ArticlePDF Available

Clinical Response and Side Effects Associated with Testosterone Cypionate for Urinary Incontinence in Male Dogs


Abstract and Figures

Urethral sphincter mechanism incompetence (USMI) is reported much more seldom in male dogs than in female dogs. The few existing reports evaluating the efficacy of medical therapy in controlling USMI in males have demonstrated limited success. In this case series, we report the effect of testosterone cypionate, given at a median dose of 1.5 mg/kg intramuscularly every 4 wk, in eight male dogs with USMI. Response was evaluated through the review of medical records and telephone interviews with the clients. Based on owners' assessments, a good to excellent response was reported in three of eight dogs (38%), a slight response was reported in one of eight dogs (12%), and a poor response was reported in four of eight dogs (50%). Adverse effects were not reported, and benefit was judged sufficient to continue therapy in two cases. The results reported in this case series suggest that testosterone cypionate might be an effective and safe treatment option for male dogs with USMI.
Content may be subject to copyright.
Clinical Response and Side Effects Associated
with Testosterone Cypionate for Urinary
Incontinence in Male Dogs
´bastien Palerme, DVM, MSc, DACVIM, Allison Mazepa, DVM, DACVIM, Rae G. Hutchins, DVM, DACVIM,
Vincent Ziglioli, DVM, DACVIM, Shelly L. Vaden, DVM, PhD, DACVIM
Urethral sphincter mechanism incompetence (USMI) is reported much more seldom in male dogs than in female dogs. The
few existing reports evaluating the efcacy of medical therapy in controlling USMI in males have demonstrated limited suc-
cess. In this case series, we report the effect of testosterone cypionate, given at a median dose of 1.5 mg/kg intramuscularly
every 4 wk, in eight male dogs with USMI. Response was evaluated through the review of medical records and telephone
interviews with the clients. Based on ownersassessments, a good to excellent response was reported in three of eight
dogs (38%), a slight response was reported in one of eight dogs (12%), and a poor response was reported in four of eight
dogs (50%). Adverse effects were not reported, and benet was judged sufcient to continue therapy in two cases. The
results reported in this case series suggest that testosterone cypionate might be an effective and safe treatment option for
male dogs with USMI. (J Am Anim Hosp Assoc 2017; 53:285–290. DOI 10.5326/JAAHA-MS-6588)
Urinary incontinence is common in dogs and is a frequent reason
that owners bring their dogs to a veterinarian. Urethral sphincter
mechanism incompetence (USMI) is the most common cause of
urinary incontinence in adult female dogs and is estimated to affect
between 5 and 20% of spayed female dogs.
Though the true
prevalence of USMI in the total male canine population remains
unknown, one report of urinary incontinence in dogs found that
adult male dogs accounted for only 9 of 320 cases.
The etiology and
pathogenesis of this condition in male dogs have not been deter-
mined; however, comparison with continent dogs has identied
many risk factors, including a shorter urethral length, caudal
bladder position, and castration.
Urethral sphincter mechanism
incompetence in male dogs is dened as involuntary leakage of
urine due to decreased urethral tone after the exclusion of other
causes, such as prostatic disease, bladder or urethral calculi, bladder
or urethral neoplasia, lower urinary tract infections, ectopic ureters,
and neurologic dysfunction. The gold standard for the diagnosis of
USMI in both male and female dogs is urethral pressure prol-
ometry. However, since this technique has limited availability, his-
tory, clinical signs, physical exam, imaging of the urinary system,
urinalysis, and urine culture typically make the diagnosis in both
The options for management of USMI in male dogs are limited.
Medical management with phenylpropanolamine (PPA), estrogens,
or anticholinergic drugs has been reported; however, the overall
reported response to these agents is poor. Although a prospective
study evaluating urinary incontinence in dogs found that seven of
From Iowa State University College of Veterinary Medicine, Ames, Iowa (J-S.P.);
Blue Pearl, Eden Prairie, Minnesota (A.M.); Veterinary Specialty Hospital
of the Carolinas, Cary, North Carolina (R.G.H.); Upstate Veterinary
Specialists, Greenville, South Carolina (V.Z.); and North Carolina
State University College of Veterinary Medicine, Raleigh, North Carolina
Correspondence: (J-S.P.)
DES (diethylstilbestrol); PPA (phenylpropanolamine); USMI (urethral
sphincter mechanism incompetence)
ª2017 by American Animal Hospital Association JAAHA.ORG 285
eight male dogs included in the study had resolution of incontinence
as well as signicant increases of their urethral pressure prole values
following oral PPA administration, a larger retrospective analysis of
43 male dogs treated with various drugs for USMI found that only
7 dogs (16%) had an excellent response to medical therapy, and
28 (65%) had a poor response.
Small case series have been published
describing surgical techniques used in the management of USMI in
male dogs. While prostatopexy was only successful in one of nine
dogs reported in one case series, urinary continence was restored in
three of seven dogs that underwent the relocation of an intrapelvic
bladder neck to an intra-abdominal position.
Likewise, two of
four males that received a single intraurethral polytetrauoro-
ethylene injection became continent.
More recently, the use of
articial urethral sphincter devices has been reported in dogs.
Although only three male dogs were included in this study, their
continence scores increased signicantly when compared to pre-
surgical scores.
Testosterone administration is an alternative medical therapy
that has been used in male dogs with urinary incontinence. The
management of a small number of castrated dogs with methyl-
testosterone was attempted in one retrospective study.
