Colposuspension in Dogs

It is not uncommon for female dogs to experience incontinence at some point in their lives. Generally, when this occurs underlying causes are looked for. In some cases, the dog's anatomical makeup results in urinary incontinence. This is often seen in female dogs who have shorter than normal urethras or whose bladders are in an abnormal position. 

Hormonal deficiencies play a part as well, with early spayed dogs experiencing more incontinence than their intact counterparts. Medical management is often attempted using estrogen supplementation. If this fails, surgical intervention is the next step. A colposuspension changes the position of the urethra and lengthens it by attaching it to the prepubic tendon. This can create different pressure in the abdomen, relieving incontinence in some cases. 

To confirm that the dog's anatomy is affecting its bladder control, an ultrasound or x-ray may be needed. Leak point pressure tests can reveal how little control the dog has of urination. Full blood work will be needed to determine if the dog is a good surgical candidate. The dog will be required to fast for several hours before surgery. Once the dog is sedated, an IV will be placed. The abdomen can then be shaved and disinfected, and a catheter will be placed in the urethra. 

To begin the surgery, an incision will be made down the middle of the abdomen. Stay sutures or forceps may be used to hold the skin and tissue open for the procedure. Large width sutures will be used to pierce the vaginal wall and the urethra on both sides. These will then be attached to each side of the prepubic tendon. The urethral catheter prevents these sutures from being too tight, which can block the urinary tract. The abdomen can then be closed using sutures.

This surgery is generally effective for treating dogs with USMI. Up to 86% of dogs experienced an improvement in their incontinence. In 50% of these cases, the dog no longer needed medication for the issue. It is estimated that over 50% of treated dogs are cured completely by a colposuspension surgery. Success rates jump to 70% in dogs who receive both a colposuspension and a urethropexy. A urethropexy involves more sutures securing the urethra to the front of the pelvis.

The dog should be monitored as the general anesthesia wears off. As the dog regains consciousness, it should be encouraged to urinate. If any difficulty is seen during urination, a urethral catheter may be needed for up to five days post-surgery. Some dogs experience uncomfortable bowel movements, so stool softeners may be prescribed. Pain medication should be administered as the dog wakes up from surgery.

A course of antibiotics will likely be given to prevent any urinary tract infections from forming and complicating the healing of the abdomen and urethra. The dog's activity should be decreased for up to one month after the operation has been performed. A leash should be used whenever the dog is outdoors. An Elizabethan collar can be used to stop the dog from licking or biting at its incision. A follow-up appointment will be needed two weeks after the procedure to assess how the dog has healed.

A colposuspension can cost anywhere from $1,000 up to $4,000. Diagnostic imaging, blood work and other tests are needed before surgery can be done, which adds to the price. Many dogs require medication even after surgery has been performed. This may involve estrogen, phenylpropanolamine, or ephedrine, all which must be administered daily. This can lead to ongoing costs to maintain the animal's bladder control. 

Up to 20% of dogs who receive this surgery experience no improvement with their incontinence. The use of general anesthesia always comes with serious risks, especially to older or unwell dogs. Rarely, a second surgery will be needed to remove the sutures if the urethra is obstructed due to the sutures being too tight. 

A small​ number of dogs may also experience dysuria for some time after surgery. In general, this procedure is associated with few complications. Medical treatment alone may be chosen instead, but it may become ineffective over time. If the dog is very old and is not a good surgical candidate, a diaper may be used to deal with incontinence.

In mid to large breeds, studies have shown that waiting until the dog has reached sexual maturity (approximately two years of age) to spay the animal lessens the likelihood that the dog will be incontinent later in life. Basic anatomical makeup can be a precursor for incontinence. Knowing your dog's family health history can help you plan for this possibility. Breeds such as the Doberman Pinscher, Rottweiler and Boxer are very susceptible to USMI. If a young dog is showing signs of incontinence, it should not yet be spayed, as these issues resolve in 50% of cases after the first heat.