Refractory Urinary Incontinence: The Use of a Hydraulic Urethral Occlusion Device

Introduction
Urinary incontinence (UI) is defined as the inability to voluntarily control the flow of urine through the urethra. It is typically associated with involuntary urinary leakage with various severity and frequency. It is most commonly seen in female dogs and occurs with less frequency in male dogs and male or female cats. The etiopathogenesis of the condition is varied but can be divided into neurogenic causes, non-neurogenic anatomical defects or functional urethral/bladder abnormalities. The most common cause of urinary incontinence is urethral sphincter mechanism incompetence (USMI), which often associated with other anatomical anomalies like an intrapelvic urinary bladder, a short/wide urethra, or a hypoplastic bladder, followed by ureteral ectopia (which is also commonly associated with USMI), and then lower motor neuron disease. Overall, ectopic ureters (EU) and USMI made up 82% of the diagnosed cases of UI in dogs in one study. Companion animals that are incontinent pets are very frustrating for owners to live with and the condition is a common cause of euthanasia due to the severity of environmental contamination that is caused. Treatment of urinary incontinence can be frustrating with some common disease processes, such as USMI and ureteral ectopia, being associated with relatively high failure rates after medical, interventional, and surgical management. However, even in the most challenging cases, if a willingness to pursue aggressive and potentially multimodality therapy exists, many patients can be dramatically improved, if not cured.  [...]