Urinary System Flashcards
What’s the distribution of grades for iUC?
70% grade 3
29% grade 2
1% grade 1
What is the rate of nodal and distant metastasis at necropsy for dogs with iUC?
Nodal: 42%
Distant: 48% –> lungs = most common (50%)
33% had both nodal and distant metastasis
What % of bony metastasis is noted on necropsy for dogs with iUC?
9-14%
What’s the percentage of urethral and prostate involvement for canine iUC?
urethra: 58%
prostate: 29%
What’s the percentage of 2nd tumour for canine iUC at necropsy?
13%
Explain the WHO staging for iUC.
Based on the WHO iUC staging, what’s the percentage of dogs with T2 and T3 tumours?
T2 = 78%
T3 = 20%
Which genetic mutation is detected in 80% of canine iUC?
B-raf
this is part of MAPK pathway
Which 2 IHC’s are commonly used for iUC?
uroplakin III
GATA 3
What’s the outcome of partial cystectomy + COX2 inhibitor +/- chemo for canine iUC?
Marvel 2017: PFI = 235 days, MST = 348 days. Subset of patient MST = 722 days (daily piroxicam therapy, with or without chemotherapy)
Fullkerson 2015: MST = 749 days
What is the outcome with urethral stents for canine iUC?
Urethral stents: MST 20-78 days
lower urinary signs persist
incontinence in 25-39% of dogs
What is the outcome with ureteral stents for canine iUC?
Ureteral stents: MST 57 days
What’s the utility of CO2 and infrared ablation for canine iUC?
has complications, and may be no better than medical management alone
What’s the outcome of radiation therapy for canine iUC?
Nolan 2012: PFI = 317 days, MST = 654 days
Prescriptions for initial courses of IM/IGRT ranged from 54–58 Gy delivered in 20 daily fractions on a Monday to Friday basis (2.7–2.85 Gy per fraction administered over 28–31 days)
What are some acute and late RT side effects for canine iUC?
From Nolan 2012:
Acute side effects = colitis - 38%; hyperpigmentation/ erythema - 19%; stranguira - 5%
Late side effects = urethral stricture - 9%; rectal and ureteral stricture - 5%
What’s the outcome of palliative RT for canine iUC?
From Choy and Fidel 2016:
CR/PR = 60%
SD = 30%
10 daily fx @ 2.7 Gy
What is the outcome of vinblastine single agent for canine iUC?
2-2.5mg/m2 IV every 2 weeks –> PFI = 143 days, MST = 407 days. With piroxicam afterwards = 531 days
Vinblastine + piroxicam = better response rate than vinblastine alone (58% vs 22%) –> PFI = 199 days, MST = 299 days
What is the outcome of mitoxantrone single agent for canine iUC?
Mitoxantrone + piroxicam –> 35% remission rate, MST = 241 days
What is the outcome of carboplatin single agent for canine iUC?
Carboplatin + piroxicam –> 38% remission, but more side effects compared to other protocols
What is the outcome of metronomic chemotherapy for canine iUC?
Chlorambucil @ 4mg/m2 PO daily
- PR in 1 dog (3%), SD in 20 (67%)
PFI = 119 days, MST = 221 days
- 10% with bone marrow suppression @ 3 months
80% @ 1 year
What is the outcome of COX inhibitor for canine iUC?
Piroxicam:
- CR 3%, PR 18%, SD 59%
PFI = 120 days, MST = 244 days
Firocoxib:
- CR 0%, PR 20%, SD 33%
Deracoxib:
- CR 0%, PR 17%, SD 71%
What are some alternative medical treatments for canine iUC?
Palladia + vinblastine – no better than vinblastine alone protocols
Vemurafinib – targets Braf, but has paraneoplastic cutaneous SCC
What are some prognostic factors for canine iUC?
- TNM staging
- young age – increases risk of nodal metastasis
- prostate involvement – increases risk of distant metastasis
- increased T stage – increases both nodal and distant metastasis
What’s the effectiveness of squash preparation for canine iUC?
The absence of neutrophilic infiltration, the presence of multinucleated cells, and nuclear molding were associated with urinary bladder carcinoma, resulting in a sensitivity of 0.98, specificity of 0.65, accuracyof0.89, PPVof0.88, and NPVof0.92
Usefulness of squash preparation cytology in the diagnosis of canine urinary bladder carcinomas. Pierinin 2022
What’s the outcome of Palladia for canine iUC?
- 6.7% PR, 80% SD (median duration 128.5 days)
- MST 149 days
- 34/37 received prior chemo
- median dosage of TOC given was 2.44 mg/kg (range 1.34–4.88 mg/kg)
Use of Toceranib Phosphate in the Treatment of Canine Bladder Tumors: 37 Cases.
Gustafson & Biller 2019
How does the survival time differ in patients with urethral vs bladder involvement for canine iUC?
- Compared to the Bladder group (n = 16), the Urethra group (n = 26) had higher metastasis rates to the bone (6.3% vs 42.3%; P = .045) and lung (6.3% vs 46.2%; P = .022).
- The survival time was shorter in the Urethra group than in the Bladder group (121.5 vs 420 days)
Survival analysis in dogs with urinary transitional cell carcinoma that underwent whole-body computed tomography at diagnosis. Iwasaki et la 2019
What’s the effectiveness of using IHC for BRAF (V595E) for canine urothelial vs prostate carcinoma?
Using IHC, BRAF(V595E) was detected in 72/122 (59%) UC and 14/21 (65%) PC
Effective detection of BRAF(V595E) mutation in canine urothelial and prostate carcinomas using immunohistochemistry. Aeschlimann et al, 2024
What’s the treatment outcome of canine iUC using RT, mitoxantrone, and NSAID?
- 57Gy in 20 fx
- Event free survival and OST for all dogs were 260 days and 510 days, respectively
- permanent urinary incontinence developing in 31% of dogs at a median of 70 days post-irradiation.
- OST shorter with prostatic involvement and severe clinical signs (EFS and OST)
What’s the outcome of balloon dilation for urothelial obstruction secondary of canine iUC?
- clinical improvement in 9/12
- recurrence noted in 5 (48 - 296 days)
What’s the outcome of feline iUC with treatment?
Surgery, chemo, NSAID, or combination - MST = 261 days
Clinical signs, treatments,
and outcome in cats with transitional cell carcinoma of the urinary
bladder: 20 cases (1990-2004). Wilson et al 2007
MST 311 days
mean dose = 0.09mg/kg/day
Clinical features, survival
times and COX-1 and COX-2 expression in cats with transitional
cell carcinoma of the urinary bladder treated with meloxicam. Bommer et al 2012
What’s the outcome of palliative RT for feline iUC?
4 weekly x 6Gy
- Urinary signs resolved for all 4 cats during the treatment,
- 2 cats showing improvement after the first treatment
- 2 after the second treatment
- acute radiation side effects included two grade 1 gastrointestinal and one grade 2 genitourinary.
Palliative radiation therapy as a treatment for feline urinary bladder masses in four cats. Yoon et al 2022
What’s the most common presenting clinical signs for cats with bladder carcinoma?
Hematuria (74/118; 62.7%)
Polakiuria (59/118; 50%)
Stranguria (57/118; 48.3%)
What’s the metastatic rate of feline bladder carcinoma on presentation?
15/118 (12.7%)
- regional LNs = most common (7.6%)
- abdominal carcinomatosis (2.5%)
- 1 cat each of LN and omentum, presumed lung met; LN and presumed lung met
What’s the median time to tumour recurrence and MST for cats that undergone partial cystectomy for urinary carcinoma?
205 days, MST = 294 days (+/- other adjunct treatment)
MST = 155 days for all cats (46 days for untreated; 176 days without partial cystectomy)
What’s a differential for canine urethral tumour?
granulomatous urethritis (24%)
What are the most common presenting signs for canine renal tumour?
hematuria
local pain
hypertrophic osteopathy
What are some ddx for canine renal tumours?
- renal cell carcinoma
- adenocarcinoma
- iUC
- cystadenocarcinoma
What syndrome can be caused by mutation in FLCN?
The syndrome is similar to BHD syndrome in people
- seen in German Shepherds –> nodular dermatofibrosis, renal cystadenocarcinoma, and uterine tumours
What’s the MST of treatment for canine renal tumours?
Sarcoma = 9m
RCC = 16m
Nephroblastoma = 6m
What are some negative prognostic factors for canine renal tumours?
- increased mitotic index
(< 10 = 1184 days; 10-30 = 452 days; > 30 = 187 days) - increased COX-2 expression
- histologic subtype (clear cell - 87 days)
- increased Fuhrman grade
(grade 1= not reached; grade 2 = 1065 days; grade 3 = 379 days; grade 4 = 87 days)
What’s the criteria for Fuhrman grade?
Fuhrman grade categories
Grade 1: Inconspicuous nucleoli at 400x magnification
Grade 2: Clearly visible nucleoli at 400x magnification
Grade 3: Clearly visible nucleoli at 100x magnification
Grade 4: Extreme pleomorphism or rhabdoid and/or sarcomatoid morphology
What is the metastatic rate of canine renal tumour diagnosed on radiographs?
overall = 16-34%
At death:
Sarcoma = 88%
Nephroblastoma = 75%
Carcinoma = 69%
What’s the complication rate of nephrectomy in dogs with renal tumours?
- complications occurred in 44.9% during the intraoperative period and 42.6% postoperatively.
- 12 dogs were diagnosed with acute kidney injury postoperatively, and 24 (45.3%) of the dogs with long-term follow-up developed chronic kidney disease.
Unilateral nephrectomy in dogs is associated with a high rate of intraoperative and postoperative complications. Johnson et al 2024.
What’s the outcome of Sx + Palladia for canine renal carcinoma?
- median time to progression (TTP) for dogs treated with surgery and TOC was 360 days, compared to 298 days for those treated with surgery alone.
Assessment of postoperative adjuvant treatment using toceranib phosphate against adenocarcinoma in dogs. Yamazaki et al 2020.
What’s the most common renal tumour in the cat?
(excluding renal LSA) renal cell carcinoma, renal transitional cell carcinoma
What’s the most common presenting complaint for cats with renal tumours?
weight loss and hyporexia
What’s the metastatic rate at diagnosis for cats with renal tumours?
Frequent (Henry et al 1999 = 64%; Kenney et al 2023 = 22% [8/36]) – may be due to selection bias
What’s the peri-op mortality rate for feline renal tumours?
22% (Kenney et al 2023: 3 died intra-op, 5 prior to discharge)
What’s the MST for cats that survived to discharge with renal tumours after nephrectomy?
1217 days
(all cause MST = 203 days)
What’s the MST for cats that survived to discharge with renal cell carcinoma after nephrectomy?
251 days
(all cause MST = 84 days)
Kenny SA, Cook MR, Lenz JA, Maritato KC, Skorupski KA, Wustefeld-Janssens BG, Pellin MA, Silveira CJ, Veytsman S, Selmic LE, Husbands BD. Clinical outcomes in cats with renal carcinoma undergoing nephrectomy: A retrospective study. Vet Comp Oncol. 2023 Dec;21(4):587-594. doi: 10.1111/vco.12921. Epub 2023 Jul 19. PMID: 37464904.
What’s the incidence and outcome of feline LSA treated with chemotherapy?
Incidence = 3.6%
L-CHOP MST = 203 days
steroids MST = 50 days
What’s the outcome of primary canine renal LSA treated with chemotherapy?
median progression free interval = 10 days
MST = 12 days
if responded, PFI = 41 days, and MST = 47 days
Clinical characteristics and outcome of dogs with presumed primary renal lymphoma. Taylor et al 2019.
What’s the most common presenting complaints for canine primary renal LSA?
lethargy and gastrointestinal signs, and biochemical testing showing azotaemia in 86% (n=25) and erythrocytosis in 51% (n=15)
Clinical characteristics and outcome of dogs with presumed primary renal lymphoma. Taylor et al 2019.
