SA LUT Disease Flashcards
- Where are LUT diseases located?
- Define dysuria.
- Define stranguria.
- Clinical signs of the above 2.
- Define haematuria.
- Define pollakuria.
- Define periuria.
- Bladder (,prostate in males) and urethra.
- Difficulty urinating.
- Straining to urinate - owners may report constipation.
- Vocalisation, licking prepuce / lower abdomen, inappetence, lethargy (similar regardless of cause).
- Bloody urine.
- Increased frequency of urination.
- Voiding in inappropriate places.
Differential diagnoses in cats.
Feline idiopathic cystitis (FIC); overwhelming majority of cases.
- urethral plugs.
- urethral spasm.
- behavioural.
Urolithiasis (10-20% cases).
Bacterial UTI.
Structural LUT disease; e.g. stricture, congenital.
Others, rare - neuro, neoplasia, prostatic.
Differential diagnoses in dogs.
Bacterial UTI (females>males).
Prostatic disease - infectious / neoplastic.
Urolithiasis.
Neoplasia; TCC.
Others, rare:
- urethritis.
- cyclophosphamide induced sterile haemorrhagic cystitis.
- structural LUT disease; e.g. stricture, congenital.
- neuro disease.
Diagnostic approach to LUT disease.
Signalment - sex, age, spp.
Hx.
CE.
- focus on genital area, rectal, testicles.
Urinalysis.
Imaging.
- US.
- Rads.
Prostatic samples.
Other lab diagnostics.
Hx taking for LUT cases.
Signs of LUT disease - as described.
MOST importantly - still able to pass urine?
- urinary obstruction = emergency.
– hyperkalaemia.
- obstruction MOST common with:
– FLUTD.
– urolithiasis (males>females).
– neoplasia.
– prostatic disease.
CE for LUT cases.
Abdominal/bladder palpation.
- often (not always) large if obstructed.
- painful?
Rectal exam:
- prostate; enlargement, symmetry, discomfort.
- urethra – uroliths?
- pain – often indicates inflammatory/infectious disease.
Penile/preputial/vulval/vaginal exam.
Neuro exam - indicated if HL ataxia, difficulty posturing, dribbling urine.
Identifying urinary obstruction.
Hx - unproductive urination attempts.
Exam:
- tense, usually large painful bladder.
– not palpable? Ruptured? AFAST.
- Associated complications.
– bradydysrhythmias.
–> life-threatening hyperkalaemia.
IMMEDIATE vet treatment.
LUT patient basic urinalysis.
USG.
- submaximally concentrated.
– appropriate vs pathological.
–> <1.030 in dog.
–> <1.035 in cat.
Dipstix analysis.
Urine biochemistry.
- NB. except some proteinuria (LUT inflammation).
LUT patient microscopy and culture.
Sediment exam (plain tube).
- crystals.
– true vs storage artefact.
– normal vs abnormal.
– calcium oxalate dihydrate and struvite crystals normal in healthy cats and dogs.
–> abnormal if present with stones.
– urate, cystine always pathological.
- bacteria.
– asymptomatic bacteriuria vs UTI.
Cytology (EDTA tube).
- cells – inflammatory, neoplastic.
- do not refrigerate.
Culture.
- refrigerate if not immediate.
May see WBCs suggestive of infection or inflammation.
LUT patient imaging.
US.
- for cystocentesis.
- bladder wall morphology.
- prostatic parenchyma.
- uroliths.
Radiography.
- plain.
– uroliths (radio-opaque).
– prostato/lymphadenomegaly.
- contrast, double contrast.
– uroliths (radiolucent).
– masses, polyps, strictures.
Further diagnostics for the LUT patient.
Haematology, serum biochemisty.
- underlying systemic disease?
Free abdominal fluid? - analyse.
Prostatic wash/suction.
Bladder suction biopsy.
Cystoscopy.
Concept of asymptomatic bacteria.
Bacteria in absence of clinical signs of a UTI.
Common.
No evidence of increasing risk of UTI, adverse urinary events or adverse systemic events.
