Urology 2 AI Flashcards
What should be monitored when administering furosemide as a diuretic?
The potassium concentration should be monitored because furosemide may cause hypokalemia.
What precaution should be taken when using intravenous fluids on animals with glomerular diseases?
Intravenous fluids should be used cautiously and with careful monitoring, as animals with glomerular diseases are prone to fluid overload.
When is fluid therapy beneficial for animals?
Fluid therapy is only beneficial for animals that are dehydrated or hypovolemic.
What are the learning objectives of this module?
- Explain how proteinuria can be categorised in relation to the glomerulus
- Describe the major steps in the investigation of dogs and cats with proteinuria
- Identify the major causes of proteinuria in dogs and cats
- Distinguish between the major types of glomerular disease
- Describe the key elements of non-specific treatment for animals with proteinuria
- Explain the mechanism of action of drugs used to decrease proteinuria
- Outline the suggested criteria for use of immunosuppressive drugs for dogs with proteinuria
- Indicate the prognosis for dogs with different forms of protein-losing nephropathy
- Describe the major types and clinical features of renal neoplasia
- Explain the major clinical findings and treatment options for dogs with Fanconi syndrome
- Discuss the clinical management of cats with ureteral obstruction
What does proteinuria refer to?
The presence of protein in the urine
What is the normal amount of protein in urine for healthy dogs and cats?
Less than 0.01 g/l of albumin
How can causes of proteinuria be categorized?
According to the location of the underlying problem in the kidney
What are the most common methods for evaluating proteinuria?
- Dipstick measurement
- Urine protein: creatinine ratio (UPC)
What are the advantages of using dipstick measurement for proteinuria evaluation?
Cheap, widely available, and immediate results
How should the results of a urine dipstick be interpreted?
Results must be interpreted alongside the urine specific gravity
What is the sensitivity of dipsticks for the presence of albumin in urine?
Approximately 0.3 g/l
What is the urine protein: creatinine ratio (UPC) used for?
To account for differences in urine specific gravity
What does a UPC ratio measured on a single urine sample provide an estimate of?
The amount of protein excreted by dogs over 24 hours
What can cause false negative results in dipstick measurements?
Proteins other than albumin, such as Bence Jones proteins
What is the specificity of the dipstick for diagnosis of albuminuria in dogs?
Approximately 50%
What is the specificity of the dipstick for diagnosis of albuminuria in cats?
Approximately 10%
What is the primary barrier to the movement of large substances into the filtrate?
The glomerular barrier
What forms the slit diaphragm in the glomerular barrier?
Overlapping podocyte foot processes
What is the width of the pores between overlapping podocyte foot processes?
25-40 nm
How are filtered proteins handled by tubular epithelial cells?
They are endocytosed and degraded
When does the mechanism for filtered protein handling become saturated?
If there is excessive protein leakage into the filtrate
What molecular weight range of proteins are filtered in small amounts?
Proteins with a molecular weight of 60 kilodaltons or greater
Which protein is kept in the blood due to filtration restrictions?
Albumin (69 kDa) and other plasma proteins
What is the function of maintaining colloid osmotic pressure?
Preventing loss of fluid from the plasma into the extracellular space
What causes renal proteinuria?
Acquired or congenital defects in the glomerular barrier
What types of diseases are related to renal proteinuria?
Familial and acquired diseases
What is the cause of primary glomerulopathy?
Mutations in the genes for type IV collagen (Col4a4)
Which breed of dogs is susceptible to primary glomerulopathy?
English Cocker spaniels, Bull terriers, Dalmatian, and Samoyed
What mutations in Soft-coated Wheaten terriers cause protein-losing nephropathy?
Mutations in nephrin and filtrin
Which conditions in various animal breeds are associated with familial amyloidosis?
Shar peis, Beagles, English foxhounds, Abyssinian cats, and Siamese cats
Which diseases causing proteinuria have been described in single families?
Other less common familial diseases in dogs and cats
What are the most common acquired diseases causing renal proteinuria?
Amyloidosis, some forms of glomerulonephritis, and membranous nephropathy
What is amyloidosis in relation to renal proteinuria?
Deposition of insoluble amyloid protein (AA) in the kidney
What is protein-losing nephropathy (PLN)?
Protein-losing nephropathy refers to proteinuria that is severe enough to cause a decrease in blood protein concentration.
What is the difference between protein-losing nephropathy (PLN) and protein-losing enteropathy (PLE)?
PLN causes only hypoalbuminemia while PLE can have hypoalbuminemia and hypoglobulinemia together.
What are the characteristics of nephrotic syndrome?
Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, hypercholesterolemia, and fluid accumulation.
Is nephrotic syndrome associated with any specific types of glomerular diseases seen on biopsy?
No, nephrotic syndrome can happen with any cause of glomerular proteinuria and is not associated with specific types seen on biopsy.
What are the additional features seen in dogs with nephrotic syndrome?
Most dogs with nephrotic syndrome have free fluid in the peritoneal cavity, subcutaneous edema, and pleural fluid.
What is the impact of nephrotic syndrome on survival?
Dogs with nephrotic syndrome and additional features have poorer survival than those without these features.
Why do animals with protein-losing nephropathy (PLN) become hypercoagulable?
PLN causes loss of anticoagulant proteins like antithrombin, leading to hypercoagulability.
What are the possible forms of thromboembolism in dogs with PLN?
Thromboembolism in dogs with PLN can occur in the pulmonary, splenic or mesenteric areas, or in the heart.
What is the common thromboembolic condition in dogs with PLN?
Saddle thrombi in the aortic bifurcation are particularly common in dogs with PLN.
How can abdominal and aortic thrombi be diagnosed?
Abdominal and aortic thrombi can be easily diagnosed by ultrasound, especially with Doppler flow scanning.
Is proteinuria always indicative of glomerular disease in animals with chronic kidney disease (CKD)?
No, proteinuria in CKD may result from tubular damage, glomerular damage, and glomerular hypertension.
What percentage of dogs with protein-losing nephropathy (PLN) are azotemic on presentation?
