Bladder disease Flashcards
Outline innervation to the bladder
(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
Outline innervation to the urethra
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
Where do the nerves controlling the bladder originate from ?
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
How can you categorise U+ disorders?
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
Outline an UMN bladder
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
Outline a LMN bladder
Normally S1-3 or pelvic plexus.
No bladder contraction
Bladder flacid/ easy to express
What occurs in detrusor dysnergia?
Increased sphincter contraction
What are the bladder differentials for dysuria?
N.B can also get issues with external genitalia causing issues
Partial obstruction or mucosal irritation UTI Neoplasia (esp TCC) Stricture Stones Rupture of UT FLUTD Prostatic dz Sterile cystitis Inflammatory polyps
Can you disolve stones not in the bladder?
No - they need to soak in u+
What prostatic diseases are there?
BPH Prostatitis Abscess Prostatic cyst Neoplasia
What are the urethral ddx for dysuria?
Calculi/ uroliths Stricture Neoplasia Granulomatous urethritis Bacterial urethritis Rupture polyps
What are the types of cystitis?
cystitis cases often drink a lot
Follicular Polypoid cyclophosphamide induced Parasitic neoplasia
Outline follicular cystitis
Consequence of chronic UTI
Multiple small mucosal follicles in the bladder and urethra with lymphoid infiltrates
Regresses once UTI controlled
Outline polypoid cystitis
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
Outline cyclophosphamide induced cystities
Sterile h+ cystitis caused by acrolein Decreased risk if give frusemide Discontinue meds, give AI, analgesia Can occur with metronomic chemo
Outline parasitic cystitis
Uncommon
Capilaria plica
Dx with ova in UA
Tx - ivermectin or fenbendazole
Outline TCC
> 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
Outline Ix of TCC
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
How do you Tx TCC?
Chemo - carboplatin, mitroxantrone, cyclophosphamide, doxorubicin, metronomic
Radiation
Piroxicam
Poor prognosis - months
What are the suggested treatment for FIC and their evidence bases?
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
What are the Ddx of FLUTD
Neoplasia
Urolithiasis
Infection
idiopathic
When is infection more likely?
Very unlikely in <10 yo CKD Diabetes Hyperthyroidism Iatorogenic
Where are TCCs in cats?
Can be at the pole so may be easier to move
How are cats with FLUTD’s response to alpha 2 receptors?
Increased response
What are neuro differences in cats with FIC?
Increased NO and NorAd release at the bladder
Increased epithelial permeability
Increased afference sensitivity
What are hormonal differences in cats with FIC?
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
Where can you get questionnaires for FIC environment assessment?
Indoor cat initiative