The drug was
reported to be ineffective, with a poorresponse in four of ve
dogs and a goodresponse in one dog. Though testosterone
, a testosterone ester, is recommended as a medical
therapy for male USMI in many veterinary textbooks, its successful
use in an incontinent male dog is only reported in a single case
Testosterone has potential adverse effects, including
prostatic hyperplasia and behavioral aggression caused by excessive
androgenic action. The frequency of the development of adverse
effects in male dogs receiving this medication for management of
urinary incontinence has not been reported. Therefore, the objective
of this case series was to report the clinical efcacy and adverse
effects of testosterone cypionate administered to a small group of
castrated male dogs with incontinence presumed to be caused by
acquired USMI.
Materials and Methods
Case Selection Criteria
Neutered male dogs with a clinical diagnosis of urinary incontinence
made between 2003 and 2012 were identied by searching the
medical records of the North Carolina State Veterinary Hospital.
Dogs were included in this series if they were administered testos-
terone cypionate for presumed USMI, the medical record was
available for review, and the owners completed a follow-up telephone
questionnaire. Intact male dogs were excluded from the study in
order to minimize the likelihood of including dogs with prostatic
disease as a cause of urinary incontinence. Dogs were also excluded
from this study if there was ultrasonographic and/or bacteriological
evidence of a cause of urinary incontinence other than USMI, such as
the presence of ectopic ureters, tumor of the lower urinary system,
prostatic disease, or a urinary tract infection, or if the owner was not
available to complete the follow-up questionnaire. Finally, dogs that
were receiving other concurrent medications for incontinence were
also excluded from the study.
Medical Record Review
Patient medical records were retrospectively reviewed. Signalment,
history pertaining to the onset and characteristics of urinary in-
continence, results of routine urine analyses (urinalysis and aerobic
urine culture), and imaging studies were recorded. A diagnosis of
USMI was made based on a history of involuntary leakage of urine
noted by the owner with the exclusion of other known causes of
incontinence, including prostatic disease, bladder or urethral calculi,
bladder or urethral neoplasia, lower urinary tract infections, ectopic
ureters, and neurologic dysfunction. Urethral pressure prolometry
was not performed in any of the dogs and was not used as an in-
clusion criterion. The dose, dosing interval, as well as number of
administrations of testosterone cypionate were recorded. Patient
medical records were also reviewed for any information regarding
other treatments initiated for urinary incontinence and the clinical
response to these treatments.
Follow-Up Questionnaire
Owners were asked to complete a telephone questionnaire assessing
the response to treatment with testosterone cypionate in their dog.
This was performed at one time point during the study. Owners were
asked to report any adverse effects noted during the administration of
testosterone cypionate, as well as time to clinical remission and length
of response to testosterone cypionate, if noted. Additionally, owners
were asked to score from 1 to 4 their satisfaction with their dogs
response to testosterone cypionate, with (1) indicating complete
dissatisfaction due to no response (poor), (2) indicating only slight
response (fair), (3) indicating the animal was now continent most of
the time (good), and (4) indicating very satised due to complete
continence (excellent).
Eleven neutered males were identied for inclusion in the study.
During the same period studied, a total of 123 spayed female dogs
were seen at our institution for USMI. Of the 11 male dogs, two
owners could not be contacted for the completion of the follow-up
questionnaire, and one dog was found to be receiving concurrent
treatment with both PPA and testosterone cypionate. Eight dogs were
included in the series (Table 1). Median follow up, as dened as the
286 JAAHA | 53:5 Sep/Oct 2017
period between the beginning of testosterone therapy and the phone
interview, was 25.5 mo (range: 267 mo). The median age of the
dogs was 7.5 yr. The median age of castration for the eight dogs for
which it was known was 1.5 yr (range: 6 mo to 3 yr). Urinary in-
continence in all dogs was rst noted at a median age of 3.5 yr
(range: 6 mo to 8 yr) and occurred during rest and recumbency in
seven of eight dogs. The remaining dog dribbled urine continuously,
especially during or following activity. Five of eight dogs had re-
ceived previous medical treatment for urinary incontinence in-
cluding diethylstilbestrol (DES) and PPA. Of these ve dogs, all had
either failed to respond to medical management or had initially
responded but then incontinence recurred.
Physical exam failed to identify an underlying cause for the
urinary incontinence of the dogs included in the study. Rectal ex-
aminations were recorded for six of eight dogs in the study and were
unremarkable. Neurologic examinations, performed in all dogs, were
unremarkable. Urinalyses and aerobic cultures were available for all
cases. Median urine specic gravity was 1.025 (range: 1.0101.044). In
no cases were pyuria, hematuria, cylinduria, or bacteriuria reported.
One case (dog 1) had glucosuria detected and was identied as being
diabetic, based on concurrent hyperglycemia and increased fructos-
amine value. Signicant bacterial growth (Proteus mirabilis) was iso-
lated from the urine of one dog (dog 3); urine from all other dogs did
not yield bacterial growth after 48 hr of aerobic culture. Urinary tract
infection was not judged to be the cause of incontinence in dog 3
based on the fact that incontinence persisted after treatment with
amoxicillin-clavulanic acid selected on the basis of microbial culture
and sensitivity. The urinary tract of each dog was assessed by ultra-
sound, positive contrast cystourethrogram, and cystoscopy in seven,
three, and two cases, respectively (Table 1). Relevant imaging ndings
such as a dilated urethra, evidence of cystitis, and prostatomegaly
were identied in two, one, and one cases, respectively.
