Bladder, urethral (perineal, preputial edema), urachal (subcutaneous edema around umbilicus, ureteral (retroperitoneal) Colts \>\>\>fillies birth trauma, congenital abnormality, sepsis Adults - rare

CS abdominal distension, colic stranguria, pollskiutis lethargy, depression, anorexia \ A colt that can urinate through his penis doesn't R/O uroperitoneum

medical treatment IV fluids 0.9% NaCl + 5% dextrose hypoglycemia and pushing K+ intracellularly Calcium gluconate, Sodium bicarbonate antimicrobials abdominal drainage surgical correction

geldings, mean age 10y cystoliths \>\> urethrolith \> nephrolith \> ureterolith Nucleation Nidus UTI? NSAID tox Urine stasis Crystallization alkalinity + CaCO3 overcome mucus

Calcium carbonate Calcium phosphate

Cystoliths hematuria post-exercise stranguria, incontinence recurrent colic nephrolith, ureterolith silent until bilateral obstructive disease and CRF

Rectal palpation feeling a ureter is bad, throw a rectal U/S probe on it ultrasound cystoscopy

Mares manual removal crushing lithotripsy urethral sphincterotomy Males pararectal cystotomy perineal urethrostomy lithotripsy, manual crushing cystotomy paramedian, ventral midline laparascopic Flank approach nephrectomy ureterotomy

centrifuge urine to differentiate from pigmenturia hematuria forms pellet hemoglobinuria stays in soln When in stream? throughout kidneys bladder beginning of urination distal urethra end urination proximal urethra

hematuria, weight loss, colic unilateral, no azotemia nephrectomy

Cystolith neoplasia blister beetle toxicity

Urinary tract disorders in horses (Reuss) Flashcards by Jessica Fuller

Uroperitoneum about

Bladder, urethral (perineal, preputial edema), urachal (subcutaneous edema around umbilicus, ureteral (retroperitoneal)
Colts >>>fillies
birth trauma, congenital abnormality, sepsis
Adults - rare

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Uroperitoneum CS

CS
- abdominal distension, colic
- stranguria, pollskiutis
- lethargy, depression, anorexia

*A colt that can urinate through his penis doesn’t R/O uroperitoneum

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Uroperitoneum

Lab abnormalities

Lab abnormalities
- post-renal azotemia
- hyponatremia,hypochloremia
- hyperkalemia
Abdominocentesis
- peritoneal creatinine > 2x serum creatinine

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Uroperitoneum TX

medical treatment
- IV fluids
  - 0.9% NaCl + 5% dextrose
    - hypoglycemia and
    - pushing K+ intracellularly
  - Calcium gluconate, Sodium bicarbonate
- antimicrobials
- abdominal drainage
surgical correction

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urolithiasis about

geldings, mean age 10y
cystoliths >> urethrolith > nephrolith > ureterolith
Nucleation
- Nidus
  - UTI?
  - NSAID tox
- Urine stasis
Crystallization
- alkalinity + CaCO₃
- overcome mucus

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Urolithiasis stones

Calcium carbonate
Calcium phosphate

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urolithiasis

Cystoliths
- hematuria post-exercise
- stranguria, incontinence
- recurrent colic
nephrolith, ureterolith
- silent until bilateral obstructive disease and CRF

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Urolithiasis

Rectal palpation
- feeling a ureter is bad, throw a rectal U/S probe on it
ultrasound
cystoscopy

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Urolithiasis

Mares
- manual removal
  - crushing
  - lithotripsy
  - urethral sphincterotomy
Males
- pararectal cystotomy
- perineal urethrostomy
  - lithotripsy, manual crushing
- cystotomy
  - paramedian, ventral midline
  - laparascopic
Flank approach
- nephrectomy
- ureterotomy

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Urolithiasis

Medical TX

Medical tx
- bladder lavage
- antiinflammatories (PROBS NOT NSAIDS)
- antimicrobials if urine cultured
- encourage water consumption
- eliminate legumes
- lower DCAD to lower urine pH
  - urinary acidifiers unproven
- 41% recurrence within 1-32 months

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Hematuria

centrifuge urine to differentiate from pigmenturia
- hematuria forms pellet
- hemoglobinuria stays in soln
When in stream?
- throughout
  - kidneys
  - bladder
- beginning of urination
  - distal urethra
- end urination
  - proximal urethra

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adenocarcinoma

hematuria, weight loss, colic
unilateral, no azotemia
nephrectomy

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Idiopathic renal hematuria

about

sudden onset, life-threatening hematuria
- multiple episodes
blood clots from one or both kidneys
no age, sex predisposition
> 50% arabians
PE: acute blood loss
No systemic dz

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Idiopathic renal hematuria

diagnostic plan

rule out
- renal adenocarcinoma
- coagulopathy
Azotemia uncommon
endoscopy
ultrasound
TX
- supportive care
  - blood transfusion
  - medications to promote hemostasis
    - aminocaproic acid, formalin (no evidence)
- unilateral nephrectomy
  - often bilateral dz
- dexamethasone
  - anecdotal evidence

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Hematuria

bladder

Cystolith
neoplasia
blister beetle toxicity

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cantharidin

cantharadin
- 1mg/kg (6-8 beetles) can be toxic
- potent irritant
  - GI and oral mucosa
  - cystitis, nephrosis
  - myocarditis
Diagnosis
- hypocalcemia, hypomagnesemia, azotemia
- GI contents or urine
- ID beetle in hay
TX
- fluid and electrolyte support, analgesia (not NSAIDS)
- charcoal, biosponge
- Mineral oil is contraindicated (may potentiate absorption)

Hematuria

Urethra/external genitalia

Neoplasia
- squamous cell carcinoma
- sarcoid
habronemiasis
- summer sore
- local hypersensitivity
- sulfur granules
- treatment
  - ivermectin, steroids, fly control

*need to submit histo to tell the difference between these two

Hematuria

Urethral Tear

At level of ischial arch, dorsocaudal aspect
hemospermia, hematuria
- end urination
- bright red
no pollakiuria, dysuria
quarter horse geldings overrepresented
- and stallions hemospermia
blowout of corpus spongiosum into urethra
DX
- HX
- endoscopy (normal bladder, back out and find tear)
TX
- benign neglect
- subischial/perineal urethrotomy
- buccal mucosal graft (for stallions, blood kills sperm)

Bacterial Cystitis

Rare in horses
- more common in mares
CS: Dysuria pollakiuria, hematuria
DX: UA/ Culture
- Sediment
  - +/- > 10 wbc/hpf, bacteriuria
  - > 10,000 cfu/ml midstream or catheterized
Etiology: G- enterics; mixed
TX
- trimethoprim sulfonamide or penicillin or ceftiofur
- diuresis
- acidify urine - no shown effective method

Pyelonephritis

less common than bacterial cystitis
Etiology
- secondary to ectopic ureter, bladder paralysis, nephrolithiasis = G-
- bacteremia
  - actinobacillus, strep equi, salmonella
Systemic illness + dysuria, hematuria
DX: US, cystoscopy, culture
TX: Antibiotics, nephrectomy

Urinary incontinence

UMN

LMN

upper motor neuron
- inc urethral resistance
- pollakiuria, sporadic dribbling
- spinal cord lesions
lower motor neuron
- relaxed bladder and sphincter, continuous dribbling
- cauda equina syndrome
  - loss of anal/tail tone, perineal analgesia, hind limb weakness/ataxia
- Etiologies
  - trauma
  - EHV-1 myeloencephalitis
  - Sorghum/Sudan grass toxicity
    - Ataxia and cystitis
    - Cyanide tox?!

Urinary incontinence

Myogenic bladder

Idiopathic or secondary obstruction
Weight of sediment stretches detrusor
- tight junctions broken down
- inability to depolarize, cannot maintain sphincter
- accumulate sabulous debris: sand stuff

Sabulous cystitis

TX: nothing really works
- culture urine/treat bact cystitis
- lavage bladder
- stimulate bladder emptying
  - bethanechol

Ectopic Ureter

Usually not clinical in males
- may go unnoticed in males
Constant urine dribbling

Polyuria / Polydipsia

* urine output \> 50 ml/kg/day * water consumption \> 100 ml/kg/day * \> 50 L/day * dependent on diet, exercise, activity, repro status

Water Deprivation Test

* baseline bloodwork: don't water restrict if azotemic; UA; body weight (5% BW loss) * check at 6, 12, 24 hrs * Stop when 5% of body weight is lost * Should concentrate USG \> 1.025 * medullary washout * modified water deprivation test * 40 ml/kg/day for 3-4 days

Diabetes Insipidus

* Neurogenic (central) * loss of hypothalamic neurons =\> dec vasopression secretion * secondary to ecephalitis * Nephrogenic * collecting duct insensitive to vasopressin * Vasopressin concentration test * 60 IU in oil * SG \> 1.020 = neurogenic

Pituitary pars intermedia dysfunction

* frequently causes PU/PD * Impingement on hpothalamus and posterior pituitary * cortisol antagonism of vasopressin * hyperglycemia and osmotic diuresis

Renal Failure

* can cause PU/PD * Recovery from AKI, CKD * inc tubular flow * medullary washout * impaired response to vasopressin

Causes of PU/PD

* Psychogenic * DIabetes Insipidus * PPID * Renal Failure * Sepsis * alpha-2 agonists * zylazine * detomidine