37. Urolithiasis. Disorders of the urination

Question 1

Causes of urolithiasis

Answer 1

Crystals in urine sediment
- struvite
- calcium oxalate
- urate
- cysteine

Question 2

Examples of organic sediment

Answer 2

blood
pus
lipid

Question 3

Pathogenesis of uroliths

Answer 3

Increase of supersaturated urine conc

Question 4

What can uroliths be secondary to

Answer 4

UTI
hepatopathy
metabolic disease
genetic disease

Question 5

Occurrence of uroliths

Answer 5

90-95% in bladder
- struvite
- ca oxalate

Question 6

Clinical signs of uroliths depend on

Answer 6

no. of stones
types of stones
location of stones

Question 7

Clinical signs of uroliths

Answer 7

signs of cystitis
Urethral obstruction
Post renal uraemia
AKI
Pain
haematuria
hydronephrosus
pyelonephritis

Question 8

Struvite Stones

Answer 8

40-60% of all uroliths
Alkaline/ Neutral urine
Femals
Dachshund, poodle, mini schnauzer

Question 9

Cause of struvite stones

Answer 9

UTI
Urease —> alkaline urine –> increased NH4

Question 10

Calcium oxalate stones

Answer 10

15-50% of all uroliths
acidic urine
Hypercalciuria
Poodle, minischanuzer, yorkie

Question 11

Urate stones

Answer 11

Ammonium acid urate
Increased urate in urine
Increase ammonium and urate in urine (pss, cirrhosis(
Decreased glycosaminoglycans in urine

Question 12

Cystein stones

Answer 12

Inherited disorder of renal tubular transport
Acidic urine
Male, middle aged
siamese cates

Question 13

Diagnosis of uroliths

Answer 13

Contrast xray
US - stone anaylsis
BActerial culture
Re-evaluation of patient

Question 14

Treatment of Uroliths
emergency urethral obstruction

Answer 14

Catheterisation
Decompression of bladder
Treatment of AKI & its consequences
Surgical removal
Urohydropropulsion
Treat UTI
Diuresis induction

Question 15

Treatment of struvite stones

Answer 15

Diet - decrease protein, Ca, Mg, P
Increase dietary salt
AB
Acidifier - NH4Cl, Methionine

Question 16

Treatment of Calcium oxalate stones

Answer 16

Surgery required
Diet - decrease Protein, nucleic acids
Increase dietary salt
Potassium citrate

Question 17

Treatment of urate stones

Answer 17

If no association with hepatic insufficiency
Diet- decrease purine, nucleic acids, added salts

Question 18

Treatment of cysteine stones

Answer 18

Diet- decrease protein, salt
Methionine
Urine alkalisation
Thiol contaning drugs - D penicilliamine/ MGP

Question 19

Disorder of urination

Answer 19

USMI
Urethral Sphincter Mechanism Incompetence

Question 20

2 types of incompetence

Answer 20

Neurogenic
Non- neurogenic

Question 21

Cause of Neurogenic Incontinence

Answer 21

UMN (spastic bladder)
LMN (flaccid bladder)

Question 22

Cause of Non - Neurogenic Incontinence

Answer 22

Anatomic - ectopic ureter, pelvic bladder, rectourethral fistula, enlarged prostate
Hormonal - lack of oestrogen, <3yrs post spay
Inflammatory - cystitis, urethritis, urolithiasis

Question 23

Predisposed to ectopic ureter

Answer 23

Terrier
Lab
Huskey

Question 24

Diagnosis of incontenance

Answer 24

History
Physical exam - orifices, palpation, pain, expression (easier in LMN)
Neuro exam
CBC
Urinalysis
Xray
US
Electrophysiological studies

Question 25

Types of electrophysiological studies

Answer 25

Leak Point pressure
Urethral pressure profile
cytometrogram

Question 26

Treatment of Neurogenic incontinence

Answer 26

UMN - decompression, stabilisation. Diazepam
LMN - bethanechol

Question 27

Treatment of Inflammatory incontinence

Answer 27

Cystitis - NSAIDS, AB
Uroliths - dietary, medical
Surgery - cystotomy, urethrotomy, urethrostomy

Question 28

Treatment of Anatomical incontinence

Answer 28

Trigonal reconstruction
Ureteroneocystomy
Bladder and urethral repositioning
Fistula correction

Question 29

Treatment of Hormonal incontinence

Answer 29

Oestradiol
Ephedrine