The median dose of testosterone cypionate was 1.8 mg/kg
(range: 1.02.2 mg/kg) administered intramuscularly for a median
Patient Data, Imaging, and Previous Treatments for Incontinence
Dog Breed
Age at
Presentation (yr)
Age at
Onset (yr)
Type of
Incontinence Imaging Performed Imaging Findings
Previous Treatment
Response to
1 Poodle 10 0.5 Continuous
Ultrasound NSF PPA (2.3 mg/kg/day) Relapse
2 Greater Swiss
mountain dog
9 3 Intermittent,
Ultrasound Possible
and possible
bladder wall
PPA (2 mg/kg/day) None
3 Border terrier 9 3 Intermittent,
Not performed N/A DES (1 mg/wk) Relapse
4 Golden retriever 4 4 Intermittent,
Ultrasound, CCU,
urethral dilation
PPA (3.3 mg/kg/day) None
5 Bernese
mountain dog
6 6 Intermittent,
Ultrasound NSF PPA (1.4 mg/kg/day) None
6 Mixed-breed
4 3 Intermittent,
Ultrasound, CCU,
NSF None N/A
7 Labrador
9 8 Intermittent,
Ultrasound NSF None N/A
8 Poodle 2 2 Continuous
CT scan, CCU
Dilation of the
proximal urethra
with strictures of the
membranous and
penile urethra
None N/A
CCU, contrast cystourethrogram; CT, computed tomography; DES, diethylstilbestrol; N/A, not available; NSF, no significant findings; PPA, Phenylpropanolamine.
Use of Testosterone Cypionate in Dogs with Incontinence
dosing interval of 4.5 wk (range: 36 wk) (Table 2). The median
number of treatments was four (range: 225). Owners scored a
median satisfaction score of 1.5 (range: 14), with three of eight
owners reporting that their dog had either a good or excellent re-
sponse to testosterone cypionate. One of eight owners indicated a fair
response, and four of eight owners indicated a poor response. No
adverse effects were reported in any dog. In two dogs, satisfaction was
deemed sufcient to warrant the continued use of testosterone.
In the present study, treatment with testosterone cypionate was
retrospectively evaluated in eight dogs. In ve of these dogs, previous
treatments with either PPA or DES had been unsuccessful. Despite
this, testosterone cypionate resulted in good or excellent control in
only three of eight dogs based on assessment by the dogsowners.
The most common medical therapies for USMI in female dogs are
PPA and estrogens. The success rate of PPA alone in female dogs has
been reported to be as high as 8590%, while the response rates for
estrogens has been reported to range from 1865%.
The re-
sponse rate to PPA and DES in male dogs has been reported to be
substantially lower in some studies, with complete response
reported in only 31 and 37% of male dogs, respectively.
Factors proposed to be important in maintaining continence in
healthy male dogs include a long proximal urethra, increased urethral
tone generated by the prostate, and, potentially, differences in fol-
licular stimulating hormone and luteinizing hormone receptors
located in the urethra and bladder.
The mechanism through which
testosterone cypionate improves urinary continence in males is
poorly understood. Though purely speculative, hypertrophy of the
prostate, mediated by nuclear androgen receptors, has been pro-
posed to play a role in maintaining urinary continence.
In ad-
dition, functional effects mediated through phosphodiesterase-5 as
well as a
-adrenergic receptors are thought to be important in
maintaining tone of the bladder and urethral smooth muscles. All of
the subjects in this study were castrated; therefore, smaller prostatic
mass might have contributed to the reduced continence in these
patients. Prostatic hypertrophy following treatment with testoster-
one cypionate, therefore, might explain the improved continence in
some of these dogs; however, prostatic size following treatment was
not recorded in the medical records.
The more traditional medical therapies used for USMI in both
males and females, PPA and DES, are oral medications that require
frequent administration to maintain continence. Diethylstilbestrol is
initially given daily and then administered once weekly to maintain
continence. Use of DES in males is uncommon because of the low
response rate as well as the serious potential side effects, including
feminization, induction of squamous prostatic metaplasia, and bone
marrow suppression. Phenylpropanolamine requires long-term oral
administration every 812 hr, and, even though clinical side effects
are rarely encountered, signicant increases in systolic blood pres-
sures have only been reported in studies of continent research
16, 2123
Therefore, intramuscular administration of testos-
terone cypionate every 4 wk might offer a more convenient and safe
dosing interval for some owners. Unfortunately, due to the small
scale of our study, no conclusions could be made about the optimal
dosing or number of treatments necessary to have the highest
likelihood of a response.
Though no published data exists documenting adverse effects
associated with testosterone supplementation in dogs, various pa-
thologies including perianal adenomas, perineal hernias, and pros-
tatic hyperplasia have been associated with increased serum
testosterone levels in dogs.
In our study, no adverse effects were
reported. The median number of treatments administered was four.
It is possible that an increased rate of side effects would have been
Testosterone Cypionate Dosing Schedule and Response
Dog Dose (mg/kg IM) Dosing Interval (wk) Total Number of Treatments Owner Score Response Follow-Up (mo) Outcome
1 1–2 3 2 1 Poor 8 Discontinued administration
2 1.4 4 Unknown 2 Fair 67 Discontinued administration
3 1.1 4–6 8 4 Excellent 22 Continued administration
4 2.2 4 4 1 Poor 41 Discontinued administration
5 2.2 4–6 4 1 Poor 29 Discontinued administration
6 2.2 6 3 1 Poor 39 Discontinued administration
7 1.0 6 2 3 Good 2 Discontinued administration
8 2.1 3 25 3 Good 17 Continued administration
IM, intramuscularly.