50-60% of dogs with PLN are azotemic when first diagnosed.
Are glomerular diseases a common cause of chronic kidney disease (CKD) in animals?
Glomerular diseases represent only a small proportion of the total CKD population.
What is the recommended staging process for animals with severe proteinuria and azotemia?
The same staging process recommended for other cases of proteinuria and chronic kidney disease (CKD) should be undertaken.
What might be contraindications for surgery in cases of ureteral obstruction?
The presence of an active sediment or infection.
How is the definitive diagnosis of ureteral obstruction obtained?
Imaging, such as abdominal ultrasound or anterograde pyelogram.
What should be done before considering surgery for cats with ureteral obstruction?
Stabilize the cat with appropriate medical treatment.
What are the two major treatment options for ureteral obstruction?
Placement of a ureteral stent or a subcutaneous ureteral bypass system (SUB).
What is the risk of permanent kidney damage in cases of ureteral obstruction?
The risk is proportional to the duration of obstruction.
What is the purpose of placing a ureteral stent?
To clear the obstruction and maintain patency of the ureter.
What complications can occur with a subcutaneous ureteral bypass system (SUB)?
Complications can include bladder irritation, blockage, dislodgement, urine leakage, chronic infection, and haematuria.
What is recommended for long-term management after placement of a subcutaneous ureteral bypass system (SUB)?
Regular flushing of the system and urine sample collection.
What are some ultrasound findings associated with renal lymphoma in dogs and cats?
Enlargement of the kidneys, disruption of corticomedullary distinction, and hypoechoic and hyperechoic areas
What is the association between renal lymphoma and cats?
There is a particular association of renal lymphoma with hypoechoic subcapsular thickening, producing a hypoechoic ‘rim’ around part or all of the kidney
What increases suspicion of neoplasia in animals presenting with azotaemia?
Concurrent dermal fibrosis in German shepherds that have the folliculin mutation.
What is the average age of onset for renal neoplasia in cats and dogs?
Approximately 8-9 years
What form of neoplasia should be considered in cats with acute onset or worsening of azotaemia?
Renal lymphoma
What blood sample results might increase suspicion for neoplasia?
Presence of erythrocytosis (increased PCV or PCV at the upper end of reference interval)
What imaging findings may suggest renal lymphoma?
Presence of hypoechoic infiltrates, particularly in the subcapsular region of cats
What is the recommended imaging modality to assess whether a mass is invading local tissues and to determine metastases in bones, lungs, or lymph nodes?
Computed tomography
What is the definitive diagnosis of neoplasia achieved through?
Cytological or histological analysis of samples from the mass
What is the treatment of choice for most primary renal tumours?
Nephrectomy
What is the typical treatment for animals with renal lymphoma?
Chemotherapy
What is an important consideration when using doxorubicin in animals with azotaemia?
Doxorubicin is nephrotoxic particularly in cats, so should be used with care
What is the median survival period for cats with renal lymphoma after treatment?
~3 months
What is the median survival period for dogs with renal lymphoma after treatment?
12 days
What is Fanconi syndrome?
A disease affecting the renal tubules, causing abnormalities in the reabsorption of solutes from the glomerular filtrate back into the blood
What is lost in the urine as a result of Fanconi syndrome?
Glucose, amino acids, and bicarbonate
What benefit have n-3 polyunsaturated fatty acids shown in dogs with CKD and proteinuria?
Some benefit in dogs with CKD and proteinuria
Are n-3 polyunsaturated fatty acids beneficial for non-azotaemic dogs?
Less clear whether this is beneficial for non-azotaemic dogs
What are most commercial renal diets supplemented with?
The appropriate levels of n-3 PUFAs
What dosage of eicosapentaenoic and docosahexaenoic acid is recommended to be added to the diet for animals eating a home-cooked diet?
0.25-0.5 grams/kg
Why is it recommended to supplement vitamin E when giving eicosapentaenoic and docosahexaenoic acid separately?
Because these fatty acids may be oxidised
What should be done if the creatinine is increased by 30% or more after starting ACE inhibitor treatment?
The treatment should be discontinued
What might ACE inhibitors cause besides worsening or precipitating azotaemia?
Hyperkalaemia
How often should the blood pressure and UPC value be checked when using ACE inhibitors?
Every 3-6 months as a routine procedure
What angiotensin receptor type 1 antagonist has been licensed for cats for treatment of proteinuria?
Telmisartan
What is the recommended dosage of telmisartan used in dogs and cats for treatment of proteinuria?
1 mg/kg PO SID
What are the risks of combining telmisartan with an ACE inhibitor in dogs and cats?
Worsening azotaemia and increased risk of kidney failure and death
How should the combination of telmisartan and an ACE inhibitor be used?
Cautiously and only if necessary
What is the Gonto protocol?
The Gonto protocol involves giving large quantities of sodium bicarbonate, vitamin supplements, and a high protein diet to correct metabolic acidosis.
Has the effectiveness of the Gonto protocol been scientifically investigated?
No, the effectiveness of the Gonto protocol has never been investigated scientifically.
In a case series of 60 dogs, what was the median survival time after diagnosis when following the Gonto protocol?
The median survival time after diagnosis was approximately 5 years when following the Gonto protocol.
What percentage of dogs following the Gonto protocol ultimately succumbed to CKD?
Approximately 40% of dogs following the Gonto protocol ultimately succumbed to CKD.
What is the most common cause of feline ureteral obstructions?
Ureteroliths, specifically composed of calcium oxalate, are the most common cause of feline ureteral obstructions in approximately 80% of cases.
What are the consequences of untreated complete ureteral obstruction in dogs?
Untreated complete ureteral obstruction in dogs leads to a decrease in glomerular filtration rate (GFR), with GFR decreasing by 50% within 2 weeks and by 100% within 40 days, resulting in loss of function in the affected kidney.
What are the clinical presentations of ureteral obstruction in cats?
Clinical presentations of ureteral obstruction in cats may include abdominal or lumbar pain, lethargy, decreased appetite, mild pyrexia, and azotaemia.
