Doctoral thesis (Dissertations and theses)
Contribution de la télémétrie à l'investigation urodynamique de la fonction vésico-urétrale chez la chienne.
Noël, Stéphanie
2013
 

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Keywords :
télémétrie; urodynamique; chienne
Abstract :
[en] 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.
Disciplines :
Veterinary medicine & animal health
Author, co-author :
Noël, Stéphanie ;  Université de Liège - ULiège > Département clinique des animaux de compagnie et des équidés > Département clinique des animaux de compagnie et des équidés
Language :
French
Title :
Contribution de la télémétrie à l'investigation urodynamique de la fonction vésico-urétrale chez la chienne.
Alternative titles :
[en] Contribution of telemetry to the urodynamic investigation of the vesico-urethral function in the bitch.
Defense date :
10 December 2013
Number of pages :
164
Institution :
ULiège - Université de Liège
Degree :
Docteur en Sciences Vétérinaire
Promotor :
Hamaide, Annick ;  Université de Liège - ULiège > Département d'Enseignement et de Clinique des animaux de Compagnie (DCC) > Dermatologie des animaux de compagnie
President :
Gillet, Laurent  ;  Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Santé publique vétérinaire
Jury member :
Combrisson, Hélène
Delaunois, Annie
Gustin, Pascal ;  Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Médecine vétérinaire comparée
Art, Tatiana ;  Université de Liège - ULiège > UDI Faculté de médecine vétérinaire
Peeters, Dominique ;  Université de Liège - ULiège > Département d'Enseignement et de Clinique des animaux de Compagnie (DCC) > Médecine interne des animaux de compagnie
Deleuze, Stefan  ;  Université de Liège - ULiège > Département d'Enseignement et de Clinique des animaux de Compagnie (DCC) > Reproduction des animaux de compagnie
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since 12 December 2013

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