Papers and Articles

The Veterinary Record, April 8, 1995, Volume 136, Number 14, pages 345-349

Canine ureteral ectopia: an analysis of 175 cases and comparison of surgical

treatments
by P.E.Holt, A.Hotston Moore

URETERAL ectopia is an important cause of incontinence in both juvenile and adult dogs,
but to date there has been no comparison of the results of different surgical treatments in a
large series of cases. On p 345, Dr Peter Holt and Mr Alasdair Hotston Moore analyse 175
cases of ureteral ectopia. They found that of 112 cases that had been surgically treated by
ureteronephrectomy, or by extravesicular or intravesicular transplantations, 65 cases were
cured of incontinence and 26 were improved. The complication rate was similar for each
procedure, although hydronephrosis occurred most commonly after extravesicular
transplantation and dysuria occurred most commonly after intravesicular transplantation.

· The case histories of 175 dogs with ureteral ectopia were reviewed, there were 156 females and
19 males. Golden retrievers, Labrador retrievers and Skye terriers appeared to be over-
represented. Their median age when examined was 10 months, and the males were significantly
older than the females. Fifty-six animals were affected bilaterally, 50 were affected on the left side
alone and 69 on the right side alone. One hundred and twenty-two cases had other abnormalities
and 67 had more than one; they included hydro-ureter, hydronephrosis, pyelonephritis, bladder
hypoplasia and congenital incompetence of the urethral sphincter mechanism. Forty-one cases
were not treated, and the other 134 were treated by ureteronephrectomy, extravesicular ureteric
transplantation or intravesicular ureteric transplantation. One hundred and twelve cases were
available for follow-up for a median period of over two years (range one month to 15 years). The
response to surgery and the incidence of complications was similar after each method of
treatment. Sixty-five of the 112 cases were cured of incontinence and 26 were improved. The
complication rate (14 per cent overall) was similar for each procedure although different types of
complications occurred. Hydronephrosis occurred most commonly after extravesicular
transplantation and dysuria occurred most commonly after intravesicular transplantation.

URETERAL ectopia is a rare condition in the dog (Smith and others 1981) but is the commonest
cause of incontinence in juvenile dogs (Holt 1990). It is also an important cause of incontinence in
the adult dog (Holt 1990). The embryological origin of the anomaly has been reviewed by Owen
(1973a) and Dean and others (1988). A North American study (Hayes 1984) reported a greater
incidence in the female and in certain breeds, particularly the Siberian husky, Newfoundland, bulldog,
West Highland white terrier, fox terrier and miniature and toy poodles. Several surgical treatments
have been described (Robins and Presnell 1974, Dingwall and others 1976, Rawlings 1984, Waldron
and others 1987), including various methods of ureteral transplantation and ureteronephrectomy. The
results of the treatment of small numbers of cases (ranging from seven to 25) have been published
(Dingwall and others 1976, Smith and others 1981, Holt and others 1982, Stone and Mason 1990,
McLaughlin and Miller 1991) but there has been no comparison of the results of different methods of
surgical treatment in a large series of cases. Similarly, an extensive case analysis of a significant
number of affected animals has not been published. This paper presents a retrospective analysis of
175 cases of ureteral ectopia and their response to different methods of surgical treatment.

Materials and methods

The materials were the case records and radiographs of 175 dogs examined between 1972 and 1993,
in which a diagnosis of ureteral ectopia had been made; they included 29 cases reported previously
(Holt and others 1982). One hundred and seventy-four animals with urinary incontinence were
examined and a single male dog was treated for an intra-abdominal mass (subsequently identified as a
hydronephrotic kidney). In each case the investigations included intravenous urography, vagino-
urethrography (females) or urethrocystography (males) and urinalysis, including bacteriology. The
later stages of intravenous urography and all the retrograde studies were done fluoroscopically.
Information about the breed, age, sex, site of termination of the ectopic ureters, other abnormalities.
the method of treatment and postoperative complications was extracted from the records. The
owners were contacted by postal questionnaire (Fig 1) and/or telephone inquiry and were asked
about the animal's progress, particularly with regard to persistent or recurrent incontinence. Using
this information, the result of the procedure was assessed as good (resolution of incontinence), fair
(continence improved but not resolved) or poor (no improvement in continence or the occurrence of
complications resulting in death, euthanasia or a second procedure). A follow-up examination
including intravenous urography was made in seven cases not requiring further surgery and in most
of the dogs affected bilaterally, before the transplantation of the second ureter in cases in which the
transplantations were carried out on separate occasions. The data were analysed statistically by using
a computer-based statistical package (Minitab; Minitab). The ages at which the male and female dogs
were presented were compared by the Mann-Whitney test. The relationship between the side and site
of termination of the ectopic ureters was analysed by the X 2 test. X2 analysis were also used to
compare the results and complication rates following different methods of treatment and, in bitches,
to determine whether suspected incompetence of the urethral sphincter mechanism affected the
outcome.

RESULTS

BREED

Thirty-one breeds were represented (Table 1). No reference hospital population was available for
comparison, but three breeds were considered to be over-represented: Labrador retriever 5 cases),
golden retriever (44 cases) and Skye terrier (13 cases).

AGE

The age of the dogs at presentation was recorded in 174 cases and varied from six weeks to nine
years, with a median of 10 months. Female dogs were significantly younger (median age 10 months)
than male dogs (median age 24 months) (P<0.05).

SEX

There were 156 female dogs and only l9 male dogs.

Side and site of termination of ectopic ureters

Fifty-six animals were affected bilaterally, 50 were affected on the right side alone and 69 were
affected on the left side alone.

In all the male dogs the ectopic ureter opened into the prostatic urethra. In the female dogs, the
ureter terminated in the urethra in 183 cases and in the vagina in 15 cases; the site of termination was
not recorded in five cases. In bitches there was no significant relationship between the side of ectopia
(right or left) and the site of termination (Table 2) (P>0.05). The ectopic ureter of one animal had
double ureteral openings (one in the bladder and the other in the urethra) and another bitch affected
bilaterally had ureteral troughs (Stone and Mason 1990). The remainder had single ureteral orifices
and the ureters were intramural in course.

Other abnormalities

Other abnormalities were present in 122 of the animals, and 67 of these had more than one, giving a
total of 220 abnormalities (Table 3) of which hydro-ureter either alone or in combination with
hydronephrosis was the most frequent. Other common abnormalities included pyelonephritis (as
judged by contrast radiography, pyuria/bacteruria and in some cases histopathology) bladder
hypoplasia (as assessed subjectively from contrast radiography) and the presence of an intrapelvic
bladder neck associated with a short urethra. The latter combination was taken to suggest a
provisional diagnosis of incompetence of the urethral sphincter mechanism (Holt 1985).

Methods and results of treatment

Forty-one animals were not treated. The remaining animals were treated by one of two methods of
ureteral transplantation and/or ureteronephrectomy. An extravesicular transplantation procedure
(tunnelling technique) was used in 49 cases, using the method of Robins and Presnell (1974). An
intravesicular transplantation procedure (stomatisation technique) was used in 44 cases. The method
was similar to that described by Rawlings (1984) except that a single ligature of number 0 chromic
catgut was used to ligate the ureter distal to the stoma. These two techniques are summarised in Fig
2. Ureteronephrectomy alone was carried out in 36 cases, including animals in which
ureteronephrectomy was used to revise a ureteric transplantation. In 11 other animals with bilateral
ectopia, only one ureter was treated surgically: in seven animals by extravesicular transplantation, in
three animals by intravesicular stomatisation and in the remaining case by ureteronephrectomy. In
one further animal, which had bilateral ectopia, one ureter was transplanted by the extravesicular
technique and the other by the intravesicular technique.