What is the syndrome called when one kidney is hypertrophied and the other is small and fibrotic?
The syndrome is called ‘big kidney, little kidney’, and it occurs when one ureter is persistently or repeatedly obstructed, causing damage to the corresponding kidney.
What percentage of cats presenting with ureteral obstruction have some level of pre-existing kidney disease?
Approximately 50-70% of cats presenting with ureteral obstruction have some level of pre-existing kidney disease.
How can ureteral obstruction be suspected in cats?
Ureteral obstruction can be suspected in cats presented with acute onset azotaemia and/or lumbar and abdominal pain.
What is the recommended approach for treating glomerular proteinuria in animals?
Offer renal biopsy, if declined and underlying causes excluded, consider a period of immunosuppressive treatment.
What does the IRIS consensus panel suggest about the use of immunosuppressive drugs for glomerular diseases in dogs with proteinuria?
Use only for dogs with evidence of immune-mediated disease on renal biopsies.
What is considered to be the most common cause of glomerular proteinuria in cats?
Membranous nephropathy.
What are the recommended options for immunomodulatory treatment according to the IRIS panel?
For acute onset or rapidly progressive PLN: glucocorticoid with mycophenolate mofetil or cyclophosphamide. For stable PLN: mycophenolate alone.
Why are glucocorticoids not the preferred treatment in dogs with glomerular diseases?
They may cause proteinuria and other side effects.
What is the recommended course of treatment for mycophenolate?
Administer at 8-12 mg/kg PO BID for 4 weeks, with or without prednisolone.
What is the major potential side effect of mycophenolate?
Diarrhoea, which may resolve within 1 week without treatment but can be severe.
Which drug is considered a better choice than mycophenolate for glomerular diseases in cats?
Chlorambucil.
At what dose is chlorambucil administered to cats?
2 mg.
What is the recommended dose of estriol for female dogs?
The recommended dose of estriol for female dogs is 0.5 – 1 mg/kg, PO, sid.
What are the side effects associated with the administration of estriol?
The side effects associated with the administration of estriol include mammary gland development, vulvar swelling, attracting males and rarely myelosuppression.
What are the surgical options for managing sphincter mechanism incompetence?
The surgical options for managing sphincter mechanism incompetence include colposuspension, transobturador vaginal tape placement, urethropexy, and hydraulic occluders.
What is urolithiasis?
Urolithiasis refers to the formation of calculi within the urinary tract.
What percentage of cats presented with lower urinary tract signs are diagnosed with urolithiasis?
It is estimated that 14% of cats presented with lower urinary tract signs are diagnosed with urolithiasis.
What are the clinical signs that cats with urolithiasis may present with?
Cats with urolithiasis may present with pollakiuria, stranguria, haematuria, inability to pass urine, and abdominal discomfort.
What are the recommended diagnostic investigations for a cat with clinical signs consistent with urolithiasis?
The recommended diagnostic investigations for a cat with clinical signs consistent with urolithiasis are observing urination, palpating the urinary bladder, serum biochemical analysis, urinalysis, and imaging.
What should be documented and monitored in cats with a previous history of urolithiasis?
In cats with a previous history of urolithiasis, it is important to document and monitor urine specific gravity to try to keep it low in order to avoid crystal aggregation and urolith formation.
What imaging methods can be used to diagnose cystouroliths in cats?
Ultrasound examination of the urinary tract and plain abdominal radiographs can be used to diagnose cystouroliths in cats.
What are the most common types of feline uroliths according to the Minnesota Urolith Center?
The most common types of feline uroliths are calcium oxalate and struvite, according to the Minnesota Urolith Center.
What is the most common urolith found in cats?
Struvite
In cats, does struvite urolithiasis frequently occur in sterile urine?
Yes
What is associated with an increased risk of struvite urolithiasis in cats?
Alkaluria
What factors may lead to an alkaline urine in cats?
Low protein diet and distal renal tubular acidosis
Is there a genetic predisposition for struvite urolithiasis in cats?
Yes
What is the second most common urolith found in cats?
Calcium oxalate
How can calcium oxalate urolithiasis in cats be prevented?
Urine dilution
What type of cats are more likely to develop calcium oxalate urolithiasis?
Himalayan and Persian cats
Does feeding an acidifying diet increase the risk for calcium oxalate urolithiasis in cats?
Yes
What is the third most common urolith in cats?
Ammonium urate
What breeds of cats are predisposed to urate urolithiasis?
Egyptian Maus, Birman, Siamese
What is usually associated with some degree of liver dysfunction and leads to urate urolithiasis?
Factors leading to urate urolithiasis
What causes cystinuria in cats?
An inherited proximal tubular defect
Which amino acids are lost in urine due to cystinuria?
Non-essential amino acids including cystine
Which cat breeds have been described to have mutations causing cystinuria?
Domestic shorthair and Siamese cats
What are the symptoms of cystinuric cats?
Lower urinary tract signs, hypersalivation, lethargy, seizures
What can cause xanthine urolithiasis in cats?
Allopurinol administration or a deficiency in xanthine dehydrogenase
Is xanthine soluble in urine?
No
What service does the Minnesota Urolith Center provide for free?
Urolith mineral composition analysis
Why is it important to submit uroliths for mineral analysis?
To institute adequate measures to prevent further stone formation
What are the two main sections of a report obtained from the Minnesota Urolith Center?
Quantitative analysis and Comments
What is the main focus for prevention of stone recurrence according to the report?
The mineral type(s) in the nidus
If no nidus is present in the urolith, what should be the focus of preventative measures?
The stone layer
What does a difference in composition between the shell and stone of a urolith indicate?
Recent changes in diet, introduction of medications, or urinary tract infection
What additional information is provided in the comments section of the report?
Recommendations on how to treat/prevent each urolith type
Which manual is recommended for further reading on canine and feline neurology?
BSAVA Manual of Canine and Feline Neurology: Tail, anal and bladder dysfunction Chapter 19, pp.: 368 - 387
What is micturition?
Micturition is the process by which the urinary bladder empties when full.
