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Renal & urinary > Urinary tract disease > Flashcards

Urinary tract disease Flashcards

1
Q

What bacteria cause an increase in urine pH in case of UTI? Why?

A

Staphylococcus spp and Proteus spp due to production of urease

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2
Q

What is the prevalence of catheter associated UTI in dogs and cats

A

Dogs: average of 11.4%
Cats: average of 15.5%

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3
Q

What urinary catheter is most suitable for long term use between red rubber, latex, plastic, and silicone

A

Silicone

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4
Q

What antiseptic is recommended for preparation before placement of a urinary catheter? How many times should the prepuce / vagina be flushed?

A

Chlorhexidine 0.05%

Should be flushed 5 times

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5
Q

How long should a catheter be kept in place to allow mucosal healing in cases of urethral tear

A

7 days

(if there is still leakage on contrast at 7 days, should give an extra 3-5 days ; if still not healed then do surgery)

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6
Q

Where is the preferred site of urethrostomy in cats and dogs? What are other options?

A

Cats: perineal / other options = prepubic, subpubic, transpelvic
Dogs: scrotal / other options = prescrotal, perineal, prepubic

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7
Q

What are the options for upper urinary diversion (and some complications)

A
  • Ureteral re-implantation. Can lead to uroabdomen and recurrent obstruction (30% complications)
  • Nephrostomy tubes.
    Can lead to uroabdomen (25% of cases), tube dislodgement, infection, discomfort, subcutaneous urine leakage (up to 50% complications overall)
  • Ureteral stents.
    Can cause stranguria, infection, have fracture, obstruction, migration, uroabdomen (33-46% complications, more frequent in cats)
  • Subcutaneous ureteral bypass (SUB).
    Can migrate, re-obstruct, kink, cause stranguria, infection (obstruction in 34% of cases)
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8
Q

Name indications for cystotomy tubes. What is the complication rate?

A
  • Bladder atony / dyssynergy
  • Urethral obstruction with stricture / neoplasia
  • Urethral trauma

Complication rate 49% (tube removal, tube displacement, fistula, infection)

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9
Q

What are the diagnostic criteria for a uroabdomen

A

Peritoneal fluid : peripheral ratio of creatinine > 2 and potassium > 1.4 in dogs, > 1.9 in cats

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10
Q

Name risk factors of UTI

A
  • Anatomical abnormalities (abnormal vulvar conformation)
  • Systemic disorders (DM, Cushing’s)
  • Immunosuppression (steroids, chemotherapy)
  • Urinary tract disorders (CKD, urolithiasis)
  • Urinary incontinence (neurogenic bladder, sphincter incompetency)
  • Urinary diversion (catheterization, cystostomy, urethrostomy, SUB, etc.)
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11
Q

What is the cut-off for significant bacteriuria for urine collected by cystocentesis / miction / urinary catheter

A
  • Cystocentesis: > 10^4 cfu/mL (not used in ISCAID guidelines)
  • Miction and catheter: > 10^5 cfu/mL

(Does not mean that treatment is always required!)

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12
Q

What is the expected time for dissolution of infection-induced and sterile struvites

A
  • Infection-induced (mostly in dogs): about 1-4 months (should be on antibiotics and dissolution diet the whole time)
  • Sterile (mostly in cats): 2-4 weeks (on dissolution diet)
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13
Q

What types of urolithiasis can be dissolved medically

A
  • Struvite
  • Ammonium urates (if no liver failure - Dalmatians, English Bulldogs)
  • Cystine
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14
Q

How quickly does renal blood flow decrease in a kidney with ureteral obstruction

A

Decreases by 60% in 24h, 80% within 2 weeks

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15
Q

True or false: A chronic partial ureteral obstruction does not need to be treated if the patient is doing well

A

False.
Even a partial obstruction decreases blood flow to the kidney and causes renal damage (more slowly than complete obstruction).

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16
Q

What is the success rate of medical management of obstructive ureteral urolithiasis? How long should be given to medical management before switching therapy?

