Kastrationsnebenwirkungen Harninkontinenz und Welpenfell bei der Hündin

Zusammenfassung

Harninkontinenz (HI) als Folge eines nicht ausreichenden Verschlussmechanismus der Harnröhre (urethrale Sphinkterinkompetenz [USMI]) oder einer gestörten Speicherfunktion der Blase ist eine gefürchtete Nebenwirkung der Kastration bei Hündinnen. Das Risiko für HI wird von Faktoren wie Rassezugehörigkeit, Körpergewicht und Zeitpunkt der Kastration beeinflusst. Typisch ist der Harnverlust im Liegen, der im Mittel 2,8 Jahre nach Kastration erstmals auftritt. Die Diagnose wird mittels Ausschlussverfahren gestellt, wobei insbesondere eine gezielte Anamnese sehr hilfreich ist. Die Therapie hat zum Ziel, den Verschlussdruck der Harnröhre und/oder die Blasencompliance zu erhöhen. In der Regel führt eine medikamentöse Therapie zum Erfolg, sodass eine chirurgische Intervention nicht notwendig ist. Neben der HI werden als unerwünschte Kastrationsfolge bei bestimmten Hunderassen auch Fell-veränderungen beobachtet. Die durch die Kastration ausgelösten pathophysiologischen Mechanismen, die zur Abnahme des Harnröhrenverschlussdrucks, zu einer veränderten Speicherfunktion der Harnblase sowie zu Fellveränderungen führen, sind bis heute nicht vollständig geklärt. Außer die in einer altbekannten Hypothese genannte Östrogendefizienz könnte die nach Kastration veränderte Sekretion der übergeordneten Sexualhormone, FSH, LH und GnRH eine Rolle spielen. Neben α-Adrenergika, Flavoxat und Estriol wird auch der erfolgreiche Einsatz von GnRH-Agonist-Depotformulierungen zur Therapie der kastrationsbedingten HI beschrieben. Diese Depotformulierungen erwiesen sich auch zur Therapie bei Fellveränderungen nach Kastration als geeignet.

Summary

Urinary incontinence as a consequence of an insufficient urethral closure mechanism (urethral sphincter mechanism incompetence, USMI) or an impaired storing capacity of the urinary bladder is a considerable side effect of castration in the female dog. Different factors such as breed, body weight and time of spaying have an impact on the risk of urinary incontinence. Loss of urine while the patient is recumbent is the most typical symptom which is first observed at a mean time of 2.8 years after castration. Diagnosis is obtained by excluding other causes, whereas a precise patient history is particularly helpful. Therapy is aimed at increasing the closing pressure of the urethra and/or the compliance of the urinary bladder. Usually success can be achieved by medical therapy, thus surgical intervention is normally not required. In addition to urinary incontinence, coat changes can be observed as an undesirable effect of castration in certain dog breeds. To date, the patho-physiology of decreased urethral closing pressure, altered storing function of the urinary bladder and coat changes induced by castration are still not fully understood. Apart from the well-known hypothesis of estrogen deficiency, altered secretion of the hypothalamic and pituitary hormones GnRH, FSH and LH due to castration may have an influence. In addition to α-adrenergic medication, Flavoxate and Estriol, depot formulations of GnRH analogues have been successfully used to treat urinary incontinence. These depot formulations have also been described for the treatment of coat changes due to spaying.

Schlüsselwörter

Kastration - Hündin - Incontinentia urinae - Welpenfell - Nebenwirkung - Gonadotropine

Key words

Spaying - bitch - urinary incontinence - puppy coat - adverse reaction - gonadotropins