What are the two main stages of the micturition process?
The two main stages of the micturition process are the storage phase and the voiding phase.
What happens during the storage phase of micturition?
During the storage phase, the bladder fills with urine and the detrusor muscle relaxes.
How is detrusor muscle relaxation achieved during the storage phase?
Detrusor muscle relaxation is achieved through activation of β3 adrenergic receptors by norepinephrine.
What happens to the smooth muscle of the urethra during the storage phase?
The smooth muscle of the urethra contracts, allowing bladder filling.
What type of muscle contraction occurs in the urethra during the storage phase?
Striated muscle contraction occurs in the urethra during the storage phase.
What initiates the voiding phase of micturition?
Stretch receptors in the bladder are stimulated by intravesical volumes or pressures, initiating the voiding phase.
What stimulates detrusor muscle contraction during the voiding phase?
Acetylcholine, released by the pelvic nerve, stimulates muscarinic receptors on the detrusor muscle, causing contraction.
What inhibits the smooth and striated muscle of the urethra and bladder neck during the voiding phase?
Afferent impulses reaching the spinal cord inhibit the cell bodies of the pudendal and hypogastric nerves.
What are the two types of micturition disorders?
The two types of micturition disorders are urinary incontinence and urinary retention.
What are some signs and symptoms of urinary retention?
Signs and symptoms of urinary retention include dysuria, enlarged bladder on palpation, weak urine stream, and post-renal azotaemia.
What reflexes associated with the pudendal nerve are important in a neurologic examination for urinary retention?
The anal sphincter tone, perineal reflex, and urethral sphincter tone are important reflexes to assess.
What diagnostic investigations may be performed for a patient suspected of having urine retention?
Observing urination, palpating the bladder, performing a neurologic examination, obtaining a urine sample, and performing imaging studies.
What imaging studies can be performed to assess bladder emptying and lower urinary tract structures?
Ultrasound examination of the bladder, voiding urethrogram, and retrograde vagino-urethrogram can be performed.
Why is catheterization of the urethra important in the diagnosis of urinary retention?
Catheterization helps differentiate structural causes from functional reasons for urinary retention.
What are some causes of urinary retention?
Causes of urinary retention include uroliths, neoplasia, prostatic disease, and neurogenic bladder dysfunction.
What is the treatment for urinary retention?
The treatment for urinary retention depends on the underlying cause and may involve addressing structural or functional issues.
What are the treatment options for managing urinary retention in dogs and cats?
Procedures to establish urine output and medical therapy
What are the procedures used to establish urine output in dogs and cats?
Indwelling or intermittent urethral catheterisation and manual expression of the bladder
What is the recommended medical therapy for urinary retention?
Medications used to treat detrusor atony and functional urethral obstruction
What is the recommended medication for treating detrusor atony in dogs?
Bethanecol
What is the recommended medication for treating detrusor atony in cats?
Bethanecol
What are the side effects associated with the administration of bethanecol?
Increased gastrointestinal motility, vomiting, diarrhea, hypersalivation, hypotension, bradycardia, and dyspnea
What is the recommended medication for treating detrusor atony and functional urethral obstruction in dogs?
Cisapride
What is the recommended medication for treating detrusor atony and functional urethral obstruction in cats?
Cisapride
What are the side effects associated with the administration of cisapride?
Diarrhea and abdominal pain
What medications are used for the management of functional urethral obstruction?
Smooth muscle relaxants and skeletal muscle relaxants of the urethra and bladder neck
What is the recommended smooth muscle relaxant for the urethra and bladder neck in dogs and cats?
Phenoxybenzamine
What is the recommended skeletal muscle relaxant for the urethra and bladder neck in dogs?
Diazepam
What is the recommended skeletal muscle relaxant for the urethra and bladder neck in cats?
Dantrolene
What are the clinical signs of urinary incontinence in dogs and cats?
History of wetting the bed while sleeping, dribbling urine around the house, leaving a small wet path of urine where they lie, stained prepuce/abdominal/perivulvar area/pelvic limbs, and recurrent urinary tract infections
What diagnostic investigations can be considered for patients with urinary incontinence?
Observing the patient’s behavior when walking around or seating/lying down and performing urinalysis (including sediment analysis and urine culture)
What is the purpose of performing urinalysis for patients with urinary incontinence?
To exclude the presence of a urinary tract infection or neoplasia
What is the topic of Chapter 332 in the course notes?
Lower Urinary Tract Urolithiasis – Feline
What are the page numbers for Chapter 332?
2005 - 2010
According to Ettinger’s book, what is the topic of Chapter 336?
Anomalies of the Urinary Bladder
What are the page numbers for Chapter 336 in Ettinger’s book?
2029 - 2031
What is the purpose of the Minnesota Urolith Center?
To submit and interpret urolith samples
How can urolith samples be submitted to the Minnesota Urolith Center?
Refer to the instructions provided by the Minnesota Urolith Center
How can urolith samples be interpreted?
Refer to the instructions provided by the Minnesota Urolith Center
What are the four distinct layers of the bladder wall?
Mucosa, submucosa, detrusor muscle, serosa or adventitia
Which receptor is activated by pain or stretch in the detrusor muscle?
Muscarinic cholinergic receptors
What is the role of β3 adrenergic receptors in the detrusor muscle?
They cause detrusor muscle relaxation and bladder filling
Where do stretch receptors send afferent impulses in the micturition process?
Sacral spinal cord (S1-S3), pontine reticular formation in the brainstem, cerebral cortex
Which receptors are present in the nerve endings of the hypogastric and pelvic nerves?
Pain receptors
What are the five distinct layers of the bladder neck and urethral wall?
Mucosa, submucosa, internal sphincter, external sphincter, serosa or adventitia
Which receptor is stimulated by norepinephrine to facilitate bladder filling in the urethra?
Alpha 1-adrenergic receptors
What is the role of nicotinic cholinergic receptors in the urethra?
They cause contraction of the striated muscle of the urethra, leading to bladder filling
Where do stretch receptors in the urethra send afferent impulses to?
