Lower urinary tract part 2 Flashcards
In one study of 163 dogs with USMI, dogs >25 kg were found to have a decreased risk of USMI with what?
Risk decreased with every month delay of neuter in the first year
No impact of delayed neutering in smaller dogs
On average, USMI developed how many years after neutering?
3.7 years
Injection of cross linked collaged into the urethral sphincter results in continence in what percent of dogs with USMI? How long does it last?
68%, lasts ~17 months in one study, 45 months in another study
What is an alternative to collagen for treatment of USMI? How effective is it and how long does it last?
Cross linked gelatin (VetFoam) - 87% of dogs achieved continence with one injection, 100% with more. Lasted 11 months
What clinicopathologic changes pre-operatively correlated with post-obstuctive diuresis in cats undergoing SUB or stent placement?
Creatinine, BUN, K, Phos - correlated with the duration and maximum severity of post-obstructive diuresis
A dog with SUBs placed due to bilateral ureteral obstruction from TCC developed what two months post-operatively?
TCC at the site of the subcutaneous access port of the SUB device :( SUBs may not be great for TCC
In SUB cats with a device obstruction and positive urine culture, what rare complication should be considered?
Migration of the SUB into the GI tract
What is the most common long term complication after SUB placement and how often does it occur?
Mineralization - 24%, median of 460 days post-placement
SUB mineralization is associated with what clinicopathologic abnormality?
High ionized calcium concentration
What is the survival to discharge rate after SUB placement in cats?
94%
What imaging modality was superior to ultrasound in diagnosing ureteral calculi in cats?
Nonenhanced CT
In a study comparing ureteral stents to SUBs in cats with ureteroliths, which group had a longer MST?
MST stent 14 months
MST SUB not reached
In a study comparing ureteral stents to SUBs in cats with ureteroliths, which group had a greater risk of LUT signs and a greater risk of device occlusion?
Stents
In a study comparing ureteral stents to ureterotomy, which group was more likely to have resolution of their azotemia prior to discharge?
Stents
What is the sensitivity and specificity of ultrasound for diagnosing ureteral obstruction in cats?
Sensitivity 98% for stones, 44% for strictures
Specificity: 96-98% for both
In humans with interstitial cystitis, what lesions are noted in the bladder on cystoscopy?
Submucosal petechial hemorrhages (glomerulations)
What changes in sensory nerve function have been shown to occur in cats with FIC?
- Increase in substance P (SP) immunoreactivity in sensory neurons
- Upregulation of neurokinin-1 receptor for SP
What abnormalities have been identified in the adrenal glands of cats with FIC?
Smaller zonae fasciculata and reticularis
- Theory: a stressful event permitted maternal glucocorticoids to cross the placenta and inhibit fetal ACTH release
What is a theory on maternal stress related to FIC?
Thought that maternal stress may lead to a sensitization of the stress response in the offspring, leading to an increased susceptibility to environmental stress - likely based on epigenetics
Activation of the stress response can lead to what changes in the urinary tract?
Increase autonomic, particularly, sympathetic outflow => increased epithelial permeability (acutely) and epithelial damage (chronically)
Did low dose meloxicam help prevent the recurrence of FIC? What percent of cats had recurrence?
-No meloxicam made no difference
-24% experienced signs of recurrent FIC within 6 months
What pro-inflammatory cytokines were increased in cats with FIC?
IL-12, IL-18, CXCL12
Is decompressive cystocentesis safe or helpful in cats with urethral obstruction?
- Appears to be safe based on two studies (no evidence of worsening effusion, etc)
- But did not decreased time to urinary catheter placement or ease of catheter placement
Why might prazosin be ineffective in preventing recurrent UO in cats?
Only the proximal 1/3 of the feline urethra is composed of smooth muscle and capable of responding to prazosin. Most obstructions occur in the distal urethra
Are empiric antibiotics warranted in male cats with UO?
No - in one study of 34 cats, 0 had positive UC at the time of presentation, and only 13% developed positive UC 24 hours after catheterization
At necropsy in cats with UO, what type of inflammation was noted in the bladder?
Lymphocytic in 78%
Neutrophilic in 71%
usually moderate to severe
In two different studies, did treatment with prazosin reduce the rate of UO recurrence? What were side effects of the drug?
No - no change in relapse in hospital, one month after or 6 months after
Side effects: ptyalism, diarrhea, anorexia, malodorous stool
What factor may be associated with the risk of recurrent UO in cats?
Abnormal urine coloration at the time of catheter removal
What is hypospadias?
Anomalous ventral malposition of the urethral meatus - the urethral opening can be located in the pets, scrotum, perineum, or anus.
- Severe form: underdevelopment or absence of a penis, failure of fusion of the scrotum, failure of the urethra to close in the perineal area
What is pseudohermaphroditism?
Seen with intersex conditions - gonads of one gender are present with the external genitalia of another gender
What conditions are associated with prostatic urethral diverticulae?
Abnormally short and wide pelvic urethra, widened urinary bladder neck, and ureteral anomalies
What primary bladder neoplasm can arise in large breed dogs <18 months of age?
Rhabdomyosarcoma
Why does a decrease in kidney function occur with a ureterolith?
Increases hydrostatic pressure of Bowman’s capsule, thus decreasing GFR. Hydronephrosis can also damage the parenchyma
By 24 hours after a ureteral obstruction develops, what is the reduction in renal blood flow?
Decreased by 60%
Within 7 days of a ureteral obstruction, what percent of GFR is permanently decreased? By 2 weeks?
7 days: 35%
2 weeks: 54%
In feline TCC, what is the most common tumor location? How frequently was metastasis documented?
Trigone
Metastasis in 21%
What is proliferative urethritis?
“Frond-like” inflammatory tissue within the urethral lumen, leading to LUT signs or obstruction
What may be the underlying cause of proliferative urethritis?
- Adherent or invasive bacteria - identified on 7/13 FISH samples in one study
- Possibly an immune component too