288 JAAHA | 53:5 Sep/Oct 2017
seen if the treatments had been continued for a longer period of
time. Interestingly, the owner of the dog that received the most
treatments (n¼25) did not report any adverse effects. None of the
dogs in the current study were reported to have gastrointestinal
signs or clinical signs suggestive of prostatic hypertrophy, such as
stranguria, hematuria, and/or tenesmus. Nonetheless, owners of
dogs undergoing this therapy should be cautioned to look for such
clinical signs. All the dogs in this study had subsequent testosterone
administration performed by their referring veterinarians. Conse-
quently, only three of the eight dogs were reassessed at our insti-
tution while on testosterone therapy. Of the two dogs that had rectal
exams recorded, no abnormalities were noted. In addition, no
follow-up imaging was performed to evaluate prostatic size fol-
lowing testosterone cypionate administration.
A recent human clinical trial evaluating three different testos-
terone formulations for the treatment of late-onset hypogonadism
reported the incidence of prostatic side effects after 3 mo of therapy.
These investigators documented no clinical signs suggestive of prostatic
hypertrophy and no statistical difference in pre- and posttreatment
prostate-specic antigen concentrations, which is a sensitive marker of
increased prostatic mass in humans. Although these data suggest that the
possible side effect of prostatic hypertrophy has little clinical relevance,
caution is warranted in extrapolating this conclusion to canine patients
until future studies involving follow-up prostatic ultrasonography have
been performed. Posttreatment complete blood counts and biochemical
proles were not available for review in this group of dogs; therefore, the
presence of laboratory abnormalities is unknown. Humans treated with
testosterone cypionate for late-onset hypogonadism have shown no
signicant hematologic abnormalities after 14 wk of therapy.
This case series has several limitations. The information re-
garding each patient was variable, based on completeness of the
medical record and the reliability of the owner to recall response to
treatment and overall satisfaction when contacted for follow-up. The
reliance on ownersobservations rather than urodynamic data to
determine the drugs effect is a signicant drawback. Several in-
vestigators have noted a placebo effect in ownersperception of their
dogscontinence following medical intervention.
Second, this
study lacked a control group. Limited comparisons were made using
previous reports that evaluated other medical therapies for incon-
tinence (PPA and DES), but no direct comparisons between the
treatments could be made. It is possible that we are reporting a
group of dogs that was more difcult to treat since a substantial
proportion had failed to respond to standard medical therapy prior
to referral. Third, since the drug dose, dosing interval, and duration
of treatment were determined based on clinician discretion as well
as the patients response to the drug, there was no standardized
treatment schedule for the patients in this study. For example, one
dog received only 2 doses of testosterone cypionate, while another
received 25 doses. This might have impacted the reported efcacy as
well as the frequency and severity of side effects of the drug. Finally,
the denitive diagnosis of USMI was not made by urethral pressure
prolometry in any dog. Therefore, some of the dogs included in this
study might have been suffering from incontinence due to another
mechanism despite our best efforts to exclude those patients.
Though the resultsreported here are based on a small retrospective case
series, our data suggest that testosterone cypionate might be an option
in treating USMI in male dogs that are refractory or have contrain-
dications to more commonly used medications. Additionally, no severe
adverse effects were noted in this case series when testosterone cypi-
onate was dosed at 1.02.2 mg/kg intramuscularly every 3 to 6 wk for
up to 25 doses. Based on these data, prospective, multi-institutional
controlled studies of the effects of testosterone cypionate in male dogs
with USMI are warranted. These studies should incorporate more
rigorous assessments of the patients anatomy using ultrasonography
or computed tomography, urethrocystoscopy, urethral prolometry
pre- and posttestosterone cypionate administration to more objec-
tively monitor response to therapy, as well as regular monitoring of
biochemical and hematologic parameters pre- and posttherapy.
DEPO-Testosterone Injection; Pzer, New York, New York
1. Holt P. Urinary incontinence in the dog. In Pract 1983;5(5):1624,16973.
2. Holt PE. Importance of urethral length, bladder neck position and
vestibulovaginal stenosis in sphincter mechanism incompetence in the
incontinent bitch. Res Vet Sci 1985;39(3):36472.
3. Holt PE. Urinary incontinence in dogs and cats. Vet Rec 1990;127(14):
4. Arnold S, Jäger P, DiBartola SP, et al. Treatment of urinary incontinence
in dogs by endoscopic injection of Teon. J Am Vet Med Assoc 1989;
5. Forsee KM, Davis GJ, Mouat EE, et al. Evaluation of the prevalence of
urinary incontinence in spayed female dogs: 566 cases (20032008). JAm
Vet Med Assoc 2013;242(7):95962.
6. Aaron A, Eggleton K, Power C, et al. Urethral sphincter mechanism
incompetence in male dogs: a retrospective analysis of 54 cases. Vet Rec
7. Coit VA, Gibson IF, Evans NP, et al. Neutering affects urinary bladder
function by different mechanisms in male and female dogs. Eur J
Pharmacol 2008;584(1):1538.
8. Power SC, Eggleton KE, Aaron AJ, et al. Urethral sphincter mechanism
incompetence in the male dog: importance of bladder neck position, prox-
9. Richter KP, Ling GV. Clinical response and urethral pressure prole
changes after phenylpropanolamine in dogs with primary sphincter in-
competence. J Am Vet Med Assoc 1985;187(6):60511.
Use of Testosterone Cypionate in Dogs with Incontinence
10. Holt PE, Coe RJ, Hotston Moore A. Prostatopexy as a treatment for
urethral sphincter mechanism incompetence in male dogs. J Small Anim
Pract 2005;46(12):56770.