One hundred and twelve cases were available with postoperative follow-up periods varying from one
month to 15 years (median two years four months). In animals that underwent a revisionary
procedure, the follow-up period was that after the latest operation. Sixty-five animals (58 per cent)
were cured by surgery, 26 (23 per cent) were still incontinent but significantly less so and the degree
of incontinence was unchanged in the remaining 21 (19 per cent). The results are summarised in
Table 4. A statistical analysis of the results in groups 1, 2 and 3 (Table 4) revealed no overall
difference between the methods of treatment. When the bitches, either with or without suspected
incompetence of the urethral sphincter mechanism, were analysed separately (Table 5), there was no
significant difference between the outcome of surgery in the two groups (P>O.05).

Postoperative complications

Complications (other than continuing or recurrent incontinence) occurred after 18 of the total of 143
surgical procedures, including bilateral cases, revisionary procedures and dogs which could not be
followed up for one month or longer after surgery. One dog suffered two complications after one
procedure, resulting in a total of 19 complications (Table 6). Postoperative complications associated
with ureteronephrectomy occurred in only two cases, in one dog, hydronephrosis developed in the
remaining kidney, resulting in renal failure and necessitating euthanasia; in the other
ureteronephrectomy was used to revise a previous extravesicular transplantation in which a pre-
operative urinary tract infection persisted and hydronephrosis developed, the infection was not
eliminated, despite appropriate antibacterial therapy, and resulted in renal failure; this animal was also
euthanased.
After the extravesicular technique, hydronephrosis requiring a second procedure
(ureteronephrectomy) was the commonest complication and occurred in four cases (Fig 3).

After the intravesicular technique, dysuria was the commonest complication (six cases). In two
mildly affected dogs it resolved spontaneously within seven days; the remaining four animals were
fitted with an indwelling urethral catheter for between three and 12 days, and all of them urinated
normally after the catheter was removed.

Further details of the complications are listed in Table 6. There were no statistically significant
differences between the rates of incidence of complications between the two transplantation
techniques. However, there were significantly more complications after ureteral transplantation than
after ureteronephrectomy (P<0.05).

Follow-up radiography

Radiographic investigations were repeated in 19 animals after a total of 20 ureteral transplantations,

including seven animals with bilateral ureteral ectopia in which each ureter was treated on separate
occasions, one animal in which hydronephrosis developed shortly after extravesicular transplantation
and 11 others. The last group included animals in which further investigations were made for
continued incontinence or in which a repeated investigation was suggested at the time of the initial
surgery. In the group investigated for continued incontinence, there were three animals which were
initially believed to have unilateral ectopia and were treated by extravesicular transplantation, but in
each case, ectopia of the contralateral ureter was found on a subsequent investigation.

After extravesicular transplantation, intravenous urography revealed that the ureteral dilation had
become worse (Fig 3) in eight of the 16 ureters treated, was unchanged in twelve (including three
that had not been dilated preoperatively) and had improved in three. After intravesicular
transplantation, the degree of hydroureter was reduced in two of the four ureters treated and was
unchanged in the other two, one of which had not been dilated preoperatively.

Discussion

Ureteral ectopia is a rare condition in the dog (Smith and others 1981) but is the commonest cause
of urinary incontinence in juvenile dogs and accounted for 115 of 221 juvenile animals with urinary
incontinence (Holt 1990). In the same series ureteral ectopia was present in only 18 of 342
incontinent adult dogs. Despite the relative importance of the condition as a cause of incontinence in
young dogs, no comparison of the results of different surgical treatments has been reported in a large
number of cases.

The embryological origin of the anomaly has been discussed by Owen (1973a) and Dean and others
(1988). Abnormalities of the development of the metanephric duct result in the termination of the
ureter in sites other than the trigone of the bladder. The terminal ureter may be within the bladder
wall (intramural) or separated from the bladder wall (extramural) and discharge into the urethra, the
vagina or the uterus. In the animals described here, all the ectopic ureters were intramural in course,
suggesting that extramural ectopia, as reported previously (Singer 1959, Lapish 1985, Mason and
others 1990) is rare in dogs. Extramural ectopia appears to be more common in cats (Holt and Gibbs
1992). In a review of 36 cases reported in the literature, Owen (1973a) found that the vagina was the
commonest site of termination for ectopic ureters, but in the present larger series the urethra was the
site of termination in 183 cases and the vagina in only 15 of the cases in bitches (Table 2). In male
dogs all the ectopic ureters terminated in the prostatic urethra, although the vas deferens and the
seminal vesicles are possible sites of termination (Dean and others 1988). Previous reports have
recorded the presence of ureteral troughs, double ureteral openings and ectopic ureters without
distal orifices (Smith and others 1981, Dean and others 1988, Stone and Mason 1990). A single
ectopic ureter with a double ureteral opening was found in the present series and was attributed to
preoperative rupture of an ureterocoele, but, apart from an animal with bilateral ureteral troughs, the
other reported anomalies were not observed.

Hayes (1984) reviewed the breed incidence of ureteral ectopia in North America. The Siberian husky,
Newfoundland, bulldog, West Highland white terrier, fox terrier and miniature and toy poodle breeds
were found to be over-represented and mixed breed dogs were under-represented. In the present
series a different spectrum of affected breeds was found (Table 1). Although it was not possible to
compare the breed representation with a hospital population, the breeds reported by Hayes (1984) as
being at particular risk did not appear to be over-represented in this series from the United Kingdom.
However, the Labrador retriever, golden retriever and Skye terrier did appear to be over-represented
while mixed breed dogs may have been under-represented. There was also a difference between the
breed incidence of urinary incontinence due to ureteral ectopia and to incompetence of the urethral
sphincter mechanism, which is the commonest cause of urinary incontinence in adult dogs and the
second commonest in juveniles (Holt 1990). Holt and Thrusfield (1993) showed that the old English
sheepdog, rottweiler, Doberman pinscher, weimaraner and Irish setter were at high risk for the
development of acquired incompetence of the urethral sphincter mechanism and the Labrador
retriever was at low risk. This apparent difference in breed incidence between the causes of urinary
incontinence, although not absolute, may serve as a guide during differential diagnosis of the
condition.

The marked preponderance of females in the present series is consistent with that reported
previously (Hayes 1994). The reason why male dogs with ureteral ectopia are older at the time of
diagnosis than females is not clear. It may be due to the longer urethra of male dogs and a more
efficient sphincter mechanism (compared with bitches) and hence a delay in the development of
incontinence until urethral tone declines with age. Although the majority of the animals were juvenile
when they were first examined, some adult animals were included. It was apparent from the history
of these animals that incontinence had developed in adult life, rather than that the owners had
delayed investigation. The oldest (male) animal was nine years old when clinical signs appeared and
the condition was diagnosed. Ureteral ectopia must be considered in the differential diagnosis of
urinary incontinence in dogs of all ages.

