Search Results (4)

Bethanechol chloride, a nonselective muscarinic agonist, is the most frequently employed drug in dogs and cats to induce detrusor smooth muscle contraction under conditions characterized by poor or absent bladder emptying. Although this drug has minimal or absent nicotinic activity, at higher doses, weak stimulation of neuronal nicotinic receptors may occur, causing the release of noradrenaline, which induces contraction of the urethral smooth muscle by activating α-adrenergic receptors. In the presence of total or partial suprasacral lesions, the elaboration and initiation phase of the urination process is absent due to an interruption of afferent signals from the bladder to the brainstem. In such cases, hypertonicity of the urethral sphincters is expected, and bethanechol is contraindicated. Bethanechol is also not indicated for reflex dyssynergia. In the presence of complete injuries involving the sacral segments, cauda equina, or pelvic nerve, both reflex and voluntary micturition are abolished, and bethanechol is usually ineffective. However, in cases of partial injuries, bethanechol is likely to be effective, as partial integrity of the micturition reflex is required to produce sustained bladder contraction. Bethanechol may benefit patients with myopathic decompensated bladder, although its effectiveness depends on the severity of detrusor damage. Full article

Micturition is an involuntary process based on spinal arcs in infants and children until a defined age. The awareness and voluntary control of voiding depends on specific areas in the central nervous system, especially cortical regions. The cells and connections between these areas develop over time and regulate the voiding process. The ability to maintain continence and to adjust physiological needs to appropriate environmental conditions is considered to be acquired through systematic behavioral education, especially toilet training. The recommendations specify the age at which to start establishing the relevant habits. The purpose of these guidelines is to achieve proper micturition control development and to avoid functional lower urinary tract (LUT) disorders. We present a case of a patient who underwent complete urinary diversion in infancy and reconstruction of the urinary tract eleven years later. For eleven years, she had an empty bladder and no toilet training. After undiversion, she regained full continence in a short space of time. The presence of proper LUT function and a controlled micturition process raises the question of the standard toilet training recommendations’ validity. The aim of our work focuses on the following question: Is toilet training the only way to achieve micturition skills and proper urinary tract function? The history of our patient and the literature reveal that voluntary micturition may develop without stimulating signals of filling from bladder receptors and independently of recommended behavioral education, so toilet training seems to not be necessary. Full article

This case series study aimed to evaluate the safety, feasibility, and positive outcome of the neurorehabilitation multimodal protocol (NRMP) in 16 chronic post-surgical IVDD Hansen type I dogs, with OFS 0/DPP− (n = 9) and OFS 1/DPP+ (n = 7). All were enrolled in the NRMP for a maximum of 90 days and were clinically discharged after achieving ambulation. The NRMP was based on locomotor training, functional electrical stimulation, transcutaneous electrical spinal cord stimulation, and 4-aminopyridine (4-AP) pharmacological management. In the Deep Pain Perception (DPP)+ dogs, 100% recovered ambulation within a mean period of 47 days, reaching OFS ≥11, which suggests that a longer period of time is needed for recovery. At follow-up, all dogs presented a positive evolution with voluntary micturition. Of the DPP− dogs admitted, all achieved a flexion/extension locomotor pattern within 30 days, and after starting the 4-AP, two dogs were discharged at outcome day 45, with 78% obtaining Spinal Reflex Locomotion (SRL) and automatic micturition within a mean period of 62 days. At follow-up, all dogs maintained their neurological status. After the NRMP, ambulatory status was achieved in 88% (14/16) of dogs, without concurrent events. Thus, an NRMP may be an important therapeutic option to reduce the need for euthanasia in the clinical setting. Full article

The literature is lacking data concerning the prognosis in cats suffering from naturally occurring acute onset of thoracolumbar (TL) spinal cord injury that are undergoing rehabilitation therapy. Therefore, we investigated the effect of physical rehabilitation in cats suffering from naturally occurring TL spinal cord injury. The medical records of 36 cats with acute onset of TL spinal cord injury that were selected for rehabilitation treatment were reviewed. Twenty-nine cats underwent an intensive physical rehabilitation protocol in the clinic (group 1), whereas the owners of seven cats declined physical rehabilitation (group 2). In group 1, seven cats had pelvic limb deep pain perception (DPP), which was significantly associated with the functional recovery of voluntary ambulatory status (p = 0.010) and voluntary micturition (p < 0.001). Spinal walking was achieved in 10/22 (45%) of the cats without DPP, and none regained voluntary micturition. In group 2, no cats regained ambulatory status or voluntary micturition, although pelvic limb DPP was present in three patients. Treatment with a clinic-based rehabilitation program and the presence of a crossed extensor reflex were significantly associated with a higher possibility of regaining functional ambulatory status (p < 0.010), but there was no difference in the recovery of voluntary micturition between the groups. Thus, cats with severe, naturally occurring, acute onset of TL spinal cord injury may benefit from physical rehabilitation. In the case of the loss of DPP, the acquisition of spinal walking is possible, despite the high possibility of a persistent neurologically dysfunctional bladder. Full article