Urinary Flashcards
Breed, Sex, and Age Predispositions for… Urinary Calculi Struvite?
Miniature Schnauzers, Bichon Frises, Cocker Spaniels, Shih Tzus, Miniature Poodles, Lhasa Apsos
- Females more than males, middle-aged dogs
- Urinary tract infection with urease-producing bacteria (e.g., Proteus, Staphylococcus)
Calcium Oxalate?
- Miniature Schnauzers, Shih Tzus, Pomeranians, Yorkshire Terriers, Maltese, Lhasa Apsos, Bichon Frises, Cairn Terriers, Miniature Poodles
- Males, neutered males more than intact males, middle-aged to older dogs, obese dogs
Calcium Phosphate
Yorkshire terrier
Urate
• Dalmatians and English Bulldogs • Dogs with congenital portosystemic shunts (Yorkshire Terriers, Miniature Schnauzers, Pekingese)
Silicate?
• German Shepherds, Old English Sheepdogs • Males, middle-aged dogs
Cystine?
• Dachshunds, Basset Hounds, English Bulldogs, Newfoundlands, Chihuahuas, Miniature Pinschers, Welsh Corgis, Mastiffs, and Australian Cattle Dogs • Males, middle-aged dogs
Low; Evaluation of trends in urolith composition and characteristics of dogs with urolithiasis: 25,499 cases. JAVMA 2010 Over the past 20 years, a long-term increase in the proportion of canine urinary calculi that contain ______________ has been noted, along with a long-term decrease in the proportion of canine urinary calculi that contain ___________
calcium oxalate; struvite
Low; Evaluation of trends in urolith composition and characteristics of dogs with urolithiasis: 25,499 cases. JAVMA 2010; Male of female dogs have more struvite?
Female dogs tend to have more struvite-containing calculi than male dogs, most likely owing to the association with urinary tract infection
Pathophys of struvite calculi in dogs
Struvite (magnesium ammonium phosphate) caused by UTI with urease-producing bacteria, which split urea to ammonia and carbon dioxide. Hydrolysis of ammonia forms ammonium ions and hydroxyl ions, which alkalinize the urine and decrease struvite solubility.
Calcium oxalate calculi occur most commonly in dogs with what?
transient, postprandial hypercalcemia and hypercalciuria. Many affected dogs have low-to-normal serum parathormone concentrations.
Urate calculi usually are composed of _________________ derived from metabolic degradation of endogenous______ribonucleotides and dietary nucleic acids. Dalmatians have defective hepatic transport of____________, resulting in decreased production of ___________ and increased urinary excretion of__________. Dalmatians also have decreased ___________ resorption and _________ secretion of uric acid, making urate urolithiasis common in this breed.
Urate calculi usually are composed of ammonium acid urate derived from metabolic degradation of endogenous purine ribonucleotides and dietary nucleic acids. Dalmatians have defective hepatic transport of uric acid, resulting in decreased production of allantoin and increased urinary excretion of uric acid. Dalmatians also have decreased proximal tubular resorption and distal tubular secretion of uric acid, making urate urolithiasis common in this breed.
Treatment for Urate stones?
Urate
• Surgical removal; • Voiding hydropropulsion if stones are small enough; • Dissolve stones using alkalinization with sodium bicarbonate or potassium citrate; feed Hill’s u/d diet; administer allopurinol
Treatment for cystine stones?
Surgical removal; • Dissolve stones by feeding Hill’s u/d diet and administering D-penicillamine or N-(2-mercaptopropionyl)-glycine (MPG)
Silicate uroliths are often ____shaped and probably are related to increased dietary intake of silicates, silicic acid, or magnesium silicate (Fig. 26-31). Two breeds that are at increased risk for formation of silica-containing urinary calculi???
jack shaped; GSD and Old English Sheepdog
Cystine uroliths occur because of an inherited disorder of ____________ __________ __________. Cystine stones usually occur in _____ urine
Cystine uroliths occur because of an inherited disorder of renal tubular transport. Cystine stones usually occur in acidic urine.
Low Javma 2010 paper: Urate uroliths most commonly occur in Dalmatians and PSS dogs; however, a predisposition in what other breed has recently been recognized?
Not just Dalmations and shunt dogs…..English Bulldogs too!
Grant Holmium:YAG lithotripsy for urolithiasis in dogs. AJVR, 2008,
?
Lulich, JP, Osborne, CA, Albasan, H, et al.: Efficacy and safety of laser lithotripsy in fragmentation of urocystoliths and urethroliths for removal in dogs. J Am Vet Med Assoc. 234, 2009, 1279.
?
The most common complication following cystotomy is failure to remove all the stones, which is reported to be as high as __% (Grant et al, 2010).
20%
Grant; Frequency of incomplete urolith removal, complications, and diagnostic imaging following cystotomy for removal of uroliths from the lower urinary tract in dogs: 128 cases (1994-2006). J Am Vet Med Assoc. 2010
- 20% incomplete removal rate after cystotomy - in the very few (15%) that had “appropriate postop imaging”, 42% had incomplete removal - patients with both cysto- and urethra-liths had a higher likelihood of incomplete removal
Hypothesized that variation in bladder tumors in dogs vs cats d/t differences in the metabolism of ________ and its carcinogenic intermediary metabolites. Although dogs excrete aromatic amine metabolites of ________ in appreciable quantities into their urine, feline urine is almost devoid of them. Prolonged contact of the bladder mucosa with such carcinogenic substances may be important in the development of tumor.
tryptophan; tryptophan
What drug may cause bladder neoplasia in dogs?
Cyclophosphamide may also cause bladder neoplasia in dogs
Besides TCC; other malignant bladder tumors? (name at least 5). Dont forget this one: A rare bladder tumor that may occur in young large-breed dogs and young cats.
TCCs are the most common tumors in canine and feline bladders; other malignant bladder tumors include squamous cell carcinoma, adenocarcinoma, fibrosarcoma, leiomyosarcoma, neurofibrosarcoma, rhabdomyosarcoma, and hemangiosarcoma. The rare tumor is Botryoid Rhabdomyosarcoma
Benign bladder tumors?
Fibroma, leiomyoma, hemangioma, rhabdomyoma, myxoma, and neurofibroma are benign bladder tumors.
True or False? Dogs with bladder tumors commonly have other concurrent, primary tumors elsewhere.
True
TCCs are the most common canine urethral neoplasms; urethral tumors are exceedingly rare in cats. Other urethral tumors?? (Name 2)
squamous cell carcinoma and adenocarcinoma
Urethral neoplasia must be differentiated from what other urethral problem that has similar clinical signs? Treatment for this non-neoplastic condition of the femal canine urethra?
Proliferative urethritis and granulomatous inflammation of the urethra in female dogs. CS’s: stranguria, hematuria, pollakiuria, vaginal discharge, and/or urinary obstruction. The cause of granulomatous urethritis is unknown. Affected dogs may respond favorably to immunosuppressive therapy (i.e., prednisone or prednisone plus cyclophosphamide)
______ is highly expressed in TCC cells, and it has been suggested that this isoform may be involved in tumor cell growth.
COX-2
Arnold. Clinical trial of _______ in dogs with transitional cell carcinoma of the urinary bladder. JVIM 2011; In this What drug was shown to have anti-tumor activity against TCC in dogs?
vinblastine
McMillan: Antitumor effects of ________ treatment in 26 dogs with transitional cell carcinoma of the urinary bladder. J Am Vet Med Assoc. 239, 2011, 1084. What drug did McMillan study?
Deracoxib
McMillan Deracoxib/TCC paper; - dogs with TCC got Deramaxx __ mg/kg/day. No control group
- MST =_____days, mean time to progressive dz =____days
__% had renal side effects, __% had liver side effects, __% had GI side effects
- dogs with TCC got Deramaxx 3 mg/kg/day. No control group
- MST = 323 days, mean time to progressive dz = 133 days
- 4% had renal side effects, 4% had liver side effects, 19% had GI side effects
- authors say this proves deracoxib has anti-tumor activity
Median survival in cats with TCC of the urinary bladder was reported at _____days; it was shown to be more prevalent in male cats, even though the condition itself is uncommon (Wilson et al, JAVMA 2007)
MST = 261 days (published in 2007)
Cooper, A protocol for managing urethral obstruction in male cats without urethral catheterization. JAVMA 2010
If catheterization is unsuccessful or is not allowed because of financial constraints, a conservative medical approach consisting of housing the cat in a quiet, nonstressful environment; administering acetylpromazine, buprenorphine, and medetomidine for sedation and analgesia; repeatedly emptying the bladder via cystocentesis; and administering subcutaneous fluids as needed has been described. It was successful in 11 of 15 (Cooper JAVMA 2010)
NEPHROSTOMY
Berent AC Use of locking-loop pigtail nephrostomy catheters in dogs and cats: 20 cases (2004-2009). J Am Vet Med Assoc. 2012
- 5 Fr and 6 Fr pigtail nephrostomy tubes placed percutaneously and via laparotomy
- How many leaked? __ (__% urine leakage)
- loop is about __ to __ mm (5Fr) and __ mm (6 Fr) around. Authors recommende placing these via laparotomy if the pelvis is < __ mm
- 5 Fr and 6 Fr pigtail nephrostomy tubes placed percutaneously and via laparotomy
- only 1 (5%) urine leakage
- loop is about 10-12 mm (5Fr) and 15mm (6 Fr) around. Authors recommende placing these via laparotomy if the pelvis is < 10 mm
Buote NJ, Kovak-McClaran JR, Loar AS, Cherrone KL. The effect of preoperative antimicrobial administration on culture results in dogs undergoing cystotomy. J Am Vet Med Assoc. 2012 Nov 1;241(9):1185–9.
