Lower Urinary Tract Problems/dz (Specht)

Question 1

Objectives

Answer 1

1. Be able to describe common clinical signs of lower urinary tract diseases.
2. Be able to describe common diagnostic tests used in cases of lower urinary tract disease and what these tests can tell you.

Question 2

Most common disorder in dogs

Answer 2

1. uroliths
2. infections
3. neoplasias
4. congenital abnormalities
5. functional disorders

Question 3

Most common disorders in cats

Answer 3

1. idiopathic
2. uroliths
3. infections
4. neoplasias
5. functional disorders

Question 4

Urinary dz must be differentiated from

Answer 4

behavioral shtuffs

Question 5

Primary HX evidence of LUTD

Answer 5

• dysuria
  
  • strangury or urgency
  • vocalization
  • pollakiuria
  • abnormal stream
• incontinence
• periuria (inappropriate urination)
• pigmenturia or discoloration
  
  • not specific, but common

Question 6

Signs not associated with LUTD

Answer 6

• Generally not PU/PD
• In most cases w/o obstructions:
  
  • few systemic signs

Question 7

Diagnosis goals

Answer 7

• verify problem has a medical origin
• characterize the problem
  
  • type of CS or abn test results
  • mechanical/structural vs functional
• Localize problem to LUT or spec location in LUT
• Attempt to find specific etiology

Question 8

Methods of diagnosis

Answer 8

• UA
  
  • pigmenturia/hematuria
  • pyuria
  • crystalluria
  • bacteriuria
  • neoplasia
• free catch vs cysto
  
  • artifacts
  • localization

Question 9

Lab DX tests

Answer 9

• Chem, CBC
  
  • values not related to LUT
  • can provide info about
    
    • underlying risk factors: liver dz, stones
    • concurrent dz: polyneuropathy (incondinence)
• Microbio (culture): almost always wanted/needed
  
  • typically aerobic
  • occasional odd bugs
  • not used in uncomplicated 1st offenders

Question 10

Diagnostic imaging

Answer 10

• rads
  
  • primary stones
• ultrasound
  
  • poor at finding urethral lesions
• contrast studies
  
  • positive (contrast)
  • negative (air)
  • double (both)
  • relevant LUT locations (look at entire urinary tract)
• Endoscopy
  
  • direct visualization
  • potential for sampling or intervention

Question 11

Other DX

Traumatic catheterization

Answer 11

• to get tissues
• cytology
• biopsy

Question 12

Feline LUTD

about

Answer 12

• Very common problem
• non specific CS
  
  • pollakiuria, hematuria, strangury, periuria, dysuria
• numerous etiologies
  
  • urolithiasis, infection, neoplasi

Question 13

Feline LUTD

Terminology

Answer 13

• FIC (feline idiopathic cystitis)
  
  • FUS
  • iFLUTD
• may account for > 50% of all FLUTDs

Question 14

FIC

Biologic behavior

Answer 14

• variable
• may be complicated by obstruction (urethral plugs)
• often resolves in 2-7 days (85%)
  
  • 39-55% have recurrence
  • some have persistence

Question 15

FIC

DX

Answer 15

• often presumptive
  
  • HX
  • physical examination
  • +/- labwork
• Diagnosis of exclusion
  
  • R/O all other reasonable causes
• Average case we recommend
  
  • UA (w/ sediment exam) - will have inflammation
  • Urine culture
  • Rads
  • other tests may not be necessary

Question 16

If CS of LUTD persist or recur frequently

Answer 16

• serum chem
• CBC
• ultrasound
• contrast urethrocytography
• urethrocytoscopy
• +/- biopsy

Question 17

FIC

TX options

Answer 17

• Do nothing: mild CS, infrequent, episodic
• inc H₂O consumption
  
  • canned food, lots of water bowls, fountains
  • avoid changing diet frequently
• Environmental enrichment
  
  • litterboxes
  • social interaction (+/- people, cats, etc)
• Feliway
• Tricyclic antidepressants
  
  • amitryptyline
  • clomipramine
  • no good evidence for other anti-depressants
• Analgesics

Question 18

Antidepressants and FIC

Answer 18

• Tricyclic antidepressants
  
  • amitryptyline
  • clomipramine
• should be reserved for severe cases
  
  • reduce anxiety
  • antiinflammatory
  • other
• must be withdrawn slowly
  
  • to avoid rebound
• drug interactions
• Other anti-depressants don’t have good evidence
  
  • buspirone
  • fluoxetine

Question 19

TX for FIC that doesn’t work

Answer 19

• Glycosaminoglycans
• steroids, NSAIDS
• antibiotics unless culture shows an infection

Question 20

LUTD

Take home points

Answer 20

1. LUTD is common in felines
2. Many cats with inappropriate urination have a medical problem
3. Most often problem is FIC
4. There are many options for cats that need tx, but little evidence
   
   • H₂O, MEMO, Diet
5. CLient Education important
6. Most cats don’t require tx

*Spend 20 minutes with client, tell them you understand, and there is not much you can do, decreases euthanasia rate