11. Weber UT, Arnold S, Hubler M, et al. Surgical treatment of male dogs
with urinary incontinence due to urethral sphincter mechanism in-
competence. Vet S u r g 1997;26(1):516.
12. Reeves L, Adin C, McLoughlin M, et al. Outcome after placement of an
articial urethral sphincter in 27 dogs. Ve t S urg 2013;42(1):128.
13. Plumb DC. Plumbs veterinary drug handbook. 8th ed. Stockholm (WI):
PharmaVet Inc.; 2015.
14. Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine:
disease of the dog and cat. 7th ed. St. Louis: Elsevier Saunders; 2010.
15. Barsanti JA, Edwards PD, Losonsky J. Testosterone responsive urinary in-
continence in a castrated male dog. J Am Anim Hosp Assoc 1981;17:1179.
16. Claeys S, Rustichelli F, Noël S, et al. Clinical evaluation of a single daily
dose of phenylpropanolamine in the treatment of urethral sphincter
mechanism incompetence in the bitch. Can Vet J 2011;52(5):5015.
17. Nendick PA, Clark WT. Medical therapy of urinary incontinence in
ovariectomised bitches: A comparison of the effectiveness of diethyl-
stilboestrol and pseudoephedrine. Aust Vet J 1987;64:1178.
18. Ponglowhapan S, Church DB, Scaramuzzi RJ, et al. Luteinizing hormone
and follicle-stimulating hormone receptors and their transcribed genes
(mRNA) are present in the lower urinary tract of intact male and female
dogs. Theriogenology 2007;67:35366.
19. Wenderorth UK, George FW, Wilson JD. The effect of a 5 alpha-reductase
inhibitor on androgen-mediated growth of the dog prostate. Endocrinology
20. Trachtenberg J, Hicks LL, Walsh PC. Androgen- and estrogen-receptor
content in spontaneous and experimentally induced canine prostatic
hyperplasia. J Clin Invest 1980;65(5):10519.
21. Scott L, Leddy M, Bernay F, et al. Evaluation of phenylpropanolamine in
the treatment of urethral sphincter mechanism incompetence in the
bitch. J Small Anim Pract 2002;43(11):4936.
22. Caroglio F, Hamaide AJ, Farnir F, et al. Evaluation of the urodynamic
and hemodynamic effects of orally administered phenylpropanolamine
and ephedrine in female dogs. Am J Vet Res 2006;67(4):72330.
23. Segev G, Westropp JL, Kulik C, et al. Changes in blood pressure fol-
lowing escalating doses of phenylpropanolamine and a suggested pro-
tocol for monitoring. Can Vet J 2015;56(1):3943.
24. Sirinarumitr K, Johnston SD, Kustritz MV, et al. Effects of nasteride on
size of the prostate gland and semen quality in dogs with benign pros-
tatic hypertrophy. J Am Vet Med Assoc 2001;218(8):127580.
25. Mann FA, Boothe HW, Amoss MS, et al. Serum testosterone and es-
tradiol 17-beta concentrations in 15 dogs with perineal hernias. JAmVet
Med Assoc 1989;194(11):157880.
26. Dow SW, Olson PN, Rosychuk RA, et al. Perianal adenomas and
hypertestosteronemia in a spayed bitch with pituitary-dependent
hyperadrenocorticism. J Am Vet Med Assoc 1988;192(10):143941.
27. Hohl A, Marques MO, Coral MH, et al. Evaluation of late-onset hypo-
gonadism (andropause) treatment using three different formulations of
injectable testosterone. Arq Bras Endocrinol Metabol 2009;53(8):98995.
28. Byron JK, March PA, Chew DJ, et al. Effect of phenylpropanolamine and
pseudoephedrine on the urethral pressure prole and continence scores
of incontinent female dogs. J Vet Intern Med 2007;21(1):4753.
290 JAAHA | 53:5 Sep/Oct 2017
... [8][9][10] There has been only 1 study investigating the use of testosterone for the treatment of urinary incontinence in neutered male dogs. 11 The purpose of this case study was to describe the health improvements in a neutered dog following restoration of reproductive hormone concentrations. ...
... In the only published report of testosterone supplementation in male dogs, no adverse effects were reported but the authors cautioned that owners should watch for clinical signs. 11 Possible side effects of testosterone administration include hepatopathy, dermatopathies, epiphora, perianal adenomas/adenocarcinomas, increased liver enzymes, cervical skin thickening, increased preputial discharge, increased body odor, and increased male sexual behaviors. Androgens are contraindicated in any animal with a poorly functioning liver and in breeds that are predisposed to copper storage diseases such as Bedlington terriers and Labrador retrievers. ...
... Intramuscular testosterone cypionate (1.5 mg/kg/ month) was used to treat urinary incontinence in neutered male dogs. 11 Testosterone cypionate at 0.5-3 mg/kg/month for male dogs was also noted as a treatment in a patent application. 18 It is No change in fear response to veterinary visit; moderate improvement when unfamiliar people at a distance and ability to go for walk in park Fear response when familiar and unfamiliar people visit house Moderate improvement and friendly behavior to routine visitors; no change to unfamiliar people Hip pain Unable to run very far or jump, avoidance of activity Significant improvement in running; jumping on furniture and owners; increase in vigorous activity Unable to stretch back legs or sit on haunches Able to stretch normally; no change in sitting posture Inability to go on walks; unable to play rough with other dog Significant improvement in exercise stamina on long walks (30+ min); significant increase in initiation and participation in play with other dog Limping after exercise requiring pain medication (4-8 times/month) Significant reduction in limping and need for pain medication (twice/year) Body condition ...