• Literatur

• 1 Arnold S. Harninkontinenz bei kastrierten Hündinnen: Bedeutung, Pathophysiologie und Behandlung. Stuttgart: Enke; 1997
• 2 Blendinger C, Blendinger K, Bostedt H. [Urinary incontinence in castrated female dogs. 2. Therapy]. Tierärztl Prax 1995; 23 (04) 402-406.
• 3 Blendinger C, Blendinger K, Bostedt H. [Urinary incontinence in spayed bitches. 1. Pathogenesis, incidence and disposition]. Tierärztl Prax 1995; 23 (03) 291-299.
• 4 Coit VA, Dowell FJ, Evans NP. Neutering affects mRNA expression levels for the LH- and GnRH-receptors in the canine urinary bladder. Theriogenology 2009; 71 (02) 239-247.
• 5 Coit VA, Gibson IF, Evans NP, Dowell FJ. Neutering affects urinary bladder function by different mechanisms in male and female dogs. Eur J Pharmacol 2008; 584 (01) 153-158.
• 6 Creed KE. Effect of hormones on urethral sensitivity to phenylephrine in normal and incontinent dogs. Res Vet Sci 1983; 34 (02) 177-181.
• 7 de Bleser B, Brodbelt DC, Gregory NG, Martinez TA. The association between acquired urinary sphincter mechanism incompetence in bitches and early spaying: A case-control study. Vet J (in press, corrected proof)
• 8 De Bosschere H, Ducatelle R, Tshamala M, Coryn M. Changes in sex hormone receptors during administration of progesterone to prevent estrus in the bitch. Theriogenology 2002; 58 (06) 1209-1217.
• 9 El Etreby M. Effect of cyproterone acetate, levonorgestrel and progesterone an adrenal glands and reproductive organs in the beagle bitch. Cell Tissue Res 1979; 200 (02) 229-243.
• 10 Finco DR, Osborne CA, Lewis RE. Nonneurongenic causes of abnormal micturition in the dog and cat. Vet Clin North Am 1974; 4 (03) 501-516.
• 11 Holt PE. Urinary-incontinence in the bitch due to sphincter mechanism incompetence – prevalence in referred dogs and retrospective analysis of 60 cases. J Small Anim Pract 1985; 26 (04) 181-190.
• 12 Holt PE, Thrusfield MV. Association in bitches between breed, size, neutering and docking, and acquired urinary incontinence due to incompetence of the urethral sphincter mechanism. Vet Rec 1993; 133 (08) 177-180.
• 13 Kakar SS, Jennes L. Expression of gonadotropin-releasing hormone and go -nadotropin-releasing hormone receptor mRNAs in various non-reproductive human tissues. Cancer Lett 1995; 98 (01) 57-62.
• 14 Lin DX, Lei ZM, Rao Ch V. Dependence of uterine cyclooxygenase2 expression on luteinizing hormone signaling. Biol Reprod 2005; 73 (02) 256-260.
• 15 Mertens PA, Unshelm J. Die Kastration des Hundes. Rechtslage, mögliche Probleme und gängige Praxis. Kleintierprax 1997; 42 (08) 631-640.
• 16 Mutoh S, Ueda S, Yano S, Ikegami K, Sakanashi M. Effects of some prosta -glandins on urinary bladder and urethra isolated from the dog. Urol Int 1983; 38 (04) 219-222.
• 17 Nickel R. Studies on the function of the urethra and bladder in continent and incontinent female dogs [PhD thesis]. Utrecht: University Press; 1998
• 18 Noel S, Claeys S, Hamaide A. Acquired urinary incontinence in the bitch: Update and perspectives from human medicine. Part 1: The bladder component, pathophysiology and medical treatment. Vet J (in press)
• 19 Osborne CA, Oliver JE, Polzin DE. Non-neurogenic urinary incontinence. In: Current Veterinary Therapy Kirk RW. ed Philadelphia: Saunders; 1980: 1128-1136.
• 20 Ponglowhapan S, Church DB, Khalid M. Differences in the expression of luteinizing hormone and follicle-stimulating hormone receptors in the lower urinary tract between intact and gonadectomised male and female dogs. Domest Anim Endocrinol 2008; 34 (04) 339-351.
• 21 Ponglowhapan S, Church DB, Khalid M. Expression of cyclooxygenase-2 in the canine lower urinary tract with regard to the effects of gonadal status and gender. Theriogenology 2009; 71 (08) 1276-1288.
• 22 Reichler I, Hubler M, Arnold S. Pathophysiologie und Therapie der kastrationsbedingten Harninkontinenz der Hündin. Tierärztl Prax 2006; 34 (K) 415-419.
