Bye-bye drugs! New tricks in vet surgery may trump old ways to treat dog diseases (urinary incontinence and Cushing's)
Imagine your pet suffers from an insidious disease she’ll have to suffer with for the rest of her life. Next, picture a simple surgery that can fix it. No more drugs. No more side effects. No more constant testing.
Not that you general practitioner or internal medicine specialist doesn’t deserve a shot at treating your pet’s ills. And trust me, you’ll not yet want to go running off to the veterinary surgeon with Dolittler post in hand expecting miracles. Nevertheless, a couple new surgeries may render some hard-to-manage diseases eminently treatable––without the benefit of side effect-ridden drugs.
Today’s two ills in question are common. One is considered just plain annoying, and because it’s often unresponsive to medical therapy, the surgical option may provide some very welcome relief. The other falls under the category of “fundamentally difficult to treat” by anyone’s standards. The possibility of a surgical treatment, though admittedly a tricky one, may well save lives for pets who don’t respond well to drug the complex drug therapies involved.
The conditions? Spay-related, hormone-responsive urinary sphincter incontinence and the dreaded Cushing's disease.
For dogs who suffer incontinence as a result of hormonal changes, medical management can be fraught with side effects and incomplete remission of symptoms. Then there are dogs whose concurrent conditions and non-urinary drug regimens may make medical treatment not so attemptable. In all these cases, surgery is an option. Here’s what it looks like according to a recent conference proceeding:
“Colposuspension is the most common surgery used to address USMI (urinary sphincter mechanism incompetence) in female dogs. This procedure involves placement of sutures from the cranial vagina to the prepubic tendon on either side of the proximal urethra, thereby positioning the proximal urethra within the abdomen and placing pressure on the urethra as it crosses the pubic brim. Several studies have looked the long-term outcome following colposuspension. One of the most recent studies reported a response rate of 82% with half of those animals completely continent without medication. These results are in contrast to a separate study which reported only a 54% response rate, although a client satisfaction rate of 86% was also found.”
Pretty good stuff, I’d say. And before I read this, I’d never once thought to refer one of my patients to the surgeons across the street for this condition––all of whom can handle this surgery in their sleep (OK, maybe not, but close).
Next up, hypophysectomy. It’s nowhere near so easy as the colposuspension, but medical treatment of pituitary-dependent canine hyperadrenocortisism (Cushing's disease) can be so complex, demanding and tricky that euthanasia is often elected in lieu of continued attempts at drug therapy. For this reason, European vets have been treating the source of the problem with brain surgery. Again, according to a conference proceeding from earlier this month:
“Hypophysectomy surgery [removal of the hypophysis (in the brain)] is performed for dogs with pituitary and adrenal-dependent [Cushing's] disease. In the United States there is limited experience with hypophysectomy for pituitary tumors but outside the United States this surgery has been performed with good results. The mortality rate can approach 10% but most dogs obtain a complete remission for several years. In addition to perioperative mortality, diabetes insipidus may occur [an easily treated side-effect that results in excessive water drinking] but is usually transient.”
The full range of risks and stats are not immediately at my command, but I’m happy to say I’ll be hearing more now that my intrepid boyfriend-the-vet-surgeon is revving up his CT scanner in anticipation of some cases.
But let’s not get too excited just yet. In the case of both these diseases, it’s clear the old ways still come first. Treating both pituitary-dependent Cushingss disease and hormone-responsive urinary incontinence will perhaps always require drugs as a first line of defense, but new treatment options are always welcome for those who can’t be treated the old way.