Full-text available
This case study reports on the use of hormone therapy to treat a dog with a range of physical and behavioral signs that began after gonadectomy. A male mixed breed dog neutered at 7 months of age presented at 1 year with health issues impacting quality of life. Reduced mobility, limping, rapid weight gain, and fear of unfamiliar people were treated over the next three years with trials of pain medication, joint supplements, thyroxine, antidepressant, and significant diet restrictions. Frequent carprofen administration and daily joint supplements reduced limping, but mobility was still poor. Weight stabilized on a strict diet but fear and anxiety responses to strangers continued to worsen. Hormone restoration therapy was initiated when the dog was almost 4 years of age. Weekly subcutaneous administration of testosterone cypionate (0.5 mg/kg) significantly reduced pain and increased muscle mass, thereby improving mobility. However, supraphysiologic concentrations of luteinizing hormone were not reduced with testosterone therapy so a gonadotropin-releasing hormone agonist was implanted. After hormone restoration, appetite was reduced, and anxiety and fear behaviors became manageable. The testosterone and gonadotropin-releasing hormone agonist treatment was easily administered, had no known side effects, and the owners were pleased with the outcome.
... Testosterone supplementation is a potential hormonal option for male dogs but its reported efficacy is low. A clinical study of five adult male dogs administered methyltestosterone reported only one good response, and a second study using testosterone cypionate produced a good to excellent result in only three of eight male dogs (Aaron et al. 1996, Palerme et al. 2017. Reported side effects may be major and include prostatic hyperplasia and behavioural aggression (Palerme et al. 2017). ...
... A clinical study of five adult male dogs administered methyltestosterone reported only one good response, and a second study using testosterone cypionate produced a good to excellent result in only three of eight male dogs (Aaron et al. 1996, Palerme et al. 2017. Reported side effects may be major and include prostatic hyperplasia and behavioural aggression (Palerme et al. 2017). ...
The two leading causes of urinary incontinence in dogs are ureteral ectopia in juveniles and urethral sphincter mechanism incompetence in adults. While the accuracy of diagnosis of ectopic ureters has improved due to increased use of CT and/or cystoscopy, the diagnosis of urethral sphincter mechanism incompetence largely remains one of exclusion. New treatment options have been developed for both conditions, which have reduced morbidity and mortality, although the rate of long‐term urinary continence has not significantly improved for either and neither has our understanding of the pathophysiology behind these failures. This review provides updates on the management of both of these conditions, with discussion of controversial areas and thoughts for future directions.
... Low prevalence in neutered male dogs may be explained due to a longer urethra and its passage through penile structures that provide greater closure pressure (COIT et al., 2008). However, the fact that USMI is occasionally reported in males (PALERME et al., 2017), strengthens the hypothesis that chronic increase in gonadotropins may be more relevant in the pathogenesis of this disease than the fall of estrogen per se. ...
Full-text available
A castração de fêmeas caninas é uma cirurgia de rotina que visa principalmente a prevenção de doenças e o controle populacional da espécie. Ela não é, todavia, desprovida de consequências indesejáveis, e a incontinência urinária pós-castração é uma das mais significativas. Tratamento medicamentoso é preconizado para estes casos, sendo o emprego dos fármacos α-adrenérgicos e estrogênicos os mais frequentemente descritos na literatura. Entretanto, o uso de antidepressivos tricíclicos pode ser eficaz no controle dos sinais clínicos da incontinência. O mecanismo exato que envolve esta afecção ainda não é completamente entendido. Acredita-se que uma deficiência de estrógeno e consequente perda de tônus uretral sejam responsáveis pela ocorrência dos sinais, mas é possível que outros fatores como os níveis de gonadotrofinas e de hormônio liberador de gonadotrofinas estejam implicados na patogenia da incontinência urinária pós-castração.
Objective To assess the outcome and safety of surgically placed artificial urethral sphincters in male dogs with urethral sphincter mechanism incompetence. Materials and Methods We included dogs with urethral sphincter mechanism incompetence treated by placing an artificial urethral sphincter from January 1, 2010 to December 31, 2017. The continence score (scale 1 to 5, with 5 indicating complete continence) was evaluated before and after implantation. Follow-up information was obtained from the institution's medical records (short-term up to 12 months) and questionnaires were completed by telephone (long-term ≥12 months) for evaluation. Results Nineteen Medical therapy was unsuccessful in 18 dogs and unknown in one dog before the artificial urethral sphincter placement. Short-term continence improved in 16 of the 19 (84%) dogs. Four patients were lost to follow-up. Nine of 15 (60%) dogs showed long-term continence improvement, eight of 15 (53%) remained completely continent. The median follow-up was 1785 (range 2 to 3234) days. The complication rate was 56% (9/16). Minor complications, including haematoma, stranguria/temporary dyssynergia and mild inflammation at the port, were reported in four of 16 (25%) dogs. Five of 16 (31%) experienced major complications, including stranguria/mechanical urethral obstruction, persistent dyssynergia, fistula at the port and port rotation. Clinical Significance Artificial urethral sphincter placement is a valid option for treating incontinent male dogs that show an insufficient response or become refractory to medical or other prior surgical management. A high-complication rate is associated with this procedure.
