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Y4 SA - urinary & endocrine disease > Urinary tract neoplasia > Flashcards

Urinary tract neoplasia Flashcards

1
Q

Are neoplasms of the kidney common in dogs?

A
  • no
  • represent 0.5-1.7% of all neoplasms in dogs
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2
Q

Are benign tumours of the kidney common?

A
  • no
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3
Q

Examples of benign tumours of the kidney

A
  • adenoma
  • lipoma
  • fibroma
  • papilloma
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4
Q

Which age groups are neoplasms of the kidney most common in?

A
  • middle-aged to older animals
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5
Q

Is there a breed predilection for kidney neoplasms?

A
  • no
  • except for heritable predilection for the development of bilateral, multifocal cystoadenocarcinomas in German Shepherds, generally between 5-11y)
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6
Q

What is the most common renal neoplasm?
Characteristics/description?

A
  • renal carcinoma
  • usually unilateral, located at 1 pole of the kidney and well demarcated
  • size varies from microscopic to bigger than the normal kidney
  • metastasise early to various organs
    – opposite kidney
    – lungs
    – liver
    – adrenals
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7
Q

What neoplasm of the kidney arises from vestigial embryonic tissue?

Age most commonly affected?

Breed predilection?

Males or females more commonly affected?

Unilateral or bilateral?

Metastasis?

A
  • nephroblastomas (embryonal nephroma, Wilms’ tumour)
  • seen in young animals
  • in dogs, most commonly diagnosed <1y/o
  • no breed predilection
  • males affected twice as commonly as females
  • usually unilateral
  • grow to immense size, not uncommon to have basically entire abdomen occupied by tumour
  • mets can occur to regional LN, liver & lungs
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8
Q

Where can transitional cell carcinomas arise from (i.e. what cell, what organs?)

A
  • from transitional epithelium of the renal pelvis, ureter, bladder or urethra
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9
Q

Other than TCC are primary malignant renal neoplasms common? Give examples of some

A
  • uncommon
  • include
    – haemangiosarcomas
    – fibrosarcomas
    – leiomyosarcomas
    – SCC
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10
Q

Are the kidneys a common site for mets or multi centric neoplasms?

A
  • yes
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11
Q

Are mets lesions uni or bilateral?

A
  • can be either / both
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12
Q

What is the most common multi centric tumour involving the kidneys?

A
  • lymphosarcoma
    – as many as 50% dogs and cats with lymphosarcoma have renal lesions, and in some cases, only the kidneys or kidneys & brain are affected
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13
Q

CS of renal neoplasia

A
  • Haematuria, dysuria, stranguria, and pollakiuria are the most common signs
  • Animals with ureteral obstruction and unilateral hydronephrosis may show signs of abdominal pain and have a palpable, enlarged kidney
  • Signs of uraemia may be apparent in animals with bilateral ureteral obstruction and hydronephrosis or with urethral obstruction
  • The bladder wall may be thickened, and a cord-like urethra or urethral mass(es) may be palpable rectally
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14
Q

Diagnosis of renal neoplasia

A
  • history
  • CS
  • US
  • urinalysis
  • radiography (contrast)
  • CT
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15
Q

Tx of renal neoplasia

A
  • majority except lymphosarcoma involves surgical removal
    – unilateral nephrectomy is usually needed
  • lymphosarcoma -> combination chemo
    – chemo is generally ineffective against renal tumours other than lymphosarcoma
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16
Q

Are neoplasms of the lower urinary tract (ureters, bladder and urethra) common in dogs and cats?

A
  • uncommon in dogs
  • rare in cats
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17
Q

Theory for low incidence of neoplasms of the lower urinary tract in cats?

A
  • difference in tryptophan metabolism that results in low urinary concentrations of carcinogenic tryptophan metabolites
18
Q

Mean age for dogs/cats affected by neoplasms of the lower urinary tract

A
  • 9 y/o
19
Q

In the lower urinary tract are primary neoplasms more likely to be benign or malignant?

A
  • malignant
20
Q

What neoplasms are infrequently found in the lower urinary tract?

A
  • papillomas
  • leiomyomas
  • fibromas
  • neurofibromas
  • haemangiomas
  • rhabdomyomas
  • myxomas
21
Q

What is the most commonly diagnosed primary malignant neoplasm of the lower urinary tract?

A
  • TCC
22
Q

What neoplasms are found more frequently in the lower urinary tract?

A
  • TCC
  • SCC
  • adenocarcinomas
  • fibrosarcomas
  • leiomyosarcomas
  • rhabdomyosarcomas
  • haemangiosarcomas
  • osteosarcomas
23
Q

Where do transitional cell carcinomas arise? What do they look like?

A
  • solitary or multiple papillary-like projections from the mucosa
  • can develop as a diffuse infiltration of the ureter, bladder, prostate and/or urethra
24
Q

Which breeds are more commonly affected by cystic transitional cell tumours?

A
  • Scottish terriers
25
Q

What previous therapy has been linked to cystic transitional cell tumours?

A
  • cyclophosphamide
  • also may be linked to exposure to herbicides and older-generation insecticides
26
Q

TCC: mets?

A
  • highly invasive
  • mets frequently
  • most commonly to regional LN and lungs
27
Q

CS of lower urinary tract neoplasia

A
  • ureteral and bladder neoplasms can cause chronic obstruction to urine flow with secondary hydronephrosis
  • urethral tumours are more likely to cause acute obstructive uropathy
  • intractable secondary bacterial UTIs are commonly associated with neoplasms of the bladder and urethra
28
Q

Diagnosis of lower urinary tract neoplasia

A
  • Hx & CS
  • urinalysis: haematuria, may be evidence of secondary infection
  • neoplastic cells may be found in sediment, esp with TCC
  • veterinary bladder tumour antigen test or the BRAF mutation test can be helpful for bladder tumours in dogs, but false results do occur
  • cystourethrogram, retrograde urethrogram or US generally needed to determine the location and extent of the tumour
  • biopsy needed for definitive diagnosis
29
Q

Tx of lower urinary tract neoplasia

A
  • Excision of the tumour, if possible, is the most beneficial therapy
  • TCCs are frequently located at the trigone
    of the bladder or in the urethra and may necessitate radical
    reconstructive surgery of the lower urinary tract
  • Prognosis is poor for these animals, even with surgery, because
    recurrence and metastasis occur rapidly
  • Radiation therapy and/or chemotherapy with piroxicam, cisplatin,
    doxorubicin, vinblastine, chlorambucil, or mitoxantrone will
    generally prolong the life of affected animals
  • Palliative stenting of the urethra is sometimes considered for
    tumours of the bladder neck and urethra
30
Q

Primary causes of urethral obstruction

A

Intraluminal
– Plugs
– Uroliths
– Sloughed tissue

Mural or extraluminal
– Neoplasms
– Strictures
– Anomalies
– Reflex dyssynergia

Combinations

31
Q

Perpetuating causes of urethral obstruction

A

Intraluminal
– Sloughed tissues
– Inflammatory cells and clots
– Increased production of mucoprotein

Mural or extraluminal
– Inflammatory swelling
– Muscular spasm
– Strictures

Combinations

32
Q

Iatrogenic causes of urethral obstruction

A
  • Tissue damage
    – Retrograde flushing solutions
    – Catheter trauma
    – Catheter-induced foreign body reaction
    – Catheter-induced infection
  • Post surgical dysfunction
33
Q

What will persistent complete urethral obstruction generally cause classic signs of?

A
  • post-renal failure
34
Q

What does post-renal urinary tract obstruction result in?

A
  • severe azotaemia
  • hyperkalaemia
  • metabolic acidosis
35
Q

Immediate relief of urethral obstruction methods

A
  • urethral catheterisation
  • therapeutic cystocentesis
36
Q

Removal of urethral plugs methods

A
  • restraint
  • use of muscle relaxants
  • use of reverse flushing solutions
  • catheter
37
Q

Use of reverse flushing solutions

A

Walpole’s solution (buffered acetic acid)
- pH of 4.5
- acid solutions precipitate proteins
- little or no effect on crystals other than struvite
- little effect on uroliths
- potential for systemic absorption
- local irritant effect (urethritis)
- DO NOT USE

38
Q

Catheters for urethral plug removal

A
  • Jackson cat catheter
  • lacrimal catheter (if v small, e.g. for rabbits)
  • Slippery Sam catheter
39
Q

How to localise urethral obstruction

A
  • best achieved by retrograde positive contrast urethrocystography
  • abdo US
40
Q

Surgical options for urethral obstruction

A
  • Tube cystotomy and urethral stenting
  • Perineal urethrostomy (based on Wilson-Harrison technique)
  • Prepubic urethrostomy
  • Subpubic urethrostomy (transpelvic urethrostomy)
41
Q

Complications of feline perineal urethrostomy

A
  • haemorrhage
  • wound dehiscence
  • SC urine leakage
  • urinary incontinence
  • UTI
  • urethral (stoma) stricture

Y4 SA - urinary & endocrine disease (16 decks)

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