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Module 17-Urinary, Endocrinology, Oncology > Approach to and Management of LUT and Prostatic Disease > Flashcards

Approach to and Management of LUT and Prostatic Disease Flashcards

1
Q

Dysuria

A

Difficult and/or painful urination

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2
Q

Stranguria

A

Slow & painful urination or straining to pass urine

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3
Q

Pollakiuria

A

Abnormally frequent passage of small volumes of urine

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4
Q

Two processes cause dysuria

A

Mucosal irritation or inflammation (cystitis)
Narrowing or obstruction of the urethra or bladder neck

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5
Q

Why do we need to look at biochemistry when animal has stranguria

A

Obstruction or bladder rupture causes:
Post-renal azotaemia
Hyperkalaemia
Metabolic acidosis
Calcium containing uroliths can be due to hypercalcaemia

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6
Q

2 reasons for urine retention

A

Obstruction
Structural problem (more common)

Functional problem
Failure of relaxation of urethral sphincter (eg. UMN lesion)
Failure of detrusor muscle contraction (detrusor atony)
Dyssynergia

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7
Q

Causes of urinary incontinence

A

Pressure in bladder > urethra
↓ detrusor compliance
- Detrusor instability (primary rare)
↓ urethral tone
- Bladder/urethral neoplasia
- UTIs
- Prostatic problems
- Overflow incontinence (pu/pd)

Anatomical abnormality bypassing urethral sphincter mechanism

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8
Q

Urinary incontinence

A

Involuntary leakage of urine through urethra

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9
Q

Signs of LUT infections

A

Urgency, haematuria, dysuria, pollakiuria & stranguria
Urinary incontinence
(Urinary retention)
Bladder may be small & thickened

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10
Q

When to suspect a UTI

A

History & clinical signs of bladder inflammation
Protein, blood, WBCs, pH ↑ on urinalysis
Imaging – thickening of bladder wall

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11
Q

When to culture urine

A

All animals with LUT signs
All animals with renal disease
Animals with non-specific/vague signs

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12
Q

Sporadic bacterial cystitis

A

Sporadic bacterial infection of the urinary bladder with compatible LUT signs
<3 episodes of cystitis in previous 12 months

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13
Q

Recurrent bacterial cystitis

A

Animals that have had 3 or more episodes of clinical bacterial cystitis in previous 12 months OR 1 recurrence in previous 3 months
May be relapsing, recurrent or persistent

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14
Q

Asymptomatic bacteriuria

A

Animals with bacteriuria in the absence of clinical signs

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15
Q

Treatment – sporadic bacterial cystitis

A

3-5 days treatment
Ideally based on culture & sensitivity
Amoxycillin or amoxycillin-clavulanate if:
- Cocci
- Small paired rods in alkaline urine (proteus)
Not predictable if rods in non-alkaline urine
- Consider – amoxicillin, cephalexin, TMPS

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16
Q

Treatment – recurrent bacterial cystitis

A

Urine culture should always be performed
Analgesia
Investigations for nidus of infection (relapsing/persistent) or reason for susceptibility (reinfection)
Ultrasound, radiography, cystoscopy may be considered
Review previous choice of antimicrobials
follow-up bacterial culture (5-7d after tx):To help differentiate relapse, re-infection, persistent infection

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17
Q

Complications of UTIs

A

Polypoid cystitis
- Can occur due to chronic UTIs
- Consider partial cystectomy

Emphysematous cystitis- Gas in the lumen & wall of bladder
- Glucose-fermenting bacteria (usually E.coli)
- Treat cause of glucosuria

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18
Q

List common benign bladder masses

A

Polypoid cystitis – inflammatory lesion
Leiomyoma

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19
Q

List malignant bladder masses

A

Transitional cell carcinoma
Squamous cell carcinoma
Leiomyosarcoma
Rhabdomyosarcoma
Prostatic neoplasia
Metastatic neoplasia

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20
Q

What dog breed is predisposed to transitional cell carcinoma

A

Scottish Terriers

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21
Q

Presentation of transitional cell carcinoma

A

Signs of lower urinary tract inflammation
Can cause urine retention
Can cause urinary incontinence (rare)

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22
Q

Diagnosis of bladder masses

A

Diagnostic imaging (ultrasound/radiographs)
- Thickening of bladder wall & mass lesions
- Mostly occur in trigone region (dogs)
Urine sediment analysis
- Neoplastic cells may be detected
Cystoscopy
- Abnormal irregular proliferation from bladder wall
Cytology or Biopsy
- For definitive diagnosis

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23
Q

Reflex dyssynergia and presentation

A

Loss of coordination between bladder & urethral sphincter muscles
Steam initiated but not maintained, large residual urine volume, difficult to express bladder

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24
Q

Dog breed predisposed to reflex dyssynergia

A

Labradors

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25
Q

Treatment for reflex dyssynergia

A

Decreasing internal urethral sphincter tone using medications like prazosin/phenoxybenzamine
Reducing external sphincter tone with drugs such as diazepam/dantrolene, Increasing detrusor contraction using bethanecol in the management of certain urinary conditions.

