Urinary Flashcards
What is a ureterocele?
Intravesicular ureterocele with concurrent renal dysfunction. JAAHA 38 (2002)
A cystic dilatation of the submucosal portion of the distal ureter.
What are two main classifications of ureteroceles?
Intravesicular ureterocele with concurrent renal dysfunction. JAAHA 38 (2002)
Entirely within the bladder - intravesicular/orthotopic
Portion with the urethra, and/or in association with an ectopic ureter - ectopic
What are clinical signs associated with ureteroceles?
Intravesicular ureterocele with concurrent renal dysfunction. JAAHA 38 (2002)
dysuria, stranguria, pollakiuria, incontinence, abdominal pain, hematuria, recurrent UTIs,
Complications associated with ureteroceles?
Intravesicular ureterocele with concurrent renal dysfunction. JAAHA 38 (2002)
obstruction of urethra, obstruction of ipsilateral or contralateral ureters, urinary tract infection, permanent renal damage (CKD)
In humans - there are 2 grades of ureteroceles which relate to their association with duplex ureters. (grade 1, 2 & 3) what are their descriptions?
Intravesicular ureterocele with concurrent renal dysfunction. JAAHA 38 (2002)
Associated kidney will have two segments (one for each ureter)
Grade 1 - only involve the ureterocele segment, with no ipsilateral second-segment disease
Grade 2 - damage to both segments of the kidney
Grade 3 - bilateral renal disease
How are ureteroceles graded in dogs (grade 1,2,3).
What is surgical outcome for each grade?
Intravesicular ureterocele with concurrent renal dysfunction. JAAHA 38 (2002)
In addition: each ureterocele is given anatomical classification (intravesicular or ectopic)
Grade 1 - no concurrent ureteral or renal diseae - usually incidental findings with no clinical signifciance - good outcome
Grade 2 - concomitant unilateral hydroureter, hydronephrosis or chronic renal disease. Surgical correction successful
Grade 3 - coexisting bilateral hydroureter, hydronephrosis or CKD.
What are the different forms of ureteral duplication?
Ureteral duplication in a dog.” Veterinary Radiology & Ultrasound. 46.6.
Complete: second ureter drains a portion fo the kidney and enters bladder at discrete junction.
Incomplete: Each renal segment is drained by a separate pelvis and ureter - which unite along the route to the bladder and only one insertion is seen.
Blind ending ureters - blind ending extends caudally or cranially and may enter the ureter or the bladder.
What is the cobra sign?
Seen in ureteroceles: contrast medium fills the distal ureter and its terminal cystic dilation in the urinary bladder
Imaging diagnosis - bilateral orthotopic ureteroceles in a dog. VRU 52.4
When does the twinkling artifact occur?
Twinkling artifact in small animal color-doppler sonography VRU 47.4
Behind a strongly reflective interface (urinary sones, or parenchymal calcifications) and appears as fluctuating mixture of Doppler signals with a characteristic spectrum of noise.
According to this article: Twinkling artifact in small animal color-doppler sonography VRU 47.4. what type of stones will produce a twinkling artifact?
All types of urinary stones. (In vitro studies included magnesium ammonium, calcium oxalate monohydrate, calcium oxalate dihydrate, cystine adn ammonium acid urate stones).
What size stones are more likely to produce a twinkle?
What grades were given to each size group?
Twinkling artifact in small animal color-doppler sonography VRU 47.4
In this study - all focal hyperechogneicities within the bladder produced a twinkle
10mm in one study
10mm - grade 3
In the in vitro study evaluating different types of crystals and their grades - what characteristics of stones produced a higher grade (size of twinkle)
Twinkling artifact in small animal color-doppler sonography VRU 47.4
Larger stones produced higher twinkle artifacts
Stone surface revealed that a mottled surface produced a stronger artifact
All stones produced a subjectively higher grade when the Doppler gain were increased from 60-75%
Which twinkle grade was common for crystalluria -
Grade 1 1cm
Why do they speculate they saw this grade?
Twinkling artifact in small animal color-doppler sonography VRU 47.4
Grade 2
No grade 3 artifact was seen.
Stones with a motlted surface had increased twinkle grades. Crystals are more likely to be bunched together (mottled surface)
What is the grading scale for a twinkle assigned in the paper Twinkling artifact in small animal color-doppler sonography VRU 47.4
Grade 0 - no twinkle
Grade 1 - 10mm
What are typical tumor types for the urinary bladder?
Lymphoma affecting the UB in 3 dogs and 1 cat VRU 47.6
Epithelial:
Transitional cell carcinoma
Squamous cell
Non-epithelial:
leiomyomas, leiomyosarcoma, hemangiomas, hemagiosarcomas
Lymphoma
What are common US findings of lymphoma within the urinary bladder?