The high incidence of other urological abnormalities is consistent with previous reports. Hydro-
ureter is commonly reported together with ureteral ectopia (Smith and others 1981, Holt and others
1982, Lapish 1985, Dean and others 1988, Mason and others 1990, Ross and Lamb 1990). These
authors also reported hydronephrosis, the absence of, or morphological abnormalities of, the kidney,
bladder hypoplasia and the intrapelvic location of the bladder. The cause of these abnormalities is not
always apparent. Hydro-ureter may result from the partial obstruction of the distal ureter owing to
its abnormally long intramural course. Abnormal ureteral peristalsis and ascending infection may also
play a part in the development of hydro-ureter. Hydronephrosis may result from the same processes
that result in hydro-ureter. Pyelonephritis is believed to be due to ascending infections and a change
in ureteral function may be a predisposing factor. The diagnosis of bladder hypoplasia was based on a
subjective assessment of the size of the bladder during excretory urography. This may result from a
failure of the bladder to grow, owing to insufficient filling by urine.

The radiographic finding in a bitch of an intrapelvic bladder neck and a urethra which was shorter
than would be expected, was taken to indicate the possibility of incompetence of the urethral
sphincter mechanism (Holt 1985). Urethral pressure profilometry has been proposed as an aid to the
diagnosis of this condition (Richter and Ling 1985, Holt 1988), but in animals with ureteral ectopia
the procedure may be hazardous and prone to artifact since urethral catheters in these animals
sometimes pass into the urethral orifice of the ectopic ureters (Holt and others 1982, Rigg and others
1983). In addition, there are no 'normal' values for profilometry measurements in animals with
ureteral ectopia which do not have incompetence of the sphincter mechanism. For these reasons the
technique was not used in these cases.

Radiographic examinations were not repeated routinely after surgery and this may have led to an
underestimation of the number of postoperative complications. A re-examination was not considered
to be justified in most cases, because of the need for the dog to return and to have a further general
anaesthetic. However, repeated intravenous urography in 19 cases confirmed the findings of
Chambers and others (1987), Mason and others (1990) and Ross and Lamb (1990), that successful
corrective surgery of ureteral abnormalities, including ureteral ectopia, can lead to an improvement
or the reversal of hydroureter. In the present series, such an improvement appeared to be less likely
after extravesicular rather than after intravesicular transplantation.

The overall response to treatment in this series was similar to that found in previous studies of
smaller numbers of animals (Owen 1973b, Robins and Presnell 1974, Dingwall and others 1976, Holt
and others 1982, Rigg and others 1983, Dean and others 1988, Stone and Mason 1990, McLaughlin
and Miller 1991).

The results confirm that continuing or recurrent urinary incontinence is a common result of surgical
treatment for ureteral ectopia. The surgical methods used had no demonstrable effect on the
incidence of postoperative incontinence. The authors had formed the subjective opinion that the
presence of suspected incompetence of the urethral sphincter mechanism in bitches with ureteral
ectopia adversely affected the outcome of treatment. However, the results demonstrated that the
radiographic assessment of the length of the urethra and the position of the bladder appeared to be of
no value in predicting the resolution of the incontinence. These results could be biased, however,
because the owners of animals with very short urethras may have been given a poorer prognosis and
declined surgery. These animals would therefore have been excluded from this analysis.

In some of the animals affected bilaterally with ureteral ectopia, in which only one ureter was
surgically treated, the urinary incontinence often improved or resolved. The reason for this outcome
is unclear, but demonstrates that some animals can regain continence despite the presence of an
ectopic ureter.

This series provides a useful basis for a comparison of the complications which may occur after the
surgical treatment of ureteral ectopia. Fewer complications occurred after ureteronephrectomy than
after ureteral transplantation, although it is generally considered preferable to salvage a viable kidney
by ureteral transplantation. Clearly, this is the only option for at least one of the kidneys in animals
affected bilaterally and in dogs which have only one kidney. The complication rates were similar after
both methods of ureteral transplantation, although the types of complication varied. The commonest
complication after extravesicular transplantation was hydronephrosis, which required
ureteronephrectomy as a revisionary procedure. After intravesicular transplantation (stomatisation),
postoperative dysuria was the commonest complication. The dysuria was probably due to surgical
trauma in the region of the bladder neck, resulting in oedematous swelling and obstruction and
possibly dyssynergia. In all cases this problem resolved spontaneously and no further surgery was
necessary. These results suggest that the complications after intravesicular transplantation are less
serious than those resulting from extravesicular transplantation, and, for this reason, the former
procedure is preferred.
Postoperative infection of the urinary tract was an uncommon but serious complication (Table 6). It
is believed to have been an exacerbation of a pre-existing bacteriuria and emphasises the importance
of preoperative bacteriological examinations of urine and appropriate treatment to eliminate any
infection before surgery. The authors recommend that, whenever possible, radiographic
investigations and laboratory investigations of urine are carried out before the planned surgery, so
that any infection can be treated appropriately and the urine culture repeated to confirm that it has
been eliminated.
===================

The Veterinary Record (1995) 136, 350-353

Feline dystocia: prevalence, and association with cranial conformation and breed
by D.A.Gunn-Moore, M.V.Thrusfield
----------------------
FELINE dystocia is a major cause of stillbirth and early infant death. However, information on the
prevalence of the condition is limited and on p 350, Mrs Danielle Gunn-Moore and Dr Michael
Thrusfield report the results of a questionnaire survey sent to cat breeders in England and Scotland.
Problems during parturition were reported in 5.8 per cent of cases with relatively few problems in
breeds with conventional-shaped heads, but a significantly higher incidence of problems in breeds
with long narrow or short wide heads. The authors point out that feline dystocia appears to occur
more frequently than some reports would suggest.
----------------------------

The litter prevalence of feline dystocia was investigated using a questionnaire survey of cat breeders.
Information was obtained on 2928 litters, from 735 queens. Dystocia was reported to have occurred
in 5.8 per cent of litters. The level of dystocia in individual breeds ranged from 0.4 per cent of litters
born in a large colony of cats of mixed breeding, to 18.2 per cent of litters in the Devon rex.
Pedigree litters were at significantly higher risk than litters of cats of mixed breeding (odds ratio:
22.6). Relatively high levels of dystocia were identified in Siamese-type, Persian and Devon rex
litters, whereas cats of mixed breeding showed a relatively low litter prevalence. Dolicocephalic and
brachycephalic types were found to have significantly higher levels of dystocia than mesocephalic
cats.

DYSTOCIA (difficult birth) and prolonged parturition are important causes of stillbirth and early
neonatal death (Prescott 1973, Povey 1978, Arthur and others 1989). The conditions are a great
source of distress, both to affected breeding queens and their owners. In recent years much attention
has been focused on the nature of dystocia in dogs (Bennett 1974, Gaudet 1985, Johnston and Raksil
1987, Darvelid and Linde-Forsberg 1994), with Zaldivar (1967) reporting 4.8 per cent of colonial
beagles affected. Far less attention, however, has been given to the condition in cats. There are some
individual case reports of feline dystocia (Corner 1974, Wilkinson 1974, Appleyard and Shelley
1975, McAfee 1979, Freeman 1988, Montgomery and others 1989), and a series of 155 cases has
recently been reported (Ekstrand and Linde-Forsberg 1994). Some authors have suggested that
dystocia occurs rarely in the cat (Colby and Stein 1983, Gruffydd-Jones 1988), while others believe
that the condition is not uncommon (Arthur and others 1989, Ekstrand and Linde-Forsberg 1994).
Humphreys (1974) reported 134 cases of dystocia in 4077 cats, occurring over approximately five
years, but the author gave no information on the number of litters born per cat, nor the types of cat
involved.