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26
Q

Bladder atony

A

Bladder atony is a condition characterized by loss of bladder muscle tone, leading to a distended, flaccid bladder, weak urine stream, and may be primary (neurological) or secondary to chronic overstretch

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27
Q

Treatment for bladder atony

A

Indwelling catheter – to rest detrusor
Bethanechol – after obstruction removed

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28
Q

What is USMI

A

Urethral sphincter mechanism incompetence

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29
Q

Risk factors for USMI

A

Congenital or acquired
Female > male
Often within 3 years of spaying

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30
Q

USMI diagnosis

A

Intermittent urine leakage & incontinent at rest
Can urinate normally
Often presumptive (spayed bitches)

31
Q

Summarise why diabetes can cause pu/pd

A

Due to elevated blood glucose levels leading to osmotic diuresis, resulting in increased urine output, and the body’s compensatory mechanism to eliminate excess glucose by increasing thirst

32
Q

Name 3 drugs used for USMI treatments

A

Phenylpropanolamine (Propaline)
Estriol
Ephedrine

33
Q

Effect of Phenylpropanolamine (Propaline)

A

Type: α sympathomimetic.
Effect: Increases internal sphincter tone.
Onset: Several days
Side effects: Restlessness, aggression, and hypertension.

34
Q

Effect of Estriol

A

Type: Synthetic, short-acting estrogen.
Effect: Upregulates α-adrenergic receptors, increasing internal sphincter tone.
Contraindicated: in males, entire bitches, and patients with polyuria-polydipsia (PUPD)

35
Q

Ectopic ureters

A

A congenital anomaly where ureters do not connect to the bladder correctly but may connect to the urethra or another part of the lower urinary tract. This condition, often seen in female dogs, can lead to urinary incontinence and recurrent urinary tract infections

36
Q

Other USMI treatments besides drugs

A

Collagen injections
Try drugs in combination
Weight reduction
Increase opportunities to urinate
Surgery

37
Q

Diagnosis for Ectopic ureters

A

History: young animals, especially females, may present with continuous urine leakage,

Diagnostic approaches: Ultrasound, X-ray, IVU or retrograde vagino-urethrogram, and CT-IVU.

Cystoscopy may be employed for direct visualization and identification of ectopic ureters

38
Q

Treatment for ectopic ureters

A

Refer for surgery

39
Q

Clinical presentations of prostate disease

A

Haematuria
Haemorrhagic urethral discharge
Tenesmus (a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness. )
Dysuria
Recurrent UTIs
Urinary incontinence
Hindlimb stiffness
Infertility

40
Q

Diagnosis of prostate disease

A

Rectal palpation
Haematology & biochemistry
Urinalysis & culture
Collection of prostatic fluid
Radiographs
Ultrasound (FNA)

41
Q

Describe a normal prostate

A

Ventrally, smooth, bi-lobed, non-painful

42
Q

Describe Benign prostatic hyperplasia (BPH)

A

Age related change
Hypertrophy & hyperplasia of secretory & connective tissues
Intraparenchymal fluid cysts

43
Q

Presentation of benign prostatic hyperplasia

A

Often asymptomatic
Haematuria, haematospermia, haemorrhagic urethral discharge
Difficulty defaecating

44
Q

Diagnosis of BPH

A

Palpation
Enlarged (symmetrical)
Non-painful
Mobile

Ultrasound:
Diffusely hyperechoic
Parenchymal cysts

Histology needed for definitive diagnosis
Response to treatment suggestive
Care! Multiple diseases possible

45
Q

Treatment of BPH

A

Asymptomatic
Not necessary

Symptomatic
Surgical castration- Resolution within 4 weeks
Medical management- Osaterone (Ypozane) (inhibits testosterone uptake & receptor binding)Deslorelin (Suprelorin) (GnRH agonist) - implant

46
Q

Bacterial prostatitis

A

Prostatic inflammation usually due to bacterial infection from urethra or haematogenous spread
Entire male dogs more likely