Sacral spinal cord (S1-S3), pontine reticular formation in the brainstem, cerebral cortex
What type of receptors are present in the nerve endings of the pudendal nerve?
Pain receptors
What imaging techniques can be used to examine the bladder and prostate gland in cats?
Ultrasound examination, excretory intravenous urogram, retrograde vagino-urethrogram, urethroscopy and cystoscopy
What are the causes of urinary incontinence in dogs and cats?
Overflow, poor bladder storage, anatomic abnormalities, detrusor instability, and sphincter mechanism incompetence
What are some examples of anatomic abnormalities that can cause urinary incontinence?
Ectopic ureters, patent urachus, urethral-vaginal fistula, vaginal vestibular stenosis
What breed of dogs are predisposed to sphincter mechanism incompetence?
Doberman, Giant Schnauzer, Old English Sheep Dog, Rottweiler, Weimaraner, and Boxer
How can urinary incontinence caused by certain anatomic variants be treated?
Surgery or laser ‘cut’ technique via urethroscopy
What medications can be used to manage detrusor instability?
Oxybutynin, Propantheline, Imipramine
What medication can be used to manage sphincter mechanism incompetence?
Phenylpropanolamine
What should be included in a radiograph of the urinary tract?
The perineum and the penile urethra.
When may a contrast cystourethrogram be required?
For radiolucent uroliths or uroliths that are too small to be seen in plain radiographs.
What should you look for in a contrast cystourethrogram?
Filling defects.
What imaging technique is used to examine the urinary tract?
Ultrasound.
What are the most common types of uroliths found in dogs?
Calcium oxalate and struvite.
Which gender of dogs are more likely to form calcium oxalate uroliths?
Males.
Which gender of dogs are more likely to have struvite urolithiasis?
Females.
How do calcium oxalate uroliths appear radiographically?
Moderately to markedly opaque.
What are the possible appearances of calcium oxalate uroliths?
Sharp, smooth, or with a mulberry appearance on their surface.
In what type of urine do calcium oxalate uroliths usually form?
Acid to neutral urine.
Which dog breeds are predisposed to calcium oxalate uroliths?
Miniature Schnauzer, Lhasa Apso, Yorkshire Terrier, Bichon Frise, Pomeranian, Poodle, Shih Tzu, Cairn Terrier, Maltese, Chihuahua.
How do struvite uroliths appear radiographically?
Moderately to markedly opaque.
How do struvite uroliths usually feel?
Smooth, particularly if multiple uroliths are present.
What size of uroliths are most likely to be struvite?
Uroliths that are more than 10 cm in diameter.
In what type of urine do struvite uroliths usually form?
Alkaline urine.
What commonly accompanies struvite urolithiasis?
Urinary tract infection caused by urease producing bacteria.
Which breed commonly has sterile struvite urolithiasis?
Cocker Spaniels.
What dog breeds are predisposed to struvite uroliths?
Miniature Schnauzer, Shih Tzu, Bichon Frise, Poodle, Lhasa Apso, Cocker Spaniels.
How do ammonium urate uroliths appear on radiographs?
Radiolucent to faintly opaque.
How do ammonium urate uroliths usually feel?
Smooth.
In what type of urine do ammonium urate uroliths usually form?
Acidic urine.
What conditions are commonly associated with ammonium urate uroliths?
Porto-systemic shunts or underlying hepatopathy.
Which dog breeds are predisposed to ammonium urate uroliths?
Dalmation, English Bulldog, Black Russian Terrier.
Why do Dalmatians develop urate urolithiasis?
Due to an autosomal inherited defect in their ability to transport insoluble uric acid into hepatic cells.
How do cystine uroliths appear on radiographs?
Faintly to moderately opaque.
How do cystine uroliths usually feel?
Round and smooth.
In what type of urine do cystine uroliths usually form?
Acidic urine.
What is the shape of cystine crystalluria?
Hexagonal shape.
Which mutations are associated with cystinuria in certain dog breeds?
SLC3A1 mutation, SLC7A9 mutation.
Which dog breeds have the SLC3A1 mutation?
Labrador, Australian Cattle Dog, Newfoundland.
Which dog breeds have the SLC7A9 mutation?
Miniature Pinscher.
Which dog breeds are predisposed to cystine uroliths, although the mutation is not identified?
Mastiff, English Bulldog, Chihuahua, Rottweiler, Pitbull, Dachshund, Staffordshire Bull Terrier.
How do calcium phosphate uroliths appear on radiographs?
Moderately to markedly opaque.
How do calcium phosphate uroliths usually feel?
Small and of variable shape.
In what type of urine do calcium phosphate uroliths usually form?
Alkaline to neutral urine.
What is the shape of calcium phosphate crystalluria?
Star shape.
Which factor has been found to be a predisposing factor for calcium phosphate uroliths?
Hypercalcaemia.
Which dog breeds are predisposed to calcium phosphate uroliths?
Yorkshire Terrier, Miniature Schnauzer, Bichon Frise, Shih Tzu, English Springer Spaniel, Pomeranian, Poodle, Cocker Spaniel.
How do silica uroliths appear on radiographs?
Moderately opaque with a jackstone appearance on their surface.
In what type of urine do silica uroliths usually form?
Acidic to neutral urine.
What is the usual cause of silica urolithiasis?
Ingestion of plants rich in silica.
What are the learning objectives of this module?
Recognizing clinical signs, identifying mineral composition, discussing causes, reviewing breed predispositions, evaluating medical and surgical management options, describing minimally invasive methods, explaining the difference in management of asymptomatic and symptomatic cases, identifying common pathogens, outlining diagnostic procedures, reviewing management and monitoring, discussing the management of pyelonephritis, and outlining the management of subclinical bacteriuria.
What are the clinical signs associated with lower urinary tract urolithiasis in dogs?
No clinical signs, pollakiuria, dysuria, stranguria, haematuria, inability to pass urine, and abdominal discomfort.
What diagnostic investigations are recommended when a dog presents with clinical signs consistent with urolithiasis?
