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See detailContribution de la télémétrie à l'investigation urodynamique de la fonction vésico-urétrale chez la chienne.
Noël, Stéphanie ULg

Doctoral thesis (2013)

Micturition disorders are common in veterinary medicine and can occur already in puppies. The congenital urethral sphincter mechanism incompetence represents the second cause of urinary incontinence in ... [more ▼]

Micturition disorders are common in veterinary medicine and can occur already in puppies. The congenital urethral sphincter mechanism incompetence represents the second cause of urinary incontinence in puppies but data on the development and the evolution of the continence mechanism are lacking in veterinary medicine. This study could be the first step in the understanding of the pathophysiology of congenital urethral sphincter mechanism incompetence which resolves spontaneously in half of the affected dogs after the first of the second oestral cycle. The lower urinary tract has been widely investigated in adult female dogs, particularly by urodynamics. Urodynamics is a useful technique providing informations on the vesico-urethral function but some limitations are described. The major limitation is the need for sedation or anaesthesia as it is not feasable to obtain interpretable data from an awake animal. A second limitation is associated with the technique of retrograde cystometry because the technique of bladder filling and the filling rate are not physiological. Therefore, techniques have been developed such as diuresis cystometry or ambulatory urodynamics to decrease the impact of these limitations. In urological research, telemetry allows the investigation of different urodynamic parameters without the need for physical or chemical restraint and during several micturition cycles. The objectives of this work were to study the development and the evolution of the continence mechanism during the prepubertal period and during the two first oestral cycles and to study the vesico-urethral function with telemetry. This technique will be standardized and afterwards will be used to study different current urological drugs commonly used in veterinary medicine. In the first study, we showed that the values of the urodynamic and morphometric parameters of the lower urogenital tract varied in function of the growth of the bitches and also in function of the different phases of the œstrus cycle. The end of the prepubertal period was characterized by an increase of the urethral pressures (maximal urethral pressure, MUP ; maximal urethral closure pressure, MUCP ; integrated pressure, IP) and functional urethral length (FPL) but also by an increase of the urethral (UL) and vaginal lengths (VL) measured by vagino-urethrography compared with values at earlier times. The bladder function was characterized by a non-linear increase of the bladder capacity, which was reached at 6 months of age and by an increase of the bladder threshold pressure observed from 7 months of age. During the oestrus cycle, the urethral pressures significantly decreased during the oestrus and the early dioestrus which are characterized by a decrease in oestrogen plasmatic concentration and by an increase in progesterone plasmatic concentration. The highest values of FPL were observed during the follicular phase (œstrus, prooestrus). Values of UL could not be determined during œstrus of the first cycle because urethras were not identifiable on vaginourethrograms obtained at that time. During the second œstrus cycle, UL was significantly higher during œstrus and early dioestrus compared to anoestrus. No significant variation in Pth was observed during the first cycle ; however during the second cycle, the lowest Pth values were observed during late anoestrus. Pth values were also lower during œstrus compared to proestrus. The luteal phase was associated with an increase in bladder capacity that reached the highest value during the dioestrus. The VL decreased progressively during the second cycle to reach the lowest value during anoestrus. The MUCP and UL were significantly higher during the anoestrus of both cycles compared to the values obtained when the dogs were 9 months old. The same observation was made for IP at the first anoestrus. The increase in values of these parameters during periods with low hormonal influence could suggest an impact of the growth but also a constant improvement of bladder function all along the study. It was interesting to observe that the position of the bladder was variable during the prepubertal period as she was either in an intrapelvic or in an intra-abdominal position. After the prepubertal period, the bladder was always in an intra-abdominal position. In the second study, we showed that a single administration of ephedrine or phenylpropanolamine (PPA) was able to significantly modify the urodynamic and the morphometric parameters. Using conventional urodynamics, both ephedrine or PPA increased the urethral pressures during 4 hours and the FPL during 2 hours. The integrated pressure was elevated during 6 hours with PPA and its value was higher than the value obtained with ephedrine. On the other hand, the FPL remained elevated during 18 hours with ephedrine. Using telemetry, ephedrine, and to a lesser extent PPA, modified bladder function. The administration of ephedrine was associated with an increase in bladder threshold volume and a decrease of the detrusor threshold pressure. An increase in bladder volume was observed after PPA administration. Both drugs modified significantly the hemodynamic parameters. Arterial pressures were significantly increased during 4 to 6 hours after the administration of both drugs and were associated with a decrease in heart rate during 12 hours. These results were in agreement with previous studies and confirmed the fact that sympathetic drugs must be used with caution in incontinent dogs suspected of cardio-vascular diseases. In the third study, we showed that interpretable values of urodynamic parameters were obtained with telemetry. Physiological data were obtained from telemetric recordings because no sedative or analgesic drugs were used during the recording and bladder filling was natural. The location of the implant inside a subcutaneous cavity in the left flank did not disturb the dogs and the quality of the signals were good when the receiver was placed on the lateral wall of the metabolic cage. Telemetry allows continuous recording of values of urodynamic parameters (abdominal pressure, bladder pressure, detrusor pressure and bladder threshold volume) and values of smooth muscle electrical activity parameters. In the first step of the study, conventional urodynamics was compared to telemetry. The values of bladder threshold volume obtained by telemetry was significantly lower than the values obtained by conventional urodynamics. No difference in values of threshold bladder pressure was observed between the two techniques. In the second step of the study, the repeatability of telemetric recordings was assessed between day and night. A good repeatability was obtained with the night recordings. Comparing day and night recordings, higher bladder threshold volumes and lower detrusor threshold pressures were obtained during the night. No variation of the urodynamic parameters was observed during the bladder filling phase. The smooth muscle urethral electrical activity did not vary during the bladder filling phase. The frequency of micturition was not different between day and night but the frequency of involuntary detrusor contractions was higher during the day. In the third step of the study, the effect of drugs currently used to treat different micturition disorders were studied. Oestriol and duloxetine increased the electrical activity at day 8 compared to days 0, 1 and 15. No significant effect of PPA, oestriol, oxybutynin, bethanechol and duloxetine was observed on the values of urodynamic parameters or on the frequency of involuntary detrusor contractions. The results obtained in this study suggest that circadian variations may influence urodynamic measurements and that long-term telemetric studies of the lower urinary tract should be conducted during the night to obtain repeatable recordings. Further pharmacokinetic and pharmacodynamics studies are needed to confirm the effects of the different drugs on vesico-urethral function. [less ▲]

