing and lying down she would leave a little puddle of urine behind. When we initially saw Flora she had developed some dermatitis between her back legs, a common problem in young puppies but this progressed to a bacterial infection. This was likely due to the skin being wet and irritated with leaking urine. Any dog or cat leaking urine without being consciously aware suggests a problem. Urinary incontinence such as this can be due to a number of different causes. These include increases in thirst such as with diabetes or kidney disease, bladder and urinary tract infection or irritation (cystitis), and bladder sphincter weakness which can be secondary to hormone changes. The other consideration was Flora’s young age which may have suggested more of a developmental or congenital problem. neouretero cystostomy As some young dogs grow and develop the internal plumbing can end up being connected a little wrongly and one cause of urinary incontinence in young dogs is an ectopic ureter. This is where the thin tube connecting one of the kidneys to the bladder (ureter) joins lower down and empties urine into the connection between the bladder and outside (urethra).  Here you can see a diagram to explain what normal and abnormal ‘plumbing’ can look like.  In simple terms your kidney produces urine, this should travel down the ureter to the bladder where it is contained until full and then you urinate the toxic waste out through your urethra to the outside world.  However if your ureter is plumbed into your vagina by mistake you will constantly dribble urine bypassing the bladder. Having ruled out other causes of Flora’s incontinence through blood testing, urine testing and treating her dermatitis the next step was to investigate her plumbing. Ultrasound scanning of Flora’s bladder and kidneys showed no signs of bladder stones, bladder growths or polyps and her kidneys were a normal size and shape. Under general anaesthetic a rigid endoscope was used to visualise the opening of Flora’s urethra and follow it up into her bladder. Have a look at the annotated pictures in the gallery below for a guided tour of how we perform cystoscopy and what amazing images you can see! As you can see the inside of the body is a beautiful thing!  Her vagina and bladder were normal with both ureters safely placed inside the bladder.  This ruled out the possibility of Flora having ectopic ureters. No abnormalities were found with the bladder itself.  In fact her ureters where in rude health and producing urine quite nicely!  Have a look at this video of jets of urine being produced and then stored in her bladder – you need to watch for a few seconds and then all of a sudden you will see a jet from the left hand side of the screen.  https://www.youtube.com/watch?v=QpLGKnzF9fU Having discussed this case with some Veterinary Specialists it is likely that she has a weakness in the sphincter muscle at her bladder neck. This condition often improves after bitches have their first season as the hormones produced have an effect on this muscle. In the meantime Flora has been prescribed a medication which helps to improve the strength of this muscle. With a bit of luck Flora will grow out of this condition and in the meantime we will be able to manage her symptoms. If not there are several procedures available to help with managing urinary incontinence in bitches.  Watch this space we will let you know how she gets on!