Observing urination, palpating the urinary lower urinary tract, performing serum biochemical analysis, conducting urinalysis, and using imaging techniques such as plain abdominal radiographs.
How can urination be observed in a dog when assessing for urolithiasis?
By taking the patient outside and directly observing the urination process.
What should be palpated during the assessment of the urinary lower urinary tract?
The urinary bladder and the accessible urethra, which can be palpated by rectal examination and in male dogs, the penile urethra can also be palpated.
Why is serum biochemical analysis important in the evaluation of a dog with urolithiasis?
It helps determine if the dog is azotaemic or has electrolyte abnormalities that may require attention. It can also help predict the mineral composition of uroliths if changes in the patient’s condition are consistent with an underlying disease.
What parameters should be analyzed during urinalysis in a dog with urolithiasis?
Urine specific gravity, urine pH, urine sediment analysis, urine culture, and antibiotic sensitivity.
What information can be obtained from analyzing urine specific gravity in cases of recurrent urolithiasis?
Maintaining a low urine specific gravity can help prevent crystal aggregation and urolith formation.
What is the significance of urine pH in the formation of uroliths in dogs?
Urine pH affects urolith formation, similar to cats.
What can be observed through urine sediment analysis in a dog with urolithiasis?
Crystalluria, which may help identify urolith composition, and the presence of a urinary tract infection.
When is urine culture and antibiotic sensitivity indicated in dogs with suspected urinary tract infection?
It is indicated for cases with an active urine sediment present.
What imaging technique can be used to detect uroliths in dogs?
Plain abdominal radiographs.
Which uroliths are easily visualized on plain abdominal radiographs in dogs?
Calcium oxalate, struvite, apatite, and silica.
What are the limitations of detecting uroliths using plain radiographs in dogs?
Uroliths smaller than 2 mm in diameter have poor radiographic opacity and may be missed.
Who are the module developer and module tutor for this distance learning module?
Joana Agguiar is the module developer, and Dr. Thurid Johnstone is the module tutor.
What should be considered when choosing an antibiotic for treatment?
The antibiotic choice and length of treatment should aim to achieve clinical cure with minimal risk of adverse effects, including the development of antimicrobial resistance.
What should be done while awaiting culture results in dogs with urinary tract infection?
In dogs, start antimicrobial therapy or just analgesia (i.e. NSAIDs) depending on the severity of the clinical signs.
What should be done if the initial culture results indicate resistance to the empirical antimicrobial started?
The drug should only be changed if there has not been a good clinical response to treatment and cure has not been achieved. Ideally a second urine culture should be performed to prove it.
How long should the treatment be for cases of re-infection?
Short duration treatments of 3 to 5 days are still recommended for cases of re-infection. However, longer courses of treatment (7 to 14 days) are recommended for persistent and relapsing infections.
When can a urine culture be performed during treatment?
When patients are being treated for longer, urine culture can be performed after 5-7 days of treatment. If the culture is positive, it is important to re-assess patient and owner compliance with treatment and do not switch antibiotic therapy, unless patient is not showing a clinical improvement.
When should a repeat urine culture be performed after cessation of antimicrobials in patients with recurrent bacterial cystitis?
A repeat urine culture can be performed 5-7 days after cessation of antimicrobials in all patients with recurrent bacterial cystitis where clinical cure was documented.
How should bacteriuria post-treatment be managed?
The presence of bacteriuria post-treatment should be managed as subclinical bacteriuria.
What is pyelonephritis?
Pyelonephritis is an infection of the renal parenchyma that results either from ascending infection from the lower urinary tract or due to bacteraemia.
What are the common features of pyelonephritis?
Common features of pyelonephritis include systemic signs such as fever, lethargy, and/or polyuria/polydipsia, renal pain on abdominal palpation, azotaemia, and peripheral neutrophilia.
What diagnostic imaging technique can reveal pyelonephritis?
Imaging of the kidneys by ultrasonography may reveal pyelectasia and hyperechoic sediment within the renal pelvis.
What is recommended to collect a urine sample for culture in suspected pyelonephritis cases?
Cystocentesis and/or pyelocentesis are usually recommended to collect urine sample for culture. The latter should be done under ultrasound guidance.
What cultures are recommended in immunosuppressed or febrile patients with suspected pyelonephritis?
Blood cultures are recommended in immunosuppressed or febrile patients with suspected pyelonephritis.
How should antibiotic therapy be initiated in pyelonephritis cases?
Antibiotic therapy should be started whilst pending results of urine culture.
What is the recommended treatment of choice for pyelonephritis?
Fluoroquinolones are a good 1st choice treatment for pyelonephritis.
When is intravenous treatment recommended for pyelonephritis?
Intravenous treatment is recommended for animals that are dehydrated, not eating, or lethargic.
How long is the recommended duration of antibiotic therapy for pyelonephritis?
10-14 days of antibiotic therapy is recommended for pyelonephritis.
When should aerobic bacterial urine culture be recommended after cessation of antimicrobials in pyelonephritis cases?
If the patient responded clinically well to treatment, aerobic bacterial urine culture is recommended 1-2 weeks after cessation of antimicrobials.
What should further investigation be focused on in pyelonephritis cases with re-isolation of the same bacterial species?
Further investigations should focus on concomitant diseases such as urolithiasis, anatomic defects, or immune deficiency.
What is subclinical bacteriuria?
Subclinical bacteriuria is the presence of bacteria in urine in the absence of clinical signs consistent with the presence of a urinary tract infection.
What is the purpose of retrograde flushes in the management of urolithiasis?
To move urethroliths towards the bladder
What should be done if the urethroliths move towards the bladder during a retrograde flush?
Advance the catheter towards the trigone
Why is sterile saline used for subsequent retrograde flushes?
Because the urethra is well lubricated
What is the recommended method to confirm successful retrograde movement of all urethroliths?
Cystoscopy or radiography
How can stone baskets be used in the removal of uroliths?
They can be passed through the working channel of the cystoscope
What precaution should be taken when using stone baskets in the urethra?