ONLY evaluate urine for bacterial presence IF there would be rationale to treat.
Urine collection methods for urinalysis.
Free-catch (mid-stream) (dogs).
Litter tray (cats) - non-absorbent.
Cystocentesis.
- preferred for culture.
Catheterisation.
- dogs vs cats.
- male vs female.
- can culture, although less sterile than cystocentesis so interpret results accordingly.
Predisposing factors to UTI?
Indwelling u cath.
Nidus (‘lith, suture).
Structural UT disease.
Abnormal voiding.
Sub-maximally concentrated urine.
Immunosuppression/systemic disease.
Need to treat and manage underlying disease too.
- Treatment of sporadic bacterial cystitis?
- Other treatment considerations.
- Ideally treat based on C&S.
Ideally NSAID only pending results.
Amoxicillin OR TMPS.
3-5d course. - Fresh water access.
Enable frequent voiding.
Keep vulva/prepuce clean and free from urine scald.
- UTIs typically due to ascending infection.
If alkaline pH, consider evaluating for struvite uroliths.
- Most common bacteria to cause UTI?
- Possible complications of UTIs?
- E. coli.
- Struvite uroliths.
- urease producing bacteria; staphylococcus spp., proteus spp.
Pyelonephritis.
Polypoid cystitis.
Emphysematous cystitis.
Complicated UTIs guidance referral?
ISCAID guidelines.
(International Society for Companion Animal Infectious Diseases).
Managing complicated UTIs.
Evaluate and treat underlying cause.
Base tx on C&S.
- prostatic – ideally pend C&S.
– only TMPS, fluoroquinolones and doxycycline will penetrate.
–> 3-6w course.
– neuter entire ma;e dogs 1-2w into tx.
- pyelonephritis – treat pending C&S.
– Quinolone –> 7-14d course.
- Re-culture.
– ~1w into tx to demonstrate control.
– 1-2w after stopping tx.
Feline idiopathic cystitis (FIC).
Susceptible cat in a provocative environment.
Susceptible cat:
- neuroendocrine modulation.
– adjusted sensory nerve function.
– abnormalities of the CNS stress response.
- GAG layer hypofunction.
Environmental stress manifests as FLUTD.
Similarities with human Interstitial Cystitis.
FIC presentation.
Non-obstructed.
- pollakuria.
- strang/dysuria.
- haematuria.
- still able to void.
- often self-limiting.
- may experience recurrent episodes.
Obstructed.
- urethral spasm or plug.
- unproductive attempts to urinate.
- emergency.
- more common in males (non-obstructive equi-prevalent).
– high recurrence rates.
– >40% experience a recurrence within 6-12m.
NEVER ATTEMPT TO EXPRESS BLADDER.
Managing FIC.
If FLUTD signs, young cat, first episode, non-obstructed:
- manage medically.
Obstructed; alleviate obstruction then manage medically.
Diagnostics (imaging) for underlying cause if:
- obstruction.
- recurrent episodes.
– if young, probably still FIC, but exclude other causes e.g. urolithiasis.
- older cat.
- exam abnormalities.
The obstructed cat.
Unproductive attempts to urinate:
- owners frequently report ‘constipation’.
Urethral obstruction.
- back pressure on kidneys so post renal azotaemia.
- hyperkalaemia.
Small or large, painful bladder.
Agitated/painful vs depressed.
Emergency management of hyperkalaemia.
Definitive correction requires alleviation of obstruction.
- u cath – requires anaesthesia.
Hyperkalaemia needs addressing first.
- fluid therapy.
- drug therapy – glucose, insulin, calcium gluconate.
Bladder decompression rarely required in interim.
- if cystocentesis needed; butterfly needle and drain as much as you can – small risk of rupture.
Analgesia with opioids during stabilisation, pending GA.
Equipment for u cath?
Clippers, Hibi and swabs for prep.
Drapes.
Gloves.
Lubricant.
Urinary catheter.
Saline.
Suture material.
Forceps, needle holders.
Syringe.
Urine pot.
Collection bag.
Buster collar.