47
Q

Presentation of Acute prostatitis

A

Fever
Depression
Anorexia
Vomiting
Urethral discharge
Tenesmus
Constipation
Dysuria
Abdominal pain
Gait changes

48
Q

Presentation of chronic prostatitis

A

Purulent/ haemorrhagic urethral discharge
Recurrent UTIs
Mild haematuria
Infertility

49
Q

Diagnosis of prostatitis

A

palpation can reveal pain (indicative of acute issues) or be non-painful (suggestive of chronic conditions), and size and shape may appear normal. Evaluation often considers signalment, history, clinical signs, consistent imaging findings, urinalysis, urine culture, prostatic fluid cytology, and culture. Bacterial prostatitis should be investigated in intact males with bacteriuria or bacterial cystitis.

50
Q

Treatment of prostatis

A

IV antibiotics empirically (fluoroquinolones, TMP-SMX) with characteristics able to cross the blood-prostate barrier; oral antibiotics (trimethoprim, fluoroquinolones, clindamycin, macrolides if susceptible) for 4-6 weeks, and consider castration,

51
Q

Presentation of prostatic abcesses

A

Often similar to acute prostatitis
Can cause chronic urethral obstruction
Acute abdomen or septic shock

52
Q

Diagnosis of prostatic abscesses

A

Palpation: Enlarged/ Asymmetric
Ultrasound

53
Q

Treatment of prostatic abcesses

A

Surgical Options:
Surgical drainage and omentalisation or percutaneous drainage may be employed.
Concurrent treatment for chronic prostatitis is recommended.

Considerations:
Due to the risk of serious complications, considering referral to specialized care is important.

54
Q

Paraprostatic cysts

A

Large sacs of fluid adjacent to prostate & attached by stalk

55
Q

Presentations of Paraprostatic cysts

A

Dysuria or tenesmus
Perineal mass
Occasionally systemic signs

56
Q

Diagnosis of Paraprostatic cysts

A

Plain Radiographs
Ultrasound
Ultrasound-guided fluid aspirate

57
Q

Treatment of paraprostatic cysts

A

Omentalisation
Castration

58
Q

Presentations of prostatic neoplasias

A

Entire or castrated dogs
Tenesmus, dysuria, haemorrhagic urethral discharge, hindlimb lameness, chronic weight loss and/or anorexia

59
Q

Palpation of prostatic neoplasia

A

Firm, irregular nodules
Enlarged, asymmetric, firm, fixed +/- painful
Enlarged sublumbar lymph nodes

60
Q

Palpation of prostatitis

A

Palpation can reveal pain (indicative of acute issues) or be non-painful (suggestive of chronic conditions), and size and shape may appear normal.

61
Q

Radiographs of prostatic neoplasia

A

Irregularly enlarged
Mineralised opacities
Lysis or proliferation on lumbar vertebrae or pelvic bones

62
Q

Ultrasound of prostatic neoplasia

A

Focal or multifocal hyperechoic parenchyma
Asymmetry
Irregular contour
Cavitatory lesions

63
Q

Radiograph of paraprostatic cysts

A

May have thin mineralisation of wall (egg shell like)

64
Q

Describe fluid aspirate of a paraprostatic cyst

A

Yellow-brown
Small numbers of red & white blood cells & epithelial cells
Usually sterile

65
Q

Treatment of prostatic neoplasia

A

Prognosis grave
No curative treatment

66
Q

3 functional problems that can cause urine retention

A

Failure of relaxation of urethral sphincter (eg. UMN lesion)
Failure of detrusor muscle contraction (detrusor atony)
Dyssynergia

67
Q

Most common bladder neoplasia

A

Transitional cell carcinoma

68
Q

Diagnosis of TCC

A

U/S: Thickening of bladder wall and mass lesions in trigone area
UA: Neoplastic cells may be seen
Cystocopy: Abnormal irregular proliferation along bladder wall
Cytology/biopsy: Definitive diagnosis- Traumatic catheterisation,cytoscopically,suction biopsy, laparoscopy

69
Q

Treatment for TCC

A

Surgery but may not be viable
Chemotherapy- Mitoxantrone/Carboplatin
NSAIDS- Meloxicm- Antineoplastic effects and antiinflammatory

70
Q

Prognosis for TCC

A

Guarded

71
Q

What drug to give to decrease internal urethral sphincter tone

A

Prazosin/Phenoxybenzamine

72
Q

What drug to give to decrease external urethral sphincter tone

A

Diazepam

73
Q

What drug to give to increase detrusor contraction

A

Bethanecol

74
Q
A

Module 17-Urinary, Endocrinology, Oncology (28 decks)

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