Ensure uroliths are smaller than the diameter of the urethra when dilated
What are the available methods of lithotripsy?
Electrohydraulic and laser lithotripsy
What procedures are performed after lithotripsy?
Voiding urohydropropulsion and radiography
Where is laser lithotripsy performed?
At the Royal Veterinary College in the United Kingdom
What is the recommended management for asymptomatic urolithiasis caused by struvite in dogs?
Urinary acidification, diet change to Hill’s c/d, Royal Canin’s urinary s/o or Purina UR ST/OX Urinary, and antibiotic treatment
What is the recommended management for asymptomatic urolithiasis caused by calcium oxalate in dogs?
Hill’s c/d with or without potassium citrate or hydrochlorothiazide administration
What dietary change is recommended for asymptomatic urolithiasis caused by cystine in dogs?
Change patient’s diet to Hill’s u/d and consider tiopronin
How should asymptomatic urolithiasis caused by ammonium urate be managed in dogs?
Look for underlying cause and correct if possible, otherwise treat patient with allopurinol and Hill’s u/d
What should be done if urolith dissolution is not achieved through diet change?
Attempt voiding urohydropulsion or perform cystoscopy and basket retrieval
What is the recommended method for managing asymptomatic urolithiasis caused by struvite in cats?
Use a dissolution diet (Hill’s s/d) followed by a less acidifying diet (Hill’s c/d, Royal Canin’s urinary s/o or Purina UR ST/OX Urinary)
Is potassium citrate beneficial for managing asymptomatic urolithiasis caused by calcium oxalate in cats?
No study has identified the benefits of potassium citrate
What has reduced the number of calcium oxalate stones in cats?
Hydrochlorothiazide
How can urine pH be increased to manage asymptomatic urolithiasis caused by cystine in cats?
Use potassium citrate
What are the recommended measures for managing symptomatic urolithiasis in dogs and cats?
Medical dissolution, urohydropropulsion, basket retrieval, and lithotripsy
When should minimally invasive cystotomy or urethrostomy be considered for managing symptomatic urolithiasis?
If minimal invasive techniques are not successful
What are the most common pathogens involved in urinary tract infections in dogs and cats?
Bacteria
What percentage of urinary tract infections in dogs and cats are caused by bacteria?
99%
What percentage of infections affecting the urinary tract are caused by fungi and parasites?
1%
Which breeds are predisposed to this type of urolithiasis?
German Shepherd Dog, English Sheepdog, Labrador, Golden Retriever, Miniature Schnauzer, Cocker Spaniel, Shih Tzu, Bichon Frise
What is the cause of xanthine urolithiasis?
Decreased activity of the enzyme xanthine oxidase
Which breed is known to have hereditary xanthinuria?
Toy Manchester Terrier, Cavalier King Charles Spaniel, English Cocker Spaniel, Dachshund, Chihuahua, mixed breed dogs
What are the radiographic characteristics of xanthine uroliths?
Radiolucent to faintly opaque, multiple smooth uroliths
Why is it important to predict the mineral composition of uroliths?
To determine if uroliths can be dissolved with medical treatment or require surgical removal
What are the commonly used diets for managing urolithiasis?
Hill’s c/d, Royal Canin’s urinary s/o, Purina UR ST/OX Urinary, Hill’s s/d, Hill’s u/d, Royal Canin’s urinary u/c
Which diets help dissolve struvite stones and reduce the risk of other stone formations?
Hill’s c/d, Royal Canin’s urinary s/o, Purina UR ST/OX Urinary
Which diet specifically targets acidic urine to dissolve struvite stones?
Hill’s s/d
Which diets help reduce the formation of calcium oxalate, urate, and cystine stones?
Hill’s u/d, Royal Canin’s urinary u/c
Which medication is used to manage urate uroliths?
Allopurinol
What is the recommended dose of allopurinol?
5-15 mg/kg, PO, bid
What adverse effects can occur with allopurinol use?
Increased predisposition for xanthine urolithiasis and hypersensitivity reactions
Which medication increases urine pH to reduce calcium oxalate urolith formation?
Potassium citrate
What is the recommended dose of potassium citrate?
75 mg/kg, PO, bid
What adverse effects can occur with potassium citrate use?
Decreased appetite and hyperkalemia
Which medication decreases urine pH to enhance struvite urolithiasis dissolution?
dl-methionine
What is the recommended dose of dl-methionine?
100 mg/kg, PO, bid
What adverse effects can occur with dl-methionine use?
Decreased appetite and increased risk of acidemia
Which vitamin minimizes oxalate production?
Vitamin B6
In which animals is vitamin B6 recommended?
Dogs and cats eating a diet deficient in vitamin B6
What are the most common bacteria identified as the cause of urinary tract infections?
E. coli and Streptococcus faecalis
What are the clinical signs of a urinary tract infection?
Pollakiuria, stranguria, haematuria, and dysuria
Why is it useful to collect a free-catch urine sample from a patient with a urinary tract infection?
To assess for the presence of haematuria (macro and microscopically)
What can induce bleeding from the needle entering the urinary bladder during cystocentesis?
The procedure itself
Why is it important to assess the urine prior to any procedures in patients with a urinary tract infection?
To check for the presence of haematuria
What may patients with a urinary tract infection be uncomfortable with on palpation of the caudal abdomen and bladder?
Palpation of the caudal abdomen and bladder
What may be difficult to feel in patients with a urinary tract infection?
A distended bladder
What may patients with a urinary tract infection suffer from most of the time?
Empty bladder
Why is it important to determine if the patient is azotaemic in cases of urinary tract infection?
As it may be an indication that the infection has reached the kidneys (pyelonephritis)
What diagnostic tests are recommended for a patient with clinical signs consistent with a urinary tract infection?
Observe urination, collect a free-catch urine sample, palpate the distal abdomen and urinary bladder, perform serum biochemical analysis, and urinalysis
What tests should be performed in a complete urinalysis for patients with suspected urinary tract infections?
Urine specific gravity, urine dip-stick analysis, sediment analysis, and culture and antibiotic sensitivity testing
What may be marginally increased in urinary tract infection cases?