A

Stone passage or repositioning allowing urine flow in 8-13%.
Should give 24-48h max and then do other technique if no movement of stone

(But in JVIM 2023 paper, medical management in 30% of kidneys and median time to success was 16 days)

17
Q

What are risk factors of urethral obstruction in cats

A

Multi-cat household, weight, long hair, indoor status, pedigreed cats, dry food diet

18
Q

Which of these catheters can be used as indwelling catheters in cats: polypropylene, polyvinyl, polytetrafluoroethylene, polyurethane

A

Polyvinyl (red rubber), polytetrafluoroethylene (Slippery Sam), polyurethane (Mila)

Polypropylene is rigid, used for unblocking

19
Q

What is the definition of a recurrent bacterial cystitis

A

Occurrence of 3 or more episodes of clinical bacterial cystitis in preceding 12 months or 2 or more episodes in preceding 6 months

20
Q

What empirical antibiotics are recommended for sporadic bacterial cystitis? What duration of treatment?

A

Amoxicillin > Clavamox > TMS

3-5 days

21
Q

What antimicrobial breakpoints should be used in a culture and susceptibility submitted for suspicion of pyelonephritis

A

Serum breakpoints (vs urine breakpoints)

22
Q

What empirical antibiotics are recommended for pyelonephritis? What duration of treatment?

A

Fluoroquinolones or 3rd generation cephalosporins

10-14 days

23
Q

What samples can be used for culture in case of suspected prostatitis

A
  • Third fraction of ejaculate
  • Prostate FNA
  • Fluid from urethral catheterization (improved with rectal prostatic massage)
24
Q

What empirical antibiotics are recommended for prostatitis? What duration of treatment?

A

Fluoroquinolone, TMS

(Penicillins, cephalosporins, aminoglycosides should be avoided due to poor penetration ; clindamycin and macrolides can be used based on culture)

4 weeks for acute disease, 4-6 weeks for chronic

25
Q

What are cases where treatment of subclinical bacteriuria can be indicated

A
  • Patients unable to display signs of cystitis having systemic signs of infection
  • Infection with Corynebacterium and urease producing bacteria (risk of encrusting cystitis and struvites)
  • High risk of ascending infection
26
Q

What is the most important risk factor for catheter associated UTI

A

Duration of catheterization

27
Q

Describe the innervation of the bladder

A
  1. Sympathetic hypogastric nerve (thoracolumbar ~T11-L4):
    - Beta receptors on detrusor -> relaxation
    - Alpha receptors on urethral smooth muscle -> contraction
  2. Somatic pudendal nerve (S1-S3) -> striated peri-urethral muscle contraction (external sphincter) (nicotinic receptors)
  3. Parasympathetic pelvic nerve (S1-S3) -> inhibits others + detrusor contraction (muscarinic receptors)

All nerves also have a sensory component (detecting stretch), with information integrated in the pontine micturition center (also receiving cortical innervation -> voluntary control)

28
Q

What are the 2 major arteries of the bladder and where do they originate from? Where are they located mostly?

A
  • Caudal vesical artery (originates from prostatic or vaginal artery)
  • Cranial vesical artery (originates from umbilical artery)

Located dorsally

29
Q

How should a cystotomy incision be closed

A

Single-layer continuous pattern with monofilament absorbable suture

30
Q

What type of muscles are present in the urethra and how are they innervated

A
  • Smooth muscles (diffusely, but thin portion): pelvic (parasympathetic) and hypogastric (sympathetic) nerves
  • Striated muscles (distal 1/3-2/3 of the urethra in dogs, postprostatic urethra in male cats, thicker up to 70% of volume): pudendal nerve (somatic)
31
Q

Which crystals typically form in a pH < 7.0 and > 7.0?

A

< 7.0: Calcium oxalates, purines, cystine

> 7.0: struvites

32
Q
A

Renal & urinary (4 decks)

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