photo 2009 Kyle Pearson | more info (via: Wylio)
Hi Dr. Barchas,

I found you (and Dogster) after searching and searching for answers to no avail… and how
coincidental, you’re local! Anyway, I’m hoping you can help where the big wide world of the internet has failed. =)

My boyfriend and I adopted a puppy (Lab/Pit) from our local animal shelter a few months ago, and she’s incontinent. We originally thought her trouble was just behavioral – that she was peeing while excited, submissive, or simply just needed more house-training because of her age and background. We realized though that she has full fecal control, and has no problems squatting outside to pee… she hasn’t intentionally peed in the house since the first few days, but she leaks almost all the time otherwise. We’ll be laying on the couch with her and she’ll do it, she’ll wake up from a nap and there will be a spot, or she’ll sit at a stoplight with us waiting to cross and a puddle will start to spread under her. She has zero
awareness that she’s doing this, other than licking herself much more often to stay clean.

Her outside-peeing never seems to be full force (she never “unleashes the dam”, as I call it), she seems to be in no pain, isn’t drinking excessively, and she doesn’t dribble while she’s active.

Through many, many vet visits (both our primary as well as a specialist), we now have: a urinalysis, a partial IVP series, an ultrasound, and a CT scan. We’ve ruled out: a UTI, hormone-deficiency from spaying (at 3 months old), kidney/bladder stones, dysfunctional sphincter, and ectopic ureters.

The urinalysis showed only barely elevated cell counts, but we had her on antibiotics just in case there was an infection (clear). For hormones, we had her on DES – we haven’t tried Proin as we don’t feel comfortable with the risks. DES was ineffective, and we even felt like her leaking got worse while she was on it. From her IVP series, the first set of dye injections didn’t show her ureters clearly, and the latter half couldn’t be completed.

While the vet was in there, he found a mystery second hole next to her cervix/urethral opening, and catheterization of both openings failed. We skipped the procedure of manually palpitating her bladder after a dye injection (I don’t recall the name of the procedure) and went to more advanced imaging. Her ultrasound and CT scans came back negative – they were able to tell that she has urethral sphincter control, and that her ureters attach to her bladder as expected. Her entire urinary system appears normal, except her left ureter terminates slightly more towards the back than her right does.

Our next recommended step is a cystoscopy, and I know that the end of the line is exploratory surgery. A cystoscopy is very expensive and will drain our savings (and the new line of credit we took out for all of this), and exporatory surgery is very invasive and a risky move we don’t want to subject our poor girl to. What I’m wondering is:

– are there other forms of treatment and/or diagnosis you would recommend we check into? We’re already planning to call pretty much everyone between Santa Cruz and UC Davis, since we’re being referred out anyway.

– have you run across something like the mystery opening she has in your experience, and if so, what possible causes are there? The specialist could only theorize at this point, such as the left ureter actually splitting into two at her bladder, and the second growth working it’s way to become that second hole.

– if the cystoscopy comes back with no results, what’s next? what procedures are in-between the cystoscopy and surgery? From what I’ve found, it sounds like surgery is what would have to happen next.

We’d really love to believe that she’s just young and she’ll grow out of this – people we know keep trying to give us this hope based on similar “leaking” problems they’ve had with their dogs… but age doesn’t explain that second opening she has, and it seems pretty likely that it would have to be the cause of her incontinence.

Thank you for your time, and any help you can
give!

Nitya
Richmond, CA

Holy @$#!, what a saga.

As I read through the first portion of this e-mail, I thought to myself, “It’s probably a mild juvenile sphincter issue. The puppy probably will outgrow it. The owners should consider phenylpropanolamine (PPA, also known as Proin) if the incontinence is intolerable.”

Then I got to this part, and I was taken aback.

we had her on DES – we haven’t tried Proin as we don’t feel comfortable with the risks.

I’m sorry — what risks are you talking about? Sure, Proin, like all drugs, has the potential to cause side effects and adverse reactions. But I have prescribed tens (or more likely hundreds) of thousands of doses of Proin, and I’ve never seen anything serious. DES, on the other hand, is considered by most vets under 70 to be a pretty dangerous drug.

There are plenty of things that could be going on here, but your dog probably has a temporary sphincter issue that will respond to PPA. The extra hole could be an ectopic ureter, but I’ll bet it’s not. I think it’s more likely to be a minor, unrelated anatomical irregularity. Just about everyone has slight irregularities that can be found if you look hard enough, and goodness knows your dog has been searched over pretty thoroughly. I wouldn’t make too much of that extra hole for now.

After reading your entire missive, here is what I think. Your dog probably has a mild juvenile sphincter incompetence (by the way, it is not possible to test sphincter competence with any of the tests you have listed). She probably will outgrow it. Until that time, PPA probably will help if the incontinence is intolerable.

And I, for one, would not recommend surgery (a terribly invasive procedure) without first trying PPA.