Urine specific gravity
Why may urine pH be raised in urinary tract infections caused by a urease producing organism?
Bacterial urease generates ammonia from urea, raising the pH of the urine
What can be detected on a droplet of unstained urine sediment under the microscope?
Bacteria, increased numbers of white blood cells, and the presence of red blood cells
How can improved bacteriuria detection be obtained in urine sediment analysis?
By staining the urine sediment with methylene blue or Gram’s stain
When will the growth of uropathogens in an aerobic urine culture be apparent in most cases?
Within 18-24 hours of incubation
What imaging tests would be recommended in cases of suspected concomitant diseases affecting the urinary tract?
Abdominal ultrasound examination and/or abdominal radiographs
What are some of the conditions that may require abdominal ultrasound examination and/or abdominal radiographs in patients with suspected urinary tract infections?
Neoplasia (transitional cell carcinoma), urolithiasis, persistent urachus, and prostatitis
What is the term used to describe the recurrence of a urinary tract infection by the same microorganism?
Relapse
What is the term used to describe the infection by a different organism?
Re-infection
What is the term used to describe an infection on top of an existing infection?
Super-infection
What is the recommended dose of Hydrochlorothiazide?
2 mg/kg, PO, bid
What is the recommended dose of Tiopronin?
5-20 mg/kg, PO, bid
What adverse effect can Hydrochlorothiazide induce?
hypercalcaemia
What adverse effects are associated with Tiopronin?
proteinuria, thrombocytopaenia, anaemia, pustules
According to the ACVIM Small Animal Consensus Recommendations, when should nonclinical urocystoliths be removed?
They do not require removal
What procedures should be avoided in the surgical management of urolithiasis?
Cystotomy and closure of the bladder with sutures, and urethral surgery
What methods should be recommended for the management of urolithiasis?
Medical dissolution and minimally invasive methods
What size of uroliths can usually pass through the canine urethra?
Up to 3 mm
What technique can be used to remove small uroliths by inducing voiding?
Voiding urohydropropulsion
What precautions should be taken in performing voiding urohydropropulsion?
Perform under general anesthesia and prevent increased pressure within the bladder to avoid bladder wall trauma
What technique is used to flush urethroliths into the urinary bladder and relieve urethral obstruction?
Retrograde urohydropropulsion
What is required for performing retrograde urohydropropulsion?
General anesthesia and catheterization of the distal urethra
What is the mixture used for flushing urethroliths in retrograde urohydropropulsion?
2:1 mixture of sterile saline and sterile aqueous lubricant
What is the term used when a new bacterial organism is isolated while the patient is still on treatment for a urinary tract infection by another microorganism?
The term used is ‘re-infection’
What is the responsibility of the profession regarding antibiotic therapy for urinary tract infections?
The responsibility is to prescribe antibiotic therapy wisely
What is the difference between sporadic and recurrent bacterial cystitis?
Sporadic cystitis occurs in otherwise healthy individuals while recurrent cystitis occurs in patients with underlying causes
How is sporadic bacterial cystitis diagnosed in dogs?
It is recommended to confirm the diagnosis with a urine culture, but empirical therapy can be justified in suspected cases
What is the recommended treatment duration for sporadic bacterial cystitis?
The recommended duration of therapy is 3–5 days
Is post-treatment urinalysis necessary for sporadic bacterial cystitis if clinical signs have fully resolved?
No, post-treatment urinalysis is not necessary if clinical signs have fully resolved
What should be done if a patient’s clinical signs do not improve within 48 hours of starting antibiotic treatment for sporadic bacterial cystitis?
Further investigations are required to confirm UTI, the presence of a super-infection, underlying disease, or development of complications
Is it recommended to empirically change antimicrobials in response to poor initial response to treatment for sporadic bacterial cystitis?
No, it is not recommended to empirically change antimicrobials in response to poor initial response to treatment
When should the antimicrobial be changed for sporadic bacterial cystitis?
The antimicrobial should only be changed if there has not been a good clinical response to treatment and initial culture results indicate resistance to the empirical antimicrobial started
What is the recommended diagnosis method for recurrent bacterial cystitis?
Urine culture, ideally from a cystocentesis sample, is recommended in all patients with recurrent cystitis
What should be reviewed for relapsing and refractory infections of recurrent bacterial cystitis?
The dose and frequency of administration of the antimicrobial, as well as owner and patient compliance to treatment, should be reviewed
Why is it important to identify and manage relevant risk factors and concurrent diseases for long-term success in the treatment of recurrent bacterial cystitis?
It is important to ensure successful treatment by addressing any underlying causes
What percentage of healthy dogs have subclinical bacteriuria?
Up to 12%
What percentage of healthy cats have subclinical bacteriuria?
Up to 13%
In what percentage of patients with underlying diseases can subclinical bacteriuria be diagnosed?
Up to 74%
What are some underlying diseases that may be associated with subclinical bacteriuria?
Diabetes mellitus, morbid obesity, parvoviral enteritis, disc disease, and immunosuppressive medication
Is there evidence of an association between subclinical bacteriuria and the risk of cystitis development in dogs and cats?
No evidence
What are some indications to culture the urine of patients without lower urinary tract signs? (Name at least 3)
Suspected pyelonephritis, bacteraemia/septicaemia, surgical or minimally invasive procedure involving the urinary tract
When is antibiotic therapy rarely indicated for subclinical bacteriuria?
In general, it is discouraged and rarely indicated
Is isolation of multidrug resistant bacteria a reason to treat subclinical bacteriuria?
No, it is not a reason
Under what circumstances may treatment of subclinical bacteriuria be required?
If caused by plaque-forming (Corynebacterium urealyticum) or urease-producing bacteria
What are the associations of plaque-forming bacteria and urease-producing bacteria with?
Plaque-forming bacteria is associated with encrusting cystitis, and urease-producing bacteria is associated with struvite urolith formation
What are some clinical signs of chronic bacterial prostatitis?
Sanguineous urethral discharge, haematuria, hindlimb gