Bladder disease

Question 1

Outline innervation to the bladder

Answer 1

(Bladder is smooth muscle)
Sympathetic control with the hypogastric nerve - ensures bladder storage and retention by contracting the internal sphincter
Parasympathetic control with the pelvic nerve - ensures voiding with contraction of the bladder
Somatic system controls external sphincter contraction

Question 2

Outline innervation to the urethra

Answer 2

Storage mode controlled by the hypogastric nerve - internal sphincter contracts
Skeletal muscle controlled by the pudendal nerve (somatic) - contracts
Voiding mode - the hyppogastric and pudendal nerves are inhibited inducing relaxation

Question 3

Where do the nerves controlling the bladder originate from ?

Answer 3

Hypogastric L1-L4 dogs, L2-L5 cats
Pelvic - S1-S3 both
Pudendal - S1-S2
Forebrain is not involved in initiating u+ but can inhibit u+ - this is why forebrain lesions can lead to inappropriate u+
Micturition centre in the brainstem - co-ordinates relaxation and contraction

Question 4

How can you categorise U+ disorders?

Answer 4

Storage (small to normal bladder, involuntary leakage of u+
Inappropriate u+/ bladder dysfunction/ urethral incompetence
Voiding (large bladder normall, retention, dysuria or stranguria)
UMN/LMN bladders of detrusor dysnergia

Question 5

Outline an UMN bladder

Answer 5

Normally T3-L3 but can be higher
Loses ability to contract, often same time as loses limb function
Bladder large and hard to express as there is increase urethral tone
Get overflow incontinence

Question 6

Outline a LMN bladder

Answer 6

Normally S1-3 or pelvic plexus.
No bladder contraction
Bladder flacid/ easy to express

Question 7

What occurs in detrusor dysnergia?

Answer 7

Increased sphincter contraction

Question 8

What are the bladder differentials for dysuria?

N.B can also get issues with external genitalia causing issues

Answer 8

Partial obstruction or mucosal irritation
UTI
Neoplasia (esp TCC)
Stricture
Stones
Rupture of UT
FLUTD
Prostatic dz
Sterile cystitis
Inflammatory polyps

Question 9

Can you disolve stones not in the bladder?

Answer 9

No - they need to soak in u+

Question 10

What prostatic diseases are there?

Answer 10

BPH
Prostatitis
Abscess
Prostatic cyst
Neoplasia

Question 11

What are the urethral ddx for dysuria?

Answer 11

Calculi/ uroliths
Stricture
Neoplasia
Granulomatous urethritis
Bacterial urethritis
Rupture
polyps

Question 12

What are the types of cystitis?

cystitis cases often drink a lot

Answer 12

Follicular
Polypoid
cyclophosphamide induced
Parasitic
neoplasia

Question 13

Outline follicular cystitis

Answer 13

Consequence of chronic UTI
Multiple small mucosal follicles in the bladder and urethra with lymphoid infiltrates
Regresses once UTI controlled

Question 14

Outline polypoid cystitis

Answer 14

uncommon - secondary to uncontrolled chronic UTI
Inflammation, epithelial proliferation, polypoid masses
f>m
on imaging - thick bladder but no distortion of the layers
More on cranioventral portion of bladder
can get spontaneous resolution with treatment of UTI
sometimes needs Sx

Question 15

Outline cyclophosphamide induced cystities

Answer 15

Sterile h+ cystitis
caused by acrolein
Decreased risk if give frusemide
Discontinue meds, give AI, analgesia
Can occur with metronomic chemo

Question 16

Outline parasitic cystitis

Answer 16

Uncommon
Capilaria plica
Dx with ova in UA
Tx - ivermectin or fenbendazole

Question 17

Outline TCC

Answer 17

> 85% malignant bladder tumours in dogs, 30% of cats
Can also occur in urethra or prostate
Can predispose to UTI and stimulate uroliths
More common in older females
Scottish Terriers predisposed
Aggressive
60% mets rate - lungs and LNs

Question 18

Outline Ix of TCC

Answer 18

30% UA shows tumour cells
Can test for bladder tumour antigen - can be affected by haematuria and proteinuria
Rads - can do contrast cystography
U/S essential, can do cystology or histopathology

Question 19

How do you Tx TCC?

Answer 19

Chemo - carboplatin, mitroxantrone, cyclophosphamide, doxorubicin, metronomic
Radiation
Piroxicam
Poor prognosis - months

Question 20

What are the suggested treatment for FIC and their evidence bases?

Answer 20

Feline facial hormone - no evidence
Environmental enrichement adn removal of stressors -good evidence
Neutraceuticals - L-tryptophan or zylkene have moderate evidence, but daily dosage may be stressful, in which case consider a stress diet, Add water or do wet only food
GAGs - currently no supporting evidence
Amitriptiline - no evidence
pain relief - poor evidnce, but should give

Question 21

What are the Ddx of FLUTD

Answer 21

Neoplasia
Urolithiasis
Infection
idiopathic

Question 22

When is infection more likely?

Answer 22

Very unlikely in <10 yo
CKD
Diabetes
Hyperthyroidism
Iatorogenic

Question 23

Where are TCCs in cats?

Answer 23

Can be at the pole so may be easier to move

Question 24

How are cats with FLUTD’s response to alpha 2 receptors?

Answer 24

Increased response

Question 25

What are neuro differences in cats with FIC?

Answer 25

Increased NO and NorAd release at the bladder
Increased epithelial permeability
Increased afference sensitivity

Question 26

What are hormonal differences in cats with FIC?

Answer 26

Uncoupling of sympathetic NS and adrenocortical activity
Sympathetic NS repsonse predominantly
Adrenal cortex stimulated, cortisol doesn’t get that high
Smaller adrenal glands than other cats

Question 27

Where can you get questionnaires for FIC environment assessment?

Answer 27

Indoor cat initiative