• 23 Reichler IM. Gonadectomy in cats and dogs: a review of risks and benefits. Reprod Domest Anim 2009; 44 (Suppl. 02) 29-35.
• 24 Reichler IM, Barth A, Piche CA, Jochle W, Roos M, Hubler M. et al. Uro -dynamic parameters and plasma LH/FSH in spayed Beagle bitches before and 8 weeks after GnRH depot analogue treatment. Theriogenology 2006; 66 (09) 2127-2136.
• 25 Reichler IM, Hubler M, Jochle W, Trigg TE, Piche CA, Arnold S. The effect of GnRH analogs on urinary incontinence after ablation of the ovaries in dogs. Theriogenology 2003; 60 (07) 1207-1216.
• 26 Reichler IM, Hung E, Jochle W, Piche CA, Roos M, Hubler M. et al. FSH and LH plasma levels in bitches with differences in risk for urinary incontinence. Theriogenology 2005; 63 (08) 2164-2180.
• 27 Reichler IM, Jochle W, Piche CA, Roos M, Arnold S. Effect of a long acting GnRH analogue or placebo on plasma LH/FSH, urethral pressure profiles and clinical signs of urinary incontinence due to sphincter mechanism incompetence in bitches. Theriogenology 2006; 66 (05) 1227-1236.
• 28 Reichler IM, Pfeiffer E, Piche CA, Jochle W, Roos M, Hubler M. et al. Changes in plasma gonadotropin concentrations and urethral closure pressure in the bitch during the 12 months following ovariectomy. Theriogenology 2004; 62 (08) 1391-1402.
• 29 Reichler IM, Welle M, Eckrich C, Sattler U, Barth A, Hubler M. et al. Spaying-induced coat changes: the role of gonadotropins, GnRH and GnRH treatment on the hair cycle of female dogs. Vet Dermatol 2008; 19 (02) 77-87.
• 30 Reichler IM, Welle M, Sattler U, Jochle W, Roos M, Hubler M. et al. Comparative quantitative assessment of GnRH- and LH-receptor mRNA expression in the urinary tract of sexually intact and spayed female dogs. Theriogenology 2007; 67 (06) 1134-1142.
• 31 Rose SA, Adin CA, Ellison GW, Sereda CW, Archer LL. Long-term efficacy of a percutaneously adjustable hydraulic urethral sphincter for treatment of urinary incontinence in four dogs. Vet Surg 2009; 38 (06) 747-753.
• 32 Rosin AE, Barsanti JA. Diagnosis of urinary incontinence in dogs: role of the urethral pressure profile. JAVMA 1981; 178 (08) 814-822.
• 33 Schneider R, Dorn CR, Taylor DO. Factors influencing canine mammary cancer development and postsurgical survival. J Natl Cancer Inst 1969; 43 (06) 1249-1261.
• 34 Scott DW, Miller WH, Griffin CE. Endocrine and Metabolic Diseases. Phila -delphia: Saunders; 2001
• 35 Spain CV, Scarlett JM, Houpt KA. Long-term risks and benefits of early-age gonadectomy in dogs. J Am Vet Med Assoc 2004; 224 (03) 380-387.
• 36 Sridaran R, Lee MA, Haynes L, Srivastava RK, Ghose M, Sridaran G. et al. GnRH action on luteal steroidogenesis during pregnancy. Steroids 1999; 64 (09) 618-623.
• 37 Stocklin-Gautschi NM, Hassig M, Reichler IM, Hubler M, Arnold S. The relationship of urinary incontinence to early spaying in bitches. J Reprod Fertil Suppl 2001; 57: 233-236.
• 38 Thrusfield MV. Association between urinary incontinence and spaying in bitches. Vet Rec 1985; 116 (26) 695
• 39 Thrusfield MV, Holt PE, Muirhead RH. Acquired urinary incontinence in bitches: its incidence and relationship to neutering practices. J Small Anim Pract 1998; 39 (12) 559-566.
• 40 van Goethem B, Schaefers-Okkens A, Kirpensteijn J. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique. Vet Surg 2006; 35 (02) 136-143.
• 41 Veronesi MC, Rota A, Battocchio M, Faustini M, Mollo A. Spaying-related urinary incontinence and oestrogen therapy in the bitch. Acta Vet Hung 2009; 57 (01) 171-182.
• 42 Welle MM, Reichler IM, Barth A, Forster U, Sattler U, Arnold S. Immuno -histochemical localization and quantitative assessment of GnRH-, FSH-, and LH-receptor mRNA expression in canine skin: a powerful tool to study the pathogenesis of side effects after spaying. Histochem Cell Biol 2006; 126 (05) 527-535.