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ACVIM Specialty 2023 Copy > Lower urinary tract part 2 > Flashcards

Lower urinary tract part 2 Flashcards

1
Q

In one study of 163 dogs with USMI, dogs >25 kg were found to have a decreased risk of USMI with what?

A

Risk decreased with every month delay of neuter in the first year

No impact of delayed neutering in smaller dogs

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2
Q

On average, USMI developed how many years after neutering?

A

3.7 years

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3
Q

Injection of cross linked collaged into the urethral sphincter results in continence in what percent of dogs with USMI? How long does it last?

A

68%, lasts ~17 months in one study, 45 months in another study

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4
Q

What is an alternative to collagen for treatment of USMI? How effective is it and how long does it last?

A

Cross linked gelatin (VetFoam) - 87% of dogs achieved continence with one injection, 100% with more. Lasted 11 months

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5
Q

What clinicopathologic changes pre-operatively correlated with post-obstuctive diuresis in cats undergoing SUB or stent placement?

A

Creatinine, BUN, K, Phos - correlated with the duration and maximum severity of post-obstructive diuresis

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6
Q

A dog with SUBs placed due to bilateral ureteral obstruction from TCC developed what two months post-operatively?

A

TCC at the site of the subcutaneous access port of the SUB device :( SUBs may not be great for TCC

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7
Q

In SUB cats with a device obstruction and positive urine culture, what rare complication should be considered?

A

Migration of the SUB into the GI tract

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8
Q

What is the most common long term complication after SUB placement and how often does it occur?

A

Mineralization - 24%, median of 460 days post-placement

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9
Q

SUB mineralization is associated with what clinicopathologic abnormality?

A

High ionized calcium concentration

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10
Q

What is the survival to discharge rate after SUB placement in cats?

A

94%

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11
Q

What imaging modality was superior to ultrasound in diagnosing ureteral calculi in cats?

A

Nonenhanced CT

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12
Q

In a study comparing ureteral stents to SUBs in cats with ureteroliths, which group had a longer MST?

A

MST stent 14 months
MST SUB not reached

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13
Q

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?

A

Stents

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14
Q

In a study comparing ureteral stents to ureterotomy, which group was more likely to have resolution of their azotemia prior to discharge?

A

Stents

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15
Q

What is the sensitivity and specificity of ultrasound for diagnosing ureteral obstruction in cats?

A

Sensitivity 98% for stones, 44% for strictures
Specificity: 96-98% for both

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16
Q

In humans with interstitial cystitis, what lesions are noted in the bladder on cystoscopy?

A

Submucosal petechial hemorrhages (glomerulations)

17
Q

What changes in sensory nerve function have been shown to occur in cats with FIC?

A
  • Increase in substance P (SP) immunoreactivity in sensory neurons
  • Upregulation of neurokinin-1 receptor for SP
18
Q

What abnormalities have been identified in the adrenal glands of cats with FIC?

A

Smaller zonae fasciculata and reticularis

  • Theory: a stressful event permitted maternal glucocorticoids to cross the placenta and inhibit fetal ACTH release
19
Q

What is a theory on maternal stress related to FIC?

A

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

20
Q

Activation of the stress response can lead to what changes in the urinary tract?

A

Increase autonomic, particularly, sympathetic outflow => increased epithelial permeability (acutely) and epithelial damage (chronically)

21
Q

Did low dose meloxicam help prevent the recurrence of FIC? What percent of cats had recurrence?

A

-No meloxicam made no difference
-24% experienced signs of recurrent FIC within 6 months

22
Q

What pro-inflammatory cytokines were increased in cats with FIC?

A

IL-12, IL-18, CXCL12

23
Q

Is decompressive cystocentesis safe or helpful in cats with urethral obstruction?

A
  • 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
24
Q

Why might prazosin be ineffective in preventing recurrent UO in cats?

A

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

25
Q

Are empiric antibiotics warranted in male cats with UO?

A

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

26
Q

At necropsy in cats with UO, what type of inflammation was noted in the bladder?

A

Lymphocytic in 78%
Neutrophilic in 71%
usually moderate to severe

27
Q

In two different studies, did treatment with prazosin reduce the rate of UO recurrence? What were side effects of the drug?

A

No - no change in relapse in hospital, one month after or 6 months after
Side effects: ptyalism, diarrhea, anorexia, malodorous stool

28
Q

What factor may be associated with the risk of recurrent UO in cats?

A

Abnormal urine coloration at the time of catheter removal

29
Q

What is hypospadias?

A

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
30
Q

What is pseudohermaphroditism?

A

Seen with intersex conditions - gonads of one gender are present with the external genitalia of another gender

31
Q

What conditions are associated with prostatic urethral diverticulae?

A

Abnormally short and wide pelvic urethra, widened urinary bladder neck, and ureteral anomalies

32
Q

What primary bladder neoplasm can arise in large breed dogs <18 months of age?

A

Rhabdomyosarcoma

33
Q

Why does a decrease in kidney function occur with a ureterolith?

A

Increases hydrostatic pressure of Bowman’s capsule, thus decreasing GFR. Hydronephrosis can also damage the parenchyma

34
Q

By 24 hours after a ureteral obstruction develops, what is the reduction in renal blood flow?

A

Decreased by 60%

35
Q

Within 7 days of a ureteral obstruction, what percent of GFR is permanently decreased? By 2 weeks?

A

7 days: 35%
2 weeks: 54%

36
Q

In feline TCC, what is the most common tumor location? How frequently was metastasis documented?

A

Trigone
Metastasis in 21%

37
Q

What is proliferative urethritis?

A

“Frond-like” inflammatory tissue within the urethral lumen, leading to LUT signs or obstruction

38
Q

What may be the underlying cause of proliferative urethritis?

A
  • Adherent or invasive bacteria - identified on 7/13 FISH samples in one study
  • Possibly an immune component too

ACVIM Specialty 2023 Copy (38 decks)

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