It appears that overall morbidity values for feline dystocia have not been determined yet, either for
individual breeds or for cats in general. However, some authors have suggested that pedigree cats
may experience dystocia morc common@y than non-pedigree cats Povey 1978, Colby and Stein
1983, Laliberte 1986). Prescott 1973) suggested that the broad, flat face of the Persian may
predispose to dystocia, and Ekstrand and Linde-Forsberg (1994) found a disproportionately high
number of Persians in their study of 155 cats with dystocia. They also found disproportionately low
numbers of Norwegian forest cats (which have a mesocephalic head shape).

Dystocia can be classified as either maternal or fetal in origin depending on whether it is caused by
problems with the queen or with the kittens. Dystocia can also be classified according to whether it
arises from obstruction of the birth canal or a functional deficiency of the myometrium (Laliberte
1986). Obstructive dystocia is caused by disproportion between the kittens and the maternal birth
canal. Factors resulting in an inadequate size of the maternal birth canal may include disorders of the
maternal skeleton, the pelvic soft tissues, or the uterus itself (Bennett 1974, Egger 1978, Donovan
1980, McIntire and Waugh 1981, Lacalandra 1985, Laliberte 1986, Freeman 1988, Montgomery and
others 1989). Fetal causes of obstructive dystocia may result from malpresentation, severe fetal
malformation, fetal oversize or fetal death (Stein 1980, Mosier 1989, Ekstrand and Linde-Forsberg
1994). Some authors believe that fetal malpresentation in cats rarely causes dystocia, except when
combined with other problems such as poor cervical relaxation or relative fetal oversize (Laliberte
1986). However, Ekstrand and Linde-Forsberg (1994) reported fetal malpresentation as the most
common cause of dystocia of fetal origin, while relative fetal oversize was reported to have caused
dystocia in less than 2 per cent of cases.

Functional dystocia is usually termed inertia, and can be either primary or secondary. Primary inertia
is by far the most common cause of dystocia in cats (Laliberte 1986, Gruffydd-Jones 1988, Ekstrand
and Linde-Forsberg 1994). It is seen when the myometrium produces only weak, infrequent
contractions and there is a failure of expulsion of normal kittens through a normal birth canal.
Primary inertia may be related to stress, old age, obesity or ill health (Colby and Stein 1983, Feldman
and Nelson 1987, Johnson 1989, Mosier 1989). It has been suggested that very small or very large
litters may result, respectively, in inadequate or excessive uterine distension, and that this may
possibly result in primary inertia (Lacalandra 1985, Laliberte 1986, Mosier 1989). However,
Ekstrand and Linde-Forsberg (1994) did not find a statistically significant difference between the
litter size of cats with dystocia due to primary inertia and the litter size of cats with dystocia for other
reasons.

All forms of dystocia increase the risk of fetal death by anoxia (Bennett 1974, Johnson 1989, Mosier
1989), while the presence of a dead fetus within the maternal pelvic canal can, in itself, result in
functional or obstructive dystocia (Donovan 1980, Gaudet 1985, Ekstrand and Linde-Forsberg
1994). Secondary inertia arises after prolonged tertiary-stage labour, and may be associated with
obstructive dystocia, muscle fatigue, or excessive pain (Mosier 1989).

The aim of this study was to determine the prevalence of feline dystocia, and to assess whether the
prevalence may be different for different breeds of cats, and for cats with different cranial
conformation.

Materials and methods

Cat breeders, selected by convenience sampling at several cat shows in Scotland, were asked to
complete a questionnaire relating to normal and abnormal births. The same questionnaire was also
sent to breeders in England, while other English breeders were questioned by telephone. Inforrnation
relating to a large laboratory colony of domestic shorthair and mixed breed cats was also obtained.
The colony had been maintained for many years with no breed selection for 'type', and cats that
experienced dystocia were not kept for further breeding.
The survey questions were:

(1) From what breeds do you breed? Breeders were then asked to answer the following questions for
each breed separately:

(2) From how many queens have you bred in total? -to determine the size of information 'pool', and
the experience of the breeder.

(3) How many litters of kittens have you bred in total? -This gave the sample size of litters in which
problem births occurred.

(4) Have any of your queens experienced dystocia and, if so, how many litters have been affected? -
to deterrnine the litter prevalence of dystocia.

(5) Was the dystocia corrected medically or surgically? Please state the cause of the dystocia, if
known.

The cats were divided into groups on the basis of breed, and the hypothesis that dystocia is related to
body type was tested. To investigate whether head shape could be a significant factor in feline
dystocia, cats were then grouped on the basis of cranial conformation: brachycephalic (Persian,
British shorthair and Devon rex), mesocephalic (colony cats of mixed breeding, Abyssinian, Burmese
and Manx), and dolicocephalic (Siamese-type and Cornish rex). (Burmese are classified differently in
some countries because of regional phenotypic variation.)

The prevalence of dystocia in litters of each group of cats was calculated with 95 per cent confidence
intervals, using the normal approximation to the binomial distribution (Gardner and Altman 1989)
where groups were large enough (n P>10 and n (1-P)>10; where n = sample size, and P = estimated
prevalence). When these caveats were invalid, exact confidence intervals were computed from
binomial tables (Beyer 1968). Tables based on the Poisson distribution (Haenszel and others 1962)
were used to calculate confidence intervals for the laboratory cats because the prevalence of dystocia
was very low. The significance of the differences in observed proportions was assessed using the x2
test interpreted at the 5 per cent level, and was supported by breed-specific point and interval
estimates of prevalence. The magnitude of association in 2 x 2 tables was expressed as the odds ratio
with its exact 95 per cent confidence interval (Mehta and others 1985).

Results

The number of queens and litters are presented in Table 1. Table 2 lists the number and percentage of
litters with dystocia, by breed, with associated 95 per cent confidence intervals. Dystocia occurred in
5.8 per cent of litters born overall (95 per cent confidence interval: 5.0, 6.6). There was a significant
difference in the litter prevalence of dystocia according to breed (P<0.001). The risk of dystocia in
pedigree cats was significantly higher than in the colony cats of mixed breeding, the odds ratio of the
former relative to the latter being 22.6 (95 per cent confidence interval: 7.6, 111.0). The breed-
specific point and interval estimates of litter prevalence show a relatively high prevalence in Siamese-
type, Persian and Devon rex litters, whereas colony cats had a relatively low level of dystocia. The
point estimates of breed-specific odds ratios, relative to colony cats, support this conclusion.
However, these estimates are imprecise because of the small sample sizes and resultant wide
confidence intervals.