Lymphoma affecting the UB in 3 dogs and 1 cat VRU 47.6
Hydronephrosis/hydroureter
Trigone and ventral wall of urinary bladder - heterogeneous
Well-defined luminal-mucosal interface
When lymphoma was found in UB - how many had generalized/diffuse lymphoma?
Lymphoma affecting the UB in 3 dogs and 1 cat VRU 47.6
50% of the patients in that study (2/4)
How long does furosemide have a diuretic effect?
Effects of furosemide on ureteral diameter and attenuation using CT excretory urography in normal dogs VRU 54.1
0.3-2.3minutes
Why is furosemide beneficial in CE-EU (IE - what is drug mechanism)
Effects of furosemide on ureteral diameter and attenuation using CT excretory urography in normal dogs VRU 54.1
Decreases fluid reabsorption
Increases renal blood flow
Increases GFR
What benefits die furosemide have on a 3 minute post contrast scan when compared to the images obtained without furosemide? (90s post furosemide injection)
Effects of furosemide on ureteral diameter and attenuation using CT excretory urography in normal dogs VRU 54.1
Increased # of segments visualized
Increased mean diameter of the ureter
% filling of the ureters did not differ between the two groups
What were benefits of 10 minute post contrast scan in a CT-EU between the two groups, furosemide or no furosemide?
Why?
Effects of furosemide on ureteral diameter and attenuation using CT excretory urography in normal dogs VRU 54.1
No significant benefit because the diuretic effect of furosemide is no longer effective
No difference in # of segments identified
No difference in diameter
HU was less in the furosemide group
Greater filling in the non-furosemide group
What is the theory as to why there was less HU and less overall filling in the furosemide group in the 10 minute post contrast CE-EU scan?
Effects of furosemide on ureteral diameter and attenuation using CT excretory urography in normal dogs VRU 54.1
Furosemide only has effects for 0.3-2.3 minutes.
By 10 minutes (8.5minutes after furosemide) - there is no longer a diuretic effect and the majority of the contrast has been flushed out.
What are differentials for non-visualization of the kidneys/renal pelvis during an excretory urogram?
Excretory urography interpretation - part II California Veterinarian 1980.
Neoplastic disease - replacement of functional tissue Obstruction Renal trauma (rupture, retorperitoneal hemorrhage, thrombosis) Infection - renal abscess
What are differentials for poor visualization (minimal enhancement) of kidneys during excretory urogram?
Excretory urography interpretation - part II California Veterinarian 1980.
Acute/chronic inflammation
Glomerular disease
Poor vascular perfusion
Neoplastic infiltrates
What are differentials for areas of decreased contrast excretion?
Excretory urography interpretation - part II California Veterinarian 1980.
Avascular lesions such as:
cysts, abscess, hydronephrosis, poorly vascularized tumors
How do ectopic ureters develop?
Diagnosis and surgical management of ectopic ureters. Clinical techniques in Small Animal Practice 15.1
Dysembryogenesis of ureteral bud - due to abnormal positioning along the mesonephric duct.
If ureteral bud is higher than normal - results in longer migration distance to reach the urogenital sinus (bladder), and thus migration within the bladder is shortened and causes ureteral orifice to rest closely associated or distal to bladder neck
What is also seen in conjunction with ectopic ureters?
Diagnosis and surgical management of ectopic ureters. Clinical techniques in Small Animal Practice 15.1
Other urinary abnormalities: absent, small/irregularly shaped kidneys, hydronehprosis, hydroureters, tortuous ureter, pelvic bladder, urachal remnants, abnormal shape of ureterovesical junction
Why may male cases be underdiagnosed when compared to females?
Diagnosis and surgical management of ectopic ureters. Clinical techniques in Small Animal Practice 15.1
Males have a longer external urethral sphincter that oppose the passage of urine distally - resulting in retrograde bladder filling
What is considered an abnormal size for a ureter on an IVU?
Diagnosis and surgical management of ectopic ureters. Clinical techniques in Small Animal Practice 15.1
> 0.09x length of L2
Why does hydroureter occur secondary to ectopic ureters?
Diagnosis and surgical management of ectopic ureters. Clinical techniques in Small Animal Practice 15.1
Partial urinary outflow obstruction - mucosal and submucosal layers of intramural tunnel create a roof that acts like a valve, intermittently obstructing flow from the ureter. As pressure within lumen of urethra increases - valve-like opening of displaced ureter is collapsed, obstructing urine outflow.
presence of bacterial infection
What is prevalence of most common post-operative complications associated with ectopic ureters?
Diagnosis and surgical management of ectopic ureters. Clinical techniques in Small Animal Practice 15.1
Continued urinary incontinence in up to 44-67% of cases.