Full-text available
Urethral sphincter mechanism incompetence (USMI) is a common cause of urinary incontinence in dogs. Although estrogen is often prescribed for the medical therapy of USMI for spayed female dogs, they are known to have limited effectiveness and potential adverse effects. In castrated male dogs with USMI, testosterone reagents have been attempted besides estrogen. In this study, the effect of testosterone drugs, mainly methyltestosterone, on spayed female dogs with USMI was retrospectively evaluated. Ten spayed female dogs with USMI were included. Diagnosis of USMI was based on the results of the dogs’ medical history, clinical signs, and no abnormalities in physical examinations, urinalysis, ultrasonography, X-ray imaging, and neurological examinations. Methyltestosterone was administered at doses of 0.32–1.27 mg/kg BW p.o. semel in die (sid.) to twice a week. Nine of the ten dogs had good or excellent responses 2 to 4 weeks after the start of treatment. The minimum effective dose was 0.32 mg/kg/day. Although no severe adverse symptoms occurred in any dog, a mild increase in alanine aminotransferase was temporally observed at doses of 1.0 and 1.1 mg/kg/day in the two dogs. After dose reduction or withdrawal, two of eight dogs had recurrence of urinary incontinence. Resumption of testosterone treatment clearly improved the symptoms in the two dogs. These results indicate that testosterone reagents might be an option for treating USMI in spayed female dogs as well.
Objective To estimate prevalence and identify demographic risk factors for urinary incontinence in male dogs. Methods and Methods The study population included all dogs within (the VetCompass database) from September 1, 2009 to July 7, 2013. Electronic patient records were searched for urinary incontinence cases; demographic and clinical information were extracted and analysed. Results Of 109,428 male dogs attending 119 clinics in England, there were an estimated 1027 dogs diagnosed with urinary incontinence, giving a prevalence of 0.94% (95% confidence interval: 0.88 to 1.00). Breeds with highest odds of incontinence in male dogs (compared with mixed breed dogs) included the bull mastiff (odds ratio: 17.21, 95% confidence interval: 6.65 to 44.56, case=5, non‐case=314, P<0.001), Irish red setter (odds ratio: 12.79, 95% confidence interval: 4.83 to 33.84, case=5, non‐case=142, P<0.001), fox terrier (odds ratio: 9.60, 95% confidence interval: 3.68 to 25.05, case=5, non‐case=176, P < 0.001), bulldog (odds ratio: 5.72, 95% confidence interval: 2.24 to 14.59, case=5, non‐case=929, P<0.001) and boxer (odds ratio: 3.65, 95% confidence interval: 1.84 to 7.25, case=10, non‐case=1470, P<0.001). Increased odds of urinary incontinence were associated with greater age (age 9 to 12 years, odds ratio: 10.46, 95% confidence interval: 6.59 to 16.62, n=12,348, P<0.001) and being insured (odds ratio: 1.96, 95% confidence interval: 1.53 to 2.51, n=26,202, P<0.001). There was no association with castration or bodyweight using multi‐variable analysis. Clinical Significance The overall prevalence of urinary incontinence in male dogs is approximately 1%, which may be higher than expected given the sparsity of reports describing this problem. In contrast to bitches, neutering and bodyweight were not associated with greater odds of urinary incontinence, which is important when giving neutering advice.
Full-text available
The objective of this retrospective study was to determine 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 body weight (BW)] 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 BW).
Full-text available
To compare the modalities of treatment for male hypogonadism available in Brazil. Thirty-two men with late-onset hypogonadism ('andropause') were followed-up in the Hospital de Guarnição de Florianópolis, in Florianópolis, south Brazil. Clinical diagnosis was established according to AMS questionnaire (positive if equal to or higher than 27 points), and laboratory diagnosis was made through low values of total testosterone (under 300 ng/dL) and/or free calculated testosterone (under 6.5 ng/dL). Patients were randomized to three non-enteral treatment groups (Deposteron--11 patients; Durateston--11 patients; and Nebido--10 patients). Clinically, Nebido seemed to be superior when compared to Deposteron (mean value of improvement percentage; p = 0.03) and when compared to Durateston (post-treatment average AMS score; p = 0.03). According to laboratory analysis, Nebido showed higher testosterone levels than Deposteron and Durateston (p < 0.001). All non-enteral testosterone formulas available in the Brazilian market are efficient in raising testosterone levels and in clinical improvement of hypogonadal patients. Nebido showed both a better clinical and laboratory effectiveness.
This prospective, cross-over, blinded study evaluated the effect of various doses of phenylpropanolamine (PPA) on blood pressure in dogs. Dogs were randomized to receive a placebo or 1 of 3 dosages of immediate release PPA, q12h for 7 days [1 mg/kg body weight (BW), 2 mg/kg BW, or 4 mg/kg BW] in a cross-over design. Blood pressure was recorded every 2 h, for 12 h, on days 1 and 7. There were significant increases in systolic, diastolic, and mean blood pressure following administration of PPA at 2 mg/kg BW and 4 mg/kg BW. A significant decrease in heart rate was also noted at all PPA dosages, but not in the placebo. Administration of PPA was associated with a dose response increase in blood pressure. Dosages of up to 2 mg/kg BW should be considered safe in healthy dogs.