- 41 dogs undergoing cystotomy for uroliths, approx.. half of them had positive culture from sx sample
- randomized into: Antibiotics at induction and Antibiotics right after surgical samples taken
- no difference in the cultures (positivity or bacterial type) between groups
- authors encourage all 3 samples submitted: swab of urine, mucosa, and stone
Westropp JL, Sykes JE, Irom S, Daniels JB, Smith A, Keil D, et al. Evaluation of the efficacy and safety of high dose short duration enrofloxacin treatment regimen for uncomplicated urinary tract infections in dogs. J Vet Intern Med. 2012 May;26(3):506–12.
- enrofloxacin group got 18-20 mg/kg q 24 hours for 3 days
- Clavamox group got 13.75-25 mg/kg q 12 hours for 14 days
- High dose short duration enrofloxacin was not inferior to accepted Clavamox protocol
- authors hope this regimen will prove to improve compliance and decrease drug resistant bug breeding
Olby NJ, MacKillop E, Cerda-Gonzalez S, Moore S, Muñana KR, Grafinger M, et al. Prevalence of urinary tract infection in dogs after surgery for thoracolumbar intervertebral disc extrusion. J Vet Intern Med. 2010 Aug;24(5):1106–11.
- 25 dogs nonambulatory at sx, most regained motor & voluntary urination during study
- Urinalysis at some point during visit, cultures at 1 and 3 months
- 38 % dogs DEVELOPED UTI’s in the 3 months (no UTI’s during initial visit)
- high prevalence despite fact that most dogs walking by 1 month
- 60 % of UTI’s were occult (no pyuria on UA)
- conclusion: even walking peeing dogs should have urine culture for 3 months postop
- trend toward risk factors for UTI: Dachshunds, females, plegic @ presentation, nonambulatory @ 3 mo
Sullivan LA, Campbell VL, Onuma SC. Evaluation of open versus closed urine collection systems and development of nosocomial bacteriuria in dogs. J Am Vet Med Assoc. 2010 Jul 15;237(2):187–90.
- low incidence of nosocomial UTI (about 10 %) IF catheters are short term (median 2 days) and IF you follow UCD protocol, regardless of whether you replace IV bag (“open system”) or use commercial bag (“closed system”)
- UCD protocol involves thorough cleaning of line & five flushes of prepuce/vulva every 8 hours or whenever catheter is visibly soiled
Bubenik L, Hosgood G. Urinary tract infection in dogs with thoracolumbar intervertebral disc herniation and urinary bladder dysfunction managed by manual expression, indwelling catheterization or intermittent catheterization. Vet Surg. 2008 Dec 1;37(8):791–800.
- 62 dogs with TL IVDD randomized into manual expression, indwelling cath, or intermittent cath
- 21% overall UTI rate
- almost 50% of bugs had some resistance
- duration of bladder management affected risk of UTI, not method
- each day increased risk 1.5 x
- took longer for dogs with indwelling caths to be recognized as peeing on their own
- suggest removing catheters within 4 days of surgery
Barrett M, Campbell VL. Aerobic bacterial culture of used intravenous fluid bags intended for use as urine collection reservoirs. J Am Anim Hosp Assoc. 2008 Jan 1;44(1):2–4.
- Used IV fluid bags (IV line left in & tied, or IV spike removed and sterile 1 ml syringe)
- stored for 0-17 days
- 95 bags cultured – none grew any bacteria
- conclusion: used IV bags stored for < 17 days can be used as urine collection bags
(also see SSI and Abx summary for landmark study)
