Reichler I M, Hubler M
Small Animal Reproduction, Clinic for Reproductive Medicine, Vetsuisse-Faculty, University of Zurich, Zurich, Switzerland.
Reprod Domest Anim. 2014 Jun;49 Suppl 2:75-80. doi: 10.1111/rda.12298.
Urinary incontinence (UI), defined as the involuntary loss of urine during the filling phase of the bladder (Abrams et al. 2002), is a commonly seen problem in veterinary practice. Urinary sphincter mechanism incompetence (USMI) after spaying is the most common micturition disorder, and its medical treatment is normally successful, even though the underlying pathophysiological mechanism is not fully understood. Hormonal changes inducing structural and functional alterations in the bladder, as well as in the urethra composition, are discussed. To manage incontinent patients successfully, possible underlying abnormalities besides USMI should be ruled out. In the majority of cases, history, physical examination and simple tests including urinalysis and urine bacterial culture lead to a presumed aetiology. If USMI is the most likely cause, then the advantage of further diagnostic tests should be discussed with the owner before starting a trial therapy with alpha-adrenergic drugs. Potential side effects of this therapy have to be mentioned even though they rarely occur. It is important to thoroughly evaluate the success of the initial treatment. Its failure should lead to further diagnostic testing. Specialized clinical assessments may provide an aetiological diagnosis, and this could serve as a basis for discussing further treatment options. Surgical procedures, which may in rare cases cause irreversible side effects, may be instituted. If incontinence reoccurs after initial treatment was successfully performed, the diagnostic work-up including urinalysis should always be repeated. As results of urinalysis did not correlate well with results of bacterial culture, a urine culture is recommended (Comer and Ling 1981). Cystocentesis is the preferred method of urine collection (Bartges 2004). Equivocal results of quantitative cultures of urine samples obtained during midstream voiding or by catheterization require repeat collection by cystocentesis (Comer and Ling 1981).
尿失禁（UI）被定义为膀胱充盈期尿液的不自主流失（艾布拉姆斯等人，2002年），是兽医临床上常见的问题。绝育后尿道括约肌功能不全（USMI）是最常见的排尿障碍，尽管其潜在的病理生理机制尚未完全明确，但药物治疗通常是成功的。文中讨论了激素变化如何引起膀胱以及尿道结构和功能的改变。为了成功管理尿失禁患者，除了USMI外，还应排除其他可能的潜在异常。在大多数情况下，病史、体格检查以及包括尿液分析和尿液细菌培养在内的简单检查可得出推测的病因。如果USMI是最可能的病因，那么在开始使用α-肾上腺素能药物进行试验性治疗之前，应与宠物主人讨论进一步诊断测试的益处。即使这种治疗的潜在副作用很少发生，也必须提及。全面评估初始治疗的效果很重要。治疗失败应导致进一步的诊断测试。专业的临床评估可能会提供病因诊断，这可为讨论进一步的治疗方案提供依据。在极少数情况下可能会导致不可逆转副作用的外科手术也可能会实施。如果在初始治疗成功后尿失禁再次出现，应始终重复包括尿液分析在内的诊断检查。由于尿液分析结果与细菌培养结果相关性不佳，建议进行尿液培养（科默和林，1981年）。膀胱穿刺术是首选的尿液采集方法（巴特格斯，2004年）。通过中段排尿或导尿获得的尿液样本定量培养结果不明确时，需要通过膀胱穿刺术重复采集样本（科默和林，1981年）。