Results comparing dolicocephalic, brachycephalic and mesocephalic cats are summarised in Table 3.
Cranial conformation was significantly associated with litter prevalence of dystocia (P<0.001).
Dystocia was more prevalent in the dolicocephalic and brachycephalic litters than the mesocephalic
litters: the first two groups demonstrated prevalences of 10.0 per cent and 7.3 per cent, respectively
(95 per cent confidence intervals: 7.5, 12.5; and 5.6, 8.6, respectively); whereas the third group
experienced dystocia in only 2.3 per cent of litters (95 per cent confidence interval: 1.5, 3.1).
However, the observed difference between the dolicocephalic and brachycephalic cats was not
significant (P=0.062); this conclusion is supported by the interval estimates of litter prevalence.

Table 3 also shows whether the dystocia was corrected medically or surgically. In the mesocephalic
cats, 39 per cent of the cases were resolved by non-surgical methods. However, these methods were
rarely successful in the other groups, and surgical intervention was needed in over threequarters of
the cases.

The reported causes of dystocia, and the frequency with which each cause had been noted, are listed
in Table 4. Malpresentation and primary inertia were the main problems reported in the
brachycephalic cats. Primary inertia was the major reported cause of dystocia in the dolicocephalic
cats.

Discussion

Dystocia was found to have affected 5 @ per ccnt of all litters born. However, the percentage of
affected litters varied widely between specific groups. To attempt to determine why this was the
case, the reasons reported to have caused dystocia, and the frequency with which each reason was
recorded, were examined.

The brachycephalic cats experienced dystocia in 7.3 per cent of their litters. Primary inertia and
malpresentation were the main problems reported. In dogs, gestation of a small number of pups has
been associated with primary inertia (Donovan 1980, Gaudet 1985, Arthur and others 1989, Darvelid
and Linde-Forsberg 1994), and it has been suggested that this may also occur in cats (Arthur and
others 1989). Previous studies have shown that Persian cats (which are brachycephalic) may have a
predisposition to having smaller litters (Prescott 1973, Povey 1978). Very small litters may result in a
lack of fetal input into parturition, which may cause primary inertia or prolonged gestation (Donovan
1980). Prolonged gestation may in tum result in oversized kittens (Arthur and others 1989).
Excessively large kittens have an increased risk of incurring dystocia via malpresentation, because
they may become wedged in the pelvic canal at a site where a similarly presented small kitten could
pass. Against this hypothesis are the recent results from Ekstrand and Linde-Forsberg (1994), which
showed that litter size was not significantly different between cats experiencing primary inertia and
those with dystocia for other reasons. However, these authors did not compare litter sizes between
cats with dystocia due to malpresentation and cats with other forrns of dystocia. Malpresentation in
brachycephalic cats may also relate directly to their flattened head shape (Prescott 1973, Laliberte
1986), possibly because they lack the wedge effect of the nose which is believed to be necessary for
engagement with the maternal pelvis and to stimulate cervical dilation (Mosier 1989).

The dolicocephalic cats experienced dystocia in 10.0 per cent of their litters, with primary inertia
being the major reported cause. Primary inertia can have many causes but it is unclear why this group
should be more susceptible than others. It has been suggested that this could relate to large litter
sizes seen in some Siamese-type cats (Povey 1978) where the inertia may be caused by excessive
uterine distension (Laliberte 1986, Mosier 1989). The counter argument to this has been discussed
above. A hereditary tendency to primary inertia has been postulated (Laliberte 1986). Intrapelvic
kitten entrapment was the second most commonly reported cause of dystocia in the dolicocephalic
cats, although the cause was generally unclear. Primary inertia and intrapelvic kitten entrapment do
not appear to relate specifically to the dolicocephalic head shape; they may, however, be associated
with other physical or behavioural characteristics of this breed type.

Mesocephalic cats experienced the least problems, with dystocia affecting only 2.3 per cent of their
kittens. This low value is explained by the large proportion of colonial laboratory cats in the survey.
Although this group may not accurately reflect normal pet cats of mixed breeding, its inclusion was
valuable. It showed how low a level of dystocia may be obtained if cats are not selectively bred for
'type', and if those cats that experience dystocia are not kept for further breeding. The very low level
of dystocia in these cats may also have been influenced by other factors, such as minimal interference
during gestation and parturition, the lack of infectious diseases, and breeding from multiparous
queens. It is therefore not known whether the same low level of dystocia could be expected in the
general domestic short- and long-haired pet cat population.

Treatment of dystocia may involve conservative management (physical manipulation, oxytocin or

calcium administration), or surgical intervention (caesarean section). Ekstrand and Linde-Forsberg
(1994) reported that only 20 per cent of their cases of feline dystocia could be resolved by medical
treatment alone. However, their population was biased towards cases being sufficiently severe to
require veterinary attention, and hence more likely to require surgery. In the current study7 26 per
cent of the cases were resolved without surgical intervention. Taking the three main groups
separately, the mesocephalic cats were found to be the least likely to need surgical intervention,
because 39 per cent were successfully managed medically. This compared with 23 per cent and 24
per cent success rates in medical management for the brachycephalic and dolicocephalic cats,
respectively.

Previous studies have involved single case reports or occasional series of cases of feline dystocia, but
none has collected information on large numbers of normal and abnormal births. In this study, the
large laboratory-maintained cat colony provided information relating to a selected population of non-
pedigree cats, while questioning cat breeders was considered to be one of the few practical methods
of collecting sufficient information on pedigree cats. Some degree of recall bias may have occurred
with the latter group, because breeders had to rely on their memory. They could all recall how many
litters each of their queens has produced, and the few (if any) occasions on which their queens had
experienced dystocia. However, many breeders could not recall accurately the total number of
kittens born in each litter, and so, while this information would have been useful when interpreting
possible causes of dystocia, it was considered that this could not be included in the questionnaire.
Breeders varied in the time over which they had been breeding cats, with the majority having been
breeding for a few years, and only a few for over 15 years. None of these long term breeders
reported a change in the incidence of dystocia in their cats. None of the breeders bred from more
than one type of cat (as defined by cranial conformation), which meant that it was not possible
directly to compare the groups under similar conditions of management.

Age and litter size may be confounding factors, particularly in relation to primary inertia (Colby and
Stein 1983, Lacalandra 1985, Laliberte 1986, Mosier 1989). However, Ekstrand and Linde-Forsberg
(1994) showed that litter size was not related to the risk of developing dystocia. The same study
found that two thirds of cats presenting with dystocia were aged between two and three years, an
age range not dissimilar to that of the general breeding cat population (Povey 1978). Moreover,
respondents could not recall accurately either the ages of their cats when dystocia occurred, or the
size of the affected litter; exclusion of these factors from a more detailed stratified analysis was
therefore deemed prudent.
In summary, this current study showed that, far from being an uncommon condition, feline dystocia
occurres frequently. It also demonstrated that purebred brachycephalic or dolicocephalic cats are
more likely to experience dystocia than cats with the more natural mesocephalic head shape.
===========================

The Veterinary Record (1995) 136, 353-355

A cluster of cases of feline dysautonomia (Key-Gaskell syndrome) in a closed

colony of cats
by H.W.Symonds, P.McWilliams, H.Thompson, A.Nash, S.Sanchez, N.Rozengurt

Twenty-five cases of feline dysautonomia (Key-Gaskell syndrome) occurred in a closed cat colony
over a period of three weeks. The clinical and pathological signs were sufficiently similar to those
reported during the 1982-1986 outbreak to establish a posiffve diagnosis. The special
epidemiological and environmental circumstances of the outbreak provide a new insight into the
cause(s) of the syndrome.