Objective: To determine the prevalence of urinary incontinence in spayed female dogs and categorize affected dogs by age at time of ovariohysterectomy, number of litters prior to ovariohysterectomy, body weight, treatment of affected dogs, and severity of incontinence and to determine associations among these variables. Design: Retrospective case series. Animals: 566 ovariohysterectomized dogs. Procedures: An attempt was made to contact owners of 912 dogs ovariohysterectomized between January 2003 and January 2008 to discuss presence or absence of urinary incontinence. The actual number of responders was 566. Those owners with incontinent pets received a questionnaire further assessing degree of incontinence, diagnostic testing, treatment, and history. Results: The prevalence of acquired urinary incontinence was determined to be 5.12% (29/566 dogs) on the basis of results of phone surveys and questionnaires. There was no significant difference in the age at time of ovariohysterectomy between incontinent and continent groups. A significant association was found between body weight and incontinence, with incontinence rates higher among larger (≥ 15 kg [33.1 lb]) dogs. Larger dogs were approximately 7 times as likely (OR, 7.2 [95% confidence interval, 2.5 to 21.1]) to develop acquired urinary incontinence, compared with small dogs (< 15 kg). Conclusions and clinical relevance: Although acquired urinary incontinence in female dogs is known to be associated with ovariohysterectomy, the prevalence in this study was low.
To evaluate the safety and efficacy of an adjustable artificial urethral sphincter (AUS) in a population of dogs with acquired or congenital urinary incontinence. Case series. Dogs (n = 27) with naturally occurring urinary incontinence. Medical records (January 2009–July 2011) of dogs that had AUS implantation for treatment of urinary incontinence were reviewed and owners were interviewed by telephone to assess outcome. Continence was scored using a previously established analogue scale, with 1 representing constant leakage and 10 representing complete continence. Twenty-four female and 3 male dogs had AUS implantation. Causes of incontinence included urethral sphincter mechanism incompetence (n = 18), continued incontinence after ectopic ureter repair (6), and pelvic bladder (3). Medical therapy was unsuccessful in 25 dogs before AUS implantation. Surgery was performed without major complications in 25 dogs; 2 developed partial urethral obstruction after 5 and 9 months. Median (interquartile range) follow-up for the other 25 dogs was 12.5 (6–19) months. Continence scores were significantly improved (P < .0001) between the preoperative period (2 [1–4]) and last follow-up (9 [8–10]). Overall, 22 owners described themselves as very satisfied, 2 as satisfied, and 3 as unsatisfied. AUS implantation was successful in restoring continence in male and female dogs with both congenital and acquired urinary incontinence. Dogs that develop partial urethral obstruction may require AUS removal.
A modified technique for fixation of the deferent ducts to the abdominal wall as a therapy for urinary incontinence caused by urethral sphincter mechanism incompetence (USMI) in male dogs is described, and the results in seven dogs are reported. The goal of this treatment was to achieve an effect similar to colposuspension in female dogs with USMI. An increase in urethral length of an average of 28 mm was obtained (range, 5 to 50 mm, measured radiographically). Preoperatively, the neck of the bladder was located intrapelvically in five of seven dogs. Postoperatively, the neck of the bladder was located intra-abdominally, near the caudo-ventral abdominal wall, in all dogs. After a follow-up period of 12 to 49 months, the response to surgery, based on lack of or decrease of incontinence, was excellent in three dogs, good in another three, and poor in one dog.
The radiographs of 37 incontinent adult male dogs with urethral sphincter mechanism incompetence were compared with those of 28 control dogs to determine if, as in the bitch, differences in bladder neck position and urethral length were implicated in the pathophysiology of urethral sphincter mechanism incompetence. Bladder neck position was significantly different; compared with continent dogs, incontinent animals were significantly more likely (P < 0.005) to have intrapelvic than intra-abdominal bladder necks. However, after allowing for the influence of body size, and unlike the situation in the bitch, there was no significant difference in proximal urethral length between the two groups. Bladder neck position was significantly related to prostate size (P < 0.001) and it is suggested that this is one reason why castrated male dogs are more prone to urethral sphincter mechanism incompetence than entire animals. A logistic regression analysis revealed that both bladder neck position and castration status were significant risk factors for incontinence and that they appeared to be acting independently of each other.
Twenty-two dogs with urethral sphincter incompetence, nonresponsive to phenylpropanolamine administration, were treated by urethral submucosal injection of Teflon. Urinary continence was achieved in all dogs for at least 2 months. Urinary incontinence recurred in 14 dogs (64%) and was controlled by a second Teflon injection in 11 of 12 dogs (92%). Minor complications included transient stranguria, with or without hematuria, after 4 of 35 injection procedures. One dog had temporary partial urethral obstruction after treatment.
Serum testosterone and estradiol 17-beta concentrations, and serum testosterone-to-estradiol ratio were evaluated in 15 dogs (greater than or equal to 5 years old) with perineal hernia (9 sexually intact males and 6 castrated males) and in 9 clinically normal sexually intact male dogs greater than or equal to 5 years old. There was no significant difference in serum testosterone-to-estradiol ratio between sexually intact male dogs with perineal hernia and clinically normal sexually intact male dogs. In castrated dogs with perineal hernia, serum testosterone concentration and testosterone-to-estradiol ratio were significantly (P less than 0.05) lower, compared with those values in sexually intact dogs with perineal hernia and in clinically normal sexually intact male dogs. There was no significant difference in serum estradiol 17-beta concentration among sexually intact male dogs with perineal hernia, castrated dogs with perineal hernia, and clinically normal sexually intact male dogs. Serum testosterone and estradiol 17-beta concentrations in dogs with perineal hernia did not differ from those values in clinically normal male dogs of the same age. Castration cannot be recommended for the treatment of perineal hernia unless a castration-responsive contributing factor such as prostatomegaly is identified, unless the pelvic diaphragm of dogs with perineal hernia has high sensitivity to normal or low serum testosterone and estradiol 17-beta concentrations, or unless there is documentation that other androgens and/or estrogens are involved.