Non-obstructed Lower Urinary Tract Disease Flashcards
What are the components of the lower urinary tract/
Bladder, urethra, prostate
What history/clinical signs is consistent with lower urinary tract disease?
Dysuria Pollakiuria/periuria Stranguria Pigmenturia Incomplete voiding Urinary incontinence
What are possible causes of dysuria/stranguria/pollakiuria ??
Irritation of bladder (bacterial/uroliths/interstitial cystitis)
Neurological disease
Secondary lower urinary tract disease
Neoplasia
You have a history of dysuria, pollakiuria, stranguria and urinary incontience…
what should you include in your physical exam ?
General
Abdominal palpation
Rectal exam
Vaginal exam
Penile/preputial exam
Watch urination
Palate bladder after urination
You have a history of dysuria, pollakiuria, stranguria and urinary incontience…
What further diagnostics would you like to do??
Collect urine on free flow and cysto
Sediment
Culture
Urethral cytology
Imaging -> radiograph/ US
Cystoscope
Bladder biopsy
Excretory contrast studies
Urethral profilometry (measure urethral pressure)
Your urine is dark yellow/orange coloured. What is the pigment?
Bilirubin
Your urine is red coloured. What is the pigment
Hematuria
Pigmenturia
-> hemoglobin/myoglobin
What are causes of hematuria?
Renal dz
Lower urinary tract dz
Reproductive (prostatic, vaginal, uterine dz)
Systemic dz (bleeding disorder/hypertension/hyperviscosity)
What species more commonly have urinary tract infections??
Dogs (14% are affected during lifetime)
Females >males
Wha are the normal host defenses against UTI?
Normal micturition Anatomy Mucosal defenses Urine properties Systemic immune system
What endocrine disorders can predispose to UTI?
Diabetes mellitus
Cushings
What abnormal anatomy can predispose an animal to UTI?
Hooded vulva
Recessed vulva
Urachal diverticulum
What microbial isolates are most common in UTI?
Ecoli
What are the possible microbial isolates of UTI?
Ecoli
Gram positive cocci
Proteus Klebsiella Pseudomonas Mycoplasma Pasturella Cornybacterium
T/F: most UTIs are due to multiple microbial organisms
False
- usually a single species
Which is the most common route of infection causing UTI?
Ascending
Hematogenous infections are uncommon
What is the best therapy for an uncomplicated UTI??
Empirical antibiotics
Amoxicillin, cephalosporins, and TMS
-> excreted in urine
Enrofloxacin should not be first line —> can lead to multidrug resistance
UTI
Culture and sensitive is positive with a new organism at > 7days after last treatment of antibiotics
What type of UTI is this?
Complicated UIT —> reinfection
UTI
Culture and sensitivity is postive with an new organism at day 7 after starting antibiotics
What type of UTI is this?
Complicated UTI
—> superinfection
UTI
Culture and sensitivity is positive with the same organism 7 days after the last treatment course
What type of UTI is this?
Relapse
What should you do if you have a recurrent UTI??
Determine cause
-imaging, culture, check for underlying dz, search for nudus
Review antimicrobial history
-drug choice, dose, freq, duration, compliance
Urine concentration
Culture - pretherapy/ during/ post
Extended course (4-6wks)
When might you concider prophylactic therapy for ruecurent UTIs?
Once infection eradicated
Drug that concentrates in urine with few side effects
Once daily at bedtime
Nitrofurans
Regular microbiology
If C&S is neg for 6 months -discontinue
Alternative therapies for UTI??
Cranberry extract
Probiotic (restore vaginal flora)
Polysulfated glycosaminoglycans (form coating on bladder wall)
Fosfomycin -> MDR Ecoli
What should you check for if you have a fungal UTI??
Underlying dz
- diabetes
- excess glucocorticoids