FELINE dysautonomia, a disease characterised by extensive degeneration of the autonomic nervous

system, was first reported in 1982 (Key and Gaskell 1982). The disease was seen in practices
throughout the United Kingdom between 1982 and 1986, and studies of the condition were
published during this period (Ruben 1983, Rochlitz 1984, Sharp and others 1984). The numbers of
cases have since declined (Edney and Gaskell 1988, Fry 1988). Early in 1994 two suspected cases
were reported (Patterson 1944) but they were not confirmed by a histological examination of the
autonomic ganglia. In November 1993 a cluster of clinical cases occurred in a large breeding colony
of cats (Nash and others 1994) and this paper describes the outbreak in detail.

Case history

The outbreak occurred in a closed cat breeding colony which had no contact with other cats. About
100 animals were kept in nine rooms, four of which held stock males and females separately. Kittens
were weaned from the breeding rooms at eight weeks of age, given a course of vaccination with
Felocell CVR (SmithKline Beecham) and Katavac (Solvay-Duphar Veterinary), and moved to single-
sex stock rooms. All the cats were looked after by one technician who kept no pet cats, dealt with no
other animals, and showered and changed clothing each day before entering the unit. There were no
banier systems between the rooms within the unit but access to them was restricted to a few people
who took showers before entering them. Cats would occasionally escape into the corridor when the
doors were opened.

Before the outbreak, the health record of the colony had been excellent. It was screened at intervals
of three months for the presence of arthropods, intestinal helminths and protozoa, including
Toxoplasma gondii, dermatophytes, salmonella and Bordetella bronchiseptica and tested
serologically for feline leukaemia virus, feline infectious peritonitis virus and feline immunodeficiency
virus. The results of all these tests had been negative for the previous two years.

The cats were fed tinned meat (Premium Cat Food, Kennelpack) which consisted largely of textured
vegetable protein with either lamb, beef, rabbit or occasionally salmon flavouring. It was
manufactured by one supplier of cat food but the tins were not necessarily all from the same batch.
The cats were fed one 12 ounce tin per three cats in the morning and small biscuits (Special Diet
Services) ad libitum in the afternoon. Water was available ad libitum. A new batch of tinned food was
started three days after the first clinical case was observed. The batch of biscuits had been started at
least a month before the outbreak started, and the same batches of food were used until well after the
outbreak had subsided.

The clinical outbreak lasted for 22 days. Twenty-five cats were affected, all under eight months of
age except for one 15-month-old breeding tom and a 22-month-old breeding queen. The tom cat was
the first to be affected. It was followed by five stock males, then five stock females and the queen
followed by two more stock males which fell ill on day 14 of the outbreak. The two last cases were a
six-week-old kitten and a four-week-old kitten, both of which had been eating some solid food for
about a week; the youngest kitten had been fostered to the affected queen before it developed
clinical signs. During the course of the outbreak, a further 15 cats were moved to two locations
outside the affected premises; five of them were moved to one location and had profuse false
diarrhoea during the journey which cleared up on arrival, and three of them subsequently developed
dysautonomia. Of the remaining 10 cats, five developed dysautonomia at their new location. One
other cat, which had been moved to the same location as these 10 cats about two-and-a-half months
before the outbreak, developed the condition towards the end of the outbreak and after the other five
had shown clinical signs. During its two and a half months away this cat had been fed a diet different
from that given to the main colony.

All but three of the sick cats had anorexia, constipation with tenesmus, persistent pupillary dilatation
responsive to pilocarpine, an absence of the light reflex and prolapse of the nictitating membrane.
Their vision appeared normal and photophobia was not apparent. Three cats had a prolapse of the
rectum. Nine of the affected cats were examined post mortem; six of them were dehydrated and in
poor general condition, but the other three did not appear dehydrated and were in fair general
condition.

The cats were killed by an intravenous injection of barbiturates and examined within half an hour of
death. Multiple tissue samples were obtained from all the organs, and samples from the autonomic
nervous system were obtained liom the cranial cervical, nodose, caudal cervical, stellate, vertebral
sympathetic, coeliac, cranial mesenteric and caudal mesenteric ganglia, and from the gastrointestinal
tract.

The six cats in poor general condition had a dilated oesophagus (Fig 1) and there was an
accumulation of dry, hard faeces in the colon. Some of the cats had full, distended bladders but this
sign was not correlated with the severity of the disease. No other gross changes were evident.

The predominant histological lesion was a marked reduction in the total number of neurons within
the autonomic ganglia, with a pronounced increase in the number of non-neuronal nuclei (Fig 2).
Many of the remaining neurons had chromatolytic changes and showed homogeneous eosinophilic
staining of the cytoplasm and eccentric displacement and pyknosis of the nucleus (Fig 3). Some
neurones had a pale eosinophilic cytoplasm with vacuoles (Figs 3 and 4), and many of these cells did
not have a nucleus, suggesting that the change followed kalyolysis. Foci of neuronophagia were
present in all the affected ganglia. In each of the cats, all the ganglia examined appeared to be
affected to a similar degree.

The three cats with only mild clinical changes had mydriasis and a prolapse of the third eyelid. The
oesophagus of these animals was not distended, but the colon was distended with hard faeces. The
ganglia of one of these cats had a small reduction in the number of neurons; about 10 per cent of
them had degenerative changes similar to those in the other cats. Another cat in this group also had
nearly normal numbers of neurons but most of them had eosinophilic chromatolysis of the cytoplasm
with a loss of Nissl substance and eccentric, pyknotic nuclei (Fig 3). Two of these cats also had
perivascular and diffuse intercellular infiltration with eosinophilic polymorphonuclear cells in the
stellate anterior and posterior mesenteric ganglia (Fig 4). Eosinophils were not concentrated
specifically at the sites of neuronal damage.

In one cat, which was in extremely poor condition, hypothermic and severely dehydrated, there were
changes in the Auerbach's plexus of the small and large intestines. Only very few neurons were found
in these sites, most of which were non-nucleated and with chromatolytic vacuolar cytoplasm.

In view of the severity of the lesions, it was decided to test the autonomic nervous system of the
cats. Two of the clinically affected cats were anaesthetised and their right cervical vagus nerve was
stimulated with an electnc current (pulse duration 1 ms amplitude 20 V, 20 Hz for 5 seconds). The
heart rate of these cats was approximately 100 beats per minute and the stimulation failed to produce
the expected bradycardia, although the contraction of the stnated muscle of the larynx and
oesophagus indicated that there had been an effective stimulation of the nerve. Five of the apparently
normal cats in the colony, which were tested same way during the period of the outbreak, also
showed no bradycardia when the right cervical vagus nerve was stimulated electrically. No such
defect was found in the cats after the outbreak had subsided.