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See detailUn cas atypique de pneumothorax et d'emphysème sous-cutané chez un jeune chien.
Bennaïm, Michaël; Liotta, Annalisa Pia ULg; Noël, Stéphanie ULg et al

in Le Monde Vétérinaire (2013), I30

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See detailClinical evaluation of a single daily dose of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch
Claeys, Stéphanie ULg; Rustichelli, Federico; Noël, Stéphanie ULg et al

in Canadian Veterinary Journal = Revue Vétérinaire Canadienne (2011), 52

Abstract The objective of this retrospective study was to report the efficacy of a single daily oral dose of phenylpropanolamine (PPA) in the treatment of urethral sphincter mechanism incompetence (USMI ... [more ▼]

Abstract The objective of this retrospective study was to report the efficacy of a single daily oral dose of phenylpropanolamine (PPA) in the treatment of urethral sphincter mechanism incompetence (USMI) in bitches. Nine bitches diagnosed with USMI were treated with a single daily dose (1.5 mg/kg) of PPA for at least 1 month. Urethral pressure profiles (UPP) were performed in 7 dogs before treatment and repeated in 4 of them after treatment. Treatment with PPA resulted in long-term continence in 8/9 bitches. One dog did not respond to PPA and was treated surgically later. Recheck UPPs showed a significant increase in maximal urethral closure pressure in the 4 bitches after treatment with PPA compared to before treatment. In conclusion, long-term continence can be achieved in bitches affected with USMI after administration of a single daily dose of PPA (1.5 mg/kg). [less ▲]

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See detailAcquired urinary incontinence in the bitch: update and perpspectives from the human medicine. Part 2: the urethral component, pathophysiology and medical treatment
Noël, Stéphanie ULg; Claeys, Stéphanie ULg; Hamaide, Annick ULg

in Veterinary Journal (2010), 186(1), 18-24

Various pathologies can affect the bladder and/or urethral contractility causing signs of urinary incontinence. In this second part of a three-part review, the pathophysiology of impaired urethral ... [more ▼]

Various pathologies can affect the bladder and/or urethral contractility causing signs of urinary incontinence. In this second part of a three-part review, the pathophysiology of impaired urethral contractility (including urethral hyper- and hypotonicity) in the bitch and in women is discussed. Urethral sphincter mechanism incompetence (USMI) is the most common form of acquired urinary incontinence in bitches and is characterized by a decreased urethral tone. The pathophysiology and current recommended medical treatment options for USMI and cases of modified urethral tonicity due to a neurological disorder or functional outlet obstruction are discussed. Treatment options in human medicine in cases of impaired urethral contractility are described. [less ▲]

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See detailUrodynamic findings secondary to compressive spinal cord lesions and surgical decompression in dogs
Brunel, Laurencie ULg; Noël, Stéphanie ULg; Peeters, Dominique ULg et al

in Proceedings of the 19th Annual Scientific Meeting of the ECVS (2010, July)

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See detailAcquired urinary incontinence in the bitch: Update and perspectives from human medicine. Part 3: The urethral component and surgical treatment.
Claeys, Stéphanie ULg; Noël, Stéphanie ULg; Hamaide, Annick ULg

in Veterinary Journal (2010), 186

Urethral sphincter mechanism incompetence (USMI) is the most common cause of urinary inence in dogs. Surgery may be recommended if the animal does not respond to medical treatment or becomes refractory ... [more ▼]

Urethral sphincter mechanism incompetence (USMI) is the most common cause of urinary inence in dogs. Surgery may be recommended if the animal does not respond to medical treatment or becomes refractory. In this third part of a three-part review, surgical options for the treatment of USMI are described. Colposuspension is the most frequently described procedure and offers a fair prognosis, with about 50% of the dogs being continent after surgery and most of the reminder being improved or more responsive to medical treatment. Urethropexy offers a similar success rate, but with a higher rate of complications. Endoscopic injection of collagen is an attractive technique due to its minimally invasive nature and low risk of adverse effects. Initial results may however deteriorate with time. Other procedures have been reported, but involve a low number of cases and have resulted in variable success rates. In women, stress urinary incontinence is mainly treated by minimally invasive procedures involving vaginal placement of sub-urethral slings. [less ▲]

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See detailEtude couplée pharmacocinétique et urodynamique de l'administration orale de différents dosages de phenylpropanolamine chez la chienne continente.
Noël, Stéphanie ULg

Master of advanced studies dissertation (2007)

The goal of this study is to establish the pharmacokinetic characteristics of oral administration of phenylpropanolamine at different dosages (1.5 mg/Kg once a day and three times a day), in continent ... [more ▼]

The goal of this study is to establish the pharmacokinetic characteristics of oral administration of phenylpropanolamine at different dosages (1.5 mg/Kg once a day and three times a day), in continent bitches, and to assess the associated urodynamic effects. The influence of phenylpropanolamine on systemic arterial pressure and heart rate is also studied. Maximal concentration appears two hours after the administration of phenylpropanolamine. Since the half-life lasts four hours and due to a mechanism of accumulation, a repeated daily administration induces an increase of the maximal concentration after each administration. After one week of a single administration of phenylpropanolamine per day, an increased urethral resistance and functional profile length are observed at the time of maximal concentration. This increase could explain the successful treatment of incontinent bitches with a single daily administration of phenylpropanolamine. However, a repeated administration of phenylpropanolamine three times a day does not increase the urethral resistance, probably after desensitization of the adrenergic receptors. The increase in arterial pressure after the administration of phenylpropanolamine is compensated by a decreased heart rate occurring at the time of maximal concentration. [less ▲]

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