Lower Urinary Tract Diseases Flashcards
Which parts of the urinary tract are considered the ‘lower’ parts?
Bladder and urethra (and prostate in males)
What is cystitis?
Inflammation of the bladder
What is dysuria?
Difficulty urinating
What is stranguria?
Straining to urinate
What is stranguria often misrecognised as?
Constipation (esp cats)
What is haematuria?
Blood in the urine
What is pollakuria?
Increased frequency of urination
What is periuria?
Urine voiding in inappropriate places
What are some of the clinical signs of cystitis?
Dysuria Stranguria Haematuria Pollakuria Periuria
Vocalisation, licking prepuce, inappetence, lethargy
What are some of the causes of cystitis?
Feline idiopathic cystitis
Bacterial UTI (females)
Urolithiasis
Neoplasia
Drug-induced
Implants/indwelling devices (e.g. catheters)
When is a lower urinary tract condition considered an emergency?
If the animal is not able to pass urine (urinary obstruction)
What is the difference between uroliths and crystals?
Uroliths are urinary stones (crystal aggregates), crystals are microscopic mineral precipitates (room temp)
What is crystalluria?
Presence of crystals in the urine
If an animal has both crystals and uroliths, will they be made of the same constituents?
Not necessarily
What type of crystals are these?
Struvite
What type of crystals are these?
Calcium oxalate dihydrate
What type of crystals are these?
Urate
What is the relationship between urine dilution and risk of precipitation?
More dilute urine = lower risk of uroliths
Is all crystalluria abnormal?
No - only some types
Are all uroliths abnormal?
Yes - need treating if symptomatic
What are uroliths of the kidneys called?
Nephroliths
What are the symptoms of nephroliths?
Abdominal pain - anorexia/inappetence, lethargy
Haematuria
Pyelonephritis (kidney infection)
What are the symptoms of ureteroliths?
May cause ureteric obstruction –> post renal azotemia symptoms
What is the main sign of urethroliths?
Unproductive/minimally productive urination
What are cystoliths?
Stones in bladder
What are the symptoms of cystoliths?
Cystitis signs - Pollakuria Stranguria Dysuria Haematuria
What are the general principles for urolith management?
Encourage water intake - aim for dilute urine
Encourage voiding
Avoid obesity
What is the ideal USG of urine for cats and dog?
<1.030 cats
<1.020 dogs
Why is dietary dissolution of stone via food not suitable for long term use or use in growing/lactating animals?
Severely protein restricted
What are the nursing considerations for a patient with urolithiasis?
Vigilance about urine monitoring
Maintain hydration/urine dilution/output
Urinary catheter care and management
Analgesia requirements
In which cats is feline idiopathic cystitis more commonly found?
2-7 years old Overweight/inactive Indoor cats Multi-animal household Nervous disposition Stressors Dry diet
What physiological factors make a cat more susceptible to FIC?
Neuroendocrine modulation
GAG layer hypofunction
Environmental stress manifests as FLUTD
How is FIC diagnosed?
Urinalysis to exclude UTI
Radiographs for uroliths and masses
Ultrasonography to visualise structural
architecture of upper UT
If nothing found = FIC
How does non-obstructed FIC present?
Pollakuria/dysuria/haematuria
Still able to void
Often self-limiting
May experience recurrent episodes
How does obstructed FIC present?
Urethral spasm or plug =
Unproductive efforts to urinate (emergency)
More common in males, high recurrence rate
What are the symptoms of an obstructed cat?
Unproductive attempts to urinate
Back pressure on kidneys –> post-renal azotemia
Hyperkalaemia –> bradydysrhythmia
Agitated/depressed
What nursing considerations should be taken post-catheterisation?
Monitor urine output/hydration/electrolytes
Examine urine sediment/cytology daily for evidence of infection
What is involved in the medical management of FIC?
Analgesia - buprenorphine, NSAIDs, gabapentin (if severe)
What environmental modifications can be made to reduce risk of FIC?
Alleviate predisposing stressor
Address negative cat-cat interactions
Consider resource availability (esp toileting)
Feliway
How can we promote urinary health in cats?
Encourage water intake
Dietary modifications
Avoid obesity
GAG supplementation
What is urinary incontinence?
Loss of normal, voluntary control of micturition
What are the symptoms of an upper motor neurone lesion (causing urinary incontinence)?
Spastic bladder (high muscle tone) - difficult to express
What are the symptoms of a lower motor neurone lesion (causing urinary incontinence)?
Flaccid bladder, easy to express
What are the non-neurogenic causes of incontinence?
USMI
Anatomical defects
Urge incontinence
Dyssynergia
What is dyssyngergia?
Failure of coordination of bladder contraction with urethral relaxation
What is the treatment for urethral sphincter mechanism incompetence?
Tighten sphincter with either:
a-agonists
Oestrogens
Urethral cuffs
OR surgical repositioning of bladder