Discussion

The reappearance of feline dysautonomia, eight years after it was last reported in the UK, raises new
questions about its aetiology. At the time of its first appearance, there was wide speculation about its
cause and an undefined toxin of unknown origin was suggested. The epidemiology of the present
outbreak contrasts sharply with that of the outbreak between 1982 and 1986. The condition was then
reported throughout the country with very few instances of more than one cat being affected in any
household (Rochlitz 1984). In contrast, the present outbreak was confined to one breeding colony.
but one quarter of all the cats in the colony developed clinical signs within 22 days, after which no
further clinical cases occurred.

No record was available of the date when the new batch of food was started. lt was routine practice
to finish all of a previous batch of tinned food before starting a new batch and, on the basis of the
usage at the time, the new batch from Kennelpack was estimated to have been begun one to two
days after the outbreak started. The one cat that had left the colony two months before the outbreak
developed the condition at the same time as the other cats in the colony. If the cause was a dietary
toxin, then it would appear that an earlier batch of food would have had to contain it, but this would
not explain how the four- and six-week-old kittens could have contracted the disease.

The colony is closed and had no direct or indirect contact with other cats for at least three years. The
environmental conditions were constant and closely monitored. As a result, the chances of an
infectious agent having caused this particular outbreak would have been less than in previous cases in
household cats. On the other hand, the lone cat was at the same location where five of 10
transported cats became ill, so the possibility of a transmissible aetiology cannot be ruled out.

The functional defect of the vagus nerve in some of the clinically normal cats from the colony
suggests that there could have been subclinical cases which may have had significant functional
abnormalities of the physiological regulation of cardiac function. This potential abnormality
constituted a previous unsuspected aspect of this complex disease.

The presence of eosinophilic polymorphonuclear cells in two of the least affected cats is a fnding
which, to the authors' knowledge, has not been previously reported in any of the dysautonomias,
including equine grass sickness. The presence of eosinophils in the lesions is usually associated with
allergic conditions or parasitic infestations. It is not clear whether this feature is of pathogenetic
significance in these two cases. Except for this change, all the lesions found in the nine cats examined
in this outbreak were similar to those recorded in previous reports of feline dysautonomia in which a
positive diagnosis could be made.
=========================

Abstracts
Survival of dogs with nasal tumours treated by surgery and/or radiotherapy
by MORRIS, J.S., DUNN, K.J., DOBSON, J.M. & WHITE R.A.S. (1994) Journal of Small Animal
Practice 35, 567

TWELVE dogs with nasal tumours were treated by radiotherapy alone and 14 were treated by
radiotherapy after having surgery. The one- and two-year actuarial survival rates for the former
group were 58 and 13 per cent, compared with 71 and 38 per cent for the latter. Sixty-seven per
cent of the dogs treated by radiotherapy alone had a occurrence of clinical signs within a year,
compared with 36 per cent the dogs treated by surgery and radiotherapy. The longer disease the
period enjoyed by the latter group was statistically significant.
-----------------------------

Diagnosis of intervertebral disc prolapse in dogs

by LAMB, C. R. (1994) Journal of Small Animal Practice 35, 549

THE surgical treatment of an acute prolapse of an intervertebral disc normally requires myelography
to pinpoint the lesion accurately. However, there are technical difficulties associated with this
procedure, including thc injection of the contrast medium and its distribution, and the selection of the
correct position for radiography, and there may be anatomical problems associated with atypical
displacements of the disc material or swelling of the spinal cord. This paper describes these problems
and suggests methods for avoiding them.
--------------------------------

Food allergy in dogs & cats

by WILLS. J. & HARVEY, R. (1994) Australian Veterinary Journal 71, 322

FOOD allergy and intolerance is rare in dogs and cats although most basic food ingredients, and
particularly proteins, can induce an allergic response. Dogs and cats can become sensitive to cow's
milk, beef, fish and cereal. The most common clinical signs is pruritus, but diagnosis can be difficult
because there is no single test for the condition diagnosis has to rely on a dietary investigation in the
form of elimination diets and test meals. Elimination diets for dogs include lamb, chicken, rabbit,
horse meat and fish as source of protein with rice or potatoes; suitable diets for cats include lamb,
chicken, rabbit or venison, with rice. An improvement in the clinical signs while the elimiation diet is
being fed, and a deterioration within seven to 14 days of return to the original diet is strongly
suggestive of a food allergy.
-------------------------------
The Veterinary Record (1995) 136, 356-358
Evidence of the polyxenous state of fleas in south west England
by C.Chesney

Fleas were collected from 60 dogs and 32 cats living in South West England. Ctenocephalides felis
felis and Ctenocephalides canis were found on both dogs and cats with a marked prepondence of C.
felis felis on both species. More female fleas than males were found. There was no apparent tendency
for C canis to be found more often in rural areas than in suburban areas. The survey confirmed the
polyxenous nature of both species of flea. The significance of this state is discussed in relation to flea
control, and the author concludes that it is unlikely that all significant flea species could be
completely eliminated from the environment of pet animals.

The owners of pet dogs ferquently express surprise that the flea species found on their animal is the
'cat flea', Ctenocephalides felis felis, rather than the dog flea, Ctenocephalides canis. Similarly, cat
owners are surprised when C canis is found in their pet. However, it is clear from several surveys
that both C felis felis and C canis can be found in dogs and cats in the United Kingdom (Beresford-
Jones 1981, Coward 1991), reland (Baker and Mulcahy 1986), and other parts of Europe (Muller
and Kutschmann 1985, Liebisch and others 1985) and in Nrth America (Harman and others 1987).
Parasites which can survive on several hosts are termed 'polyxenus' a phenomenom well recognized
among students of the siphon (Jameson 1985). Several surveys of flea species found among dogs
and cats have appeared in recent years, and there are no real differences between them. However,
there appear to be some trend for particular patterns to occur in various regions of the world. The
purpose of this study was to establish the pattern of infestation in dogs and cats in wouth west
England, an area not previously investgated.

Materials and Methods

The survey was conducted in the author's first-opinion small animal practice in 1990 and 1991. All
the animals in the survey had some evidence of flea infection and were drawn from two main groups.
The first group was submitted for routine vaccination or for castration or spaying, the second for a
variety of dermatological disorders. The routine clinical examination included a visual inspection of
the coat and skin; the coat was then combed for 30 seconds with a steel-toothed fine comb (nine
points/cm) over the dorsal and lateral trunk. Any fleas found were immediately placed on methyl
alcohol-soaked filter paper, then wrapped in aluminium foil thus preserved they were subsequently
identified by Mr R.S.George,.

Results

A total of 60 dogs and 32 cats were examined. Twenty-six distinct breeds of dogs, and crossbreeds
were represented in the sample. among the cats, the majority were domestic short or long haired, of
three distinct breeds. The age ranges and sex of the animals is shown in Table 1. Many more C felis
felis than C canis were found. On one dog two female Archaeopsylla erinacei were found. No single
dog or cat bore more than one species of flea. Two cats (6.3 per cent) carried only C canis, but 47
dogs (78.3 per cent) carried only C felis felis. Among the C felis felis collected, 76.5 per cent were
female and 23.5 per cent male, and among the C canis, 71.4 per cent were female and 28.6 per cent
male (Table 2).

Among the data recorded was the position of the pet animal's home within the Ordnance Survey's
grid of 10 km squares. There are no truly urban areas in the region studied, but the grid references
were classified as being either 'rural' or 'suburban'. The ratio of C felis felis to C canis, found on the
dogs from the rural areas was 2.69:1, and the ratio on the dogs from the suburban areas was 7.5:1.
When examined by X2 analysis with Yates' correction for small samples, the difference between these
ratios was not significant (X2 =0.456, df=1).

The results of this survey are in accord with the findings of several other surveys. Evidence of the
polyxenous state has been recorded in surveys by Baker and Hatch (1972), Kristensen and others
(1978), Beresford Jones (1981) and Kalvelage and Munster (1991). Many surveys have observed a
preponderance of C felis felis (Beresford-Jones 1981, Harrnan and others 1987, Steinbrink 1989,
Kalvelage and Munster 1991). Similarly, a preponderance of female fleas has been observed by
Kristensen and others (1978) and Baker and Mulcahy (1986).

The methods used in this study can be criticised because it is doubtful whether simple combing
would remove all the fleas from an animal's coat. Beresford-Jones (1981) conducted his survey on
cadavers which were sealed into plastic bags immediately after the animals were euthanased and
examined after refrigeration overnight. However, such an approach limits the numbers of animals
available, and probably distorts the age range of the animals, because older, sick animals are more
likely to be euthanased Guzman (1984), moreover, has pointed out that male fleas are both smaller
and faster moving than the females and may thus be more difficult to trap by simple methods such as
combing. Many surveys have followed the approach described above (Kristensen and others 1978,
Baker and Mulcahy 1986), but is is probably unwise to attempt to draw conclusions from the relative
proportions of male and female fleas in this survey.

Parasite species evolve in parallel with the evolution of their hosts. Some are highly host specific and
are termed monoxenous. Others have the ability to affect a wider range of hosts, but are restricted to
different species of the same zoological family or genus. Some species of parasite are more catholic
in their adaptability, and can survive on hosts from widely differing taxonomic groups (Jameson
1985).

C felis felis and C canis belong to the Ceratophyllidae, among which are several polyxenous species
of flea (Jameson 1985). C canis has been recorded from foxes (Vulpes vulpes) and a beech marten
(Martes foina) (Aubert and Beaucornu 1976); fe is fe is has been found on foxes (V vulpes), beech
martens (M foina), a badger (Meles meles) and wild cats (Felis sylvestris) (Aubert and Beaucornu
1976), on the Virginia opossum (Didelphus virginiana) (Durden and Wilson 1990) and on man
(Daniel and others 1989).

Many surveys have recorded small numbers of other species of flea, such as the rabbit flea,
Spilopsyllus cuniculi (Studdert and Arundel 1988) and the badger flea (Paraceras melis melis)
(Coward 1991) and some surveys have recorded the significant presence of species not cornmonly
associated with cats or dogs. Baker and Hatch (1972) found that six of 50 dogs in Dublin carried the
human flea, Pulex irritans. Kalvelage and Munster (1991) found A erinacei (the hedgehog flea) on
2.5 per cent of 163 dogs, compared with 1.2 per cent carrying C felis felis and 0.6 per cent with C
canis. Kristensen and others (1978) in a sample of 312 dogs in Denmark found found C felis felis on
65 per cent, C canis 30 per cent and A erinacei on 8 per cent, and several dogs had multiple
infections.

The biology of fleas is still poorly understood, despite their importance and ubiquity, and the reasons
for the disparity in species found on pet animals in different surveys are obscure. Baker and Mulcahy
(1986), for example, recorded that A erinacei is common in Ireland, yet in this survey only one dog
carried the parasite. Such differences may be a function of various biological factors including the
geographical range of the parasite, since, as can be seen from Table 3, A erinacei is more likely to
occur as a significant species on dogs in northem latitudes, whereas C felis felis is usually recorded as
the only flea found on dogs in southern and subtropical latitudes. Harman and others (1987)
suggested that C canis might be being ousted by C felis felis, at least in Florida, and 'heading towards
extinction'. The inability to find C canis in Florida is, however, more likely to be associated with the
natural geographical range of the parasite, which appears to be more common in higher latitudes
(Table 3).
Both Haarloev and Kristensen (1977) and Muller and Kutschmann (1985) recorded that although the
numbers of C felis felis exceeded the numbers of C canis in both rural and urban areas, C canis was
present in significantly greater numbers in rural areas. The biological factors responsible for this
distribution have not been explored and the findings underline our lack of knowledge. The present
survey did not show any such difference, perhaps because there were no truly urban areas in the
region studied.

These facts have important implications for flea control. A current approach to this problem is the
long term administration of an inhibitor of chitin synthesis, for example, lufenuron (Ciba;
Cambridge), diflubenzuron or triflumuron to pet animals, with the expectation that they might
significantly reduce the problem of fleas on pet animals. However, one study (Willemse 1993) has
shown that in animals treated regularly with lufenuron for a year, there were almost as many fleas at
the end of the study as at the beginning, although the expected rise in numbers in the summer did not
occur. Given the recognised efficacy of the drug (Willemse 1993) this failure implies that there is a
reservoir of cat and dog fleas in the local environment, from which free roaming animals (cats in
particular) would be steadily recontaminated. Willemse (1993) concluded that it would be essential
to use an agent to kill adult fleas in conjunction with the lufenuron.

The present study, and numerous others, have clearly shown the polyxenous nature not only of C
felis felis and C canis but of other species capable of parasitising dogs and cats, such as A erinacei. It
therefore seems unlikely that the problem of flea infestation in pet animals would be eliminated by
even a widespread programme of administering drugs which interrupt the life-cycle of fleas, to just
two of their possible host species. Should the numbers of one species of flea decrease, it would be
expected that others would exploit the newly available biological niche. An event demonstrating the
polyxenous nature of the cat flea was recorded by Hunter and others (1979). They observed that a
family of raccoons in Maryland, USA, nested in the cavity wall of a house. Three days after the
raccoons left, the people living in the house and in adjoining properties, began to suffer problems
from infestation with C felis felis, including several hypersensitivity reactions, which lasted for six
weeks.

Baker and Mulcahy (1986) showed that the intradermal injection of dogs with either flea saliva or
whole flea extract from C canis or A erinacei produced similar immediate hypersensitivity reactions.
This implies that when A erinacei is a significant parasite of the dog it would be just as likely as C
canis to cause the clinical signs of flea bite hypersensitivity. Similarly, a rabbit flea, Spilopsyllus
cuniculi, can cause hypersensitivity reactions in the cat (Studdert and Arundel 1988).

Since most urban areas in the UK have populations of feral cats, and often other species such as
foxes, which may act as hosts to polyxenous species of flea, it must be concluded that the concurrent
use of drugs capable of killing adult fleas will continue to be necessary, whether in a rural or an urban
environment.

Clinicians should inform their clients of this problem, and advice should be given on local
environmental control in conjunction with life-cycle inhibitors. Baker and Mulcahy (1986) advised
'spraying hedgehogs and their nests lightly with an organophosphorous spray ... in the environment
of hypersensitive dogs'. Although it is less drastic than the advice to mix 'anti-flea powder into peat
or other gardening materials' (Clover 1969) such a course would probably be unacceptabb in the
current climate of ecological awareness. The thorough and continuous use within the home of
degradable substances such as the pyrethroids, would probably be more appropriate.
--------------------------------