Urinary tract disease Flashcards
What bacteria cause an increase in urine pH in case of UTI? Why?
Staphylococcus spp and Proteus spp due to production of urease
What is the prevalence of catheter associated UTI in dogs and cats
Dogs: average of 11.4%
Cats: average of 15.5%
What urinary catheter is most suitable for long term use between red rubber, latex, plastic, and silicone
Silicone
What antiseptic is recommended for preparation before placement of a urinary catheter? How many times should the prepuce / vagina be flushed?
Chlorhexidine 0.05%
Should be flushed 5 times
How long should a catheter be kept in place to allow mucosal healing in cases of urethral tear
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)
Where is the preferred site of urethrostomy in cats and dogs? What are other options?
Cats: perineal / other options = prepubic, subpubic, transpelvic
Dogs: scrotal / other options = prescrotal, perineal, prepubic
What are the options for upper urinary diversion (and some complications)
- 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)
Name indications for cystotomy tubes. What is the complication rate?
- Bladder atony / dyssynergy
- Urethral obstruction with stricture / neoplasia
- Urethral trauma
Complication rate 49% (tube removal, tube displacement, fistula, infection)
What are the diagnostic criteria for a uroabdomen
Peritoneal fluid : peripheral ratio of creatinine > 2 and potassium > 1.4 in dogs, > 1.9 in cats
Name risk factors of UTI
- 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.)
What is the cut-off for significant bacteriuria for urine collected by cystocentesis / miction / urinary catheter
- 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!)
What is the expected time for dissolution of infection-induced and sterile struvites
- 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)
What types of urolithiasis can be dissolved medically
- Struvite
- Ammonium urates (if no liver failure - Dalmatians, English Bulldogs)
- Cystine
How quickly does renal blood flow decrease in a kidney with ureteral obstruction
Decreases by 60% in 24h, 80% within 2 weeks
True or false: A chronic partial ureteral obstruction does not need to be treated if the patient is doing well
False.
Even a partial obstruction decreases blood flow to the kidney and causes renal damage (more slowly than complete obstruction).
What is the success rate of medical management of obstructive ureteral urolithiasis? How long should be given to medical management before switching therapy?
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)
What are risk factors of urethral obstruction in cats
Multi-cat household, weight, long hair, indoor status, pedigreed cats, dry food diet
Which of these catheters can be used as indwelling catheters in cats: polypropylene, polyvinyl, polytetrafluoroethylene, polyurethane
Polyvinyl (red rubber), polytetrafluoroethylene (Slippery Sam), polyurethane (Mila)
Polypropylene is rigid, used for unblocking
What is the definition of a recurrent bacterial cystitis
Occurrence of 3 or more episodes of clinical bacterial cystitis in preceding 12 months or 2 or more episodes in preceding 6 months
What empirical antibiotics are recommended for sporadic bacterial cystitis? What duration of treatment?
Amoxicillin > Clavamox > TMS
3-5 days
What antimicrobial breakpoints should be used in a culture and susceptibility submitted for suspicion of pyelonephritis
Serum breakpoints (vs urine breakpoints)
What empirical antibiotics are recommended for pyelonephritis? What duration of treatment?
Fluoroquinolones or 3rd generation cephalosporins
10-14 days
What samples can be used for culture in case of suspected prostatitis
- Third fraction of ejaculate
- Prostate FNA
- Fluid from urethral catheterization (improved with rectal prostatic massage)
What empirical antibiotics are recommended for prostatitis? What duration of treatment?
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
What are cases where treatment of subclinical bacteriuria can be indicated
- 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
What is the most important risk factor for catheter associated UTI
Duration of catheterization
Describe the innervation of the bladder
- Sympathetic hypogastric nerve (thoracolumbar ~T11-L4):
- Beta receptors on detrusor -> relaxation
- Alpha receptors on urethral smooth muscle -> contraction - Somatic pudendal nerve (S1-S3) -> striated peri-urethral muscle contraction (external sphincter) (nicotinic receptors)
- 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)
What are the 2 major arteries of the bladder and where do they originate from? Where are they located mostly?
- Caudal vesical artery (originates from prostatic or vaginal artery)
- Cranial vesical artery (originates from umbilical artery)
Located dorsally
How should a cystotomy incision be closed
Single-layer continuous pattern with monofilament absorbable suture
What type of muscles are present in the urethra and how are they innervated
- 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)
Which crystals typically form in a pH < 7.0 and > 7.0?
< 7.0: Calcium oxalates, purines, cystine
> 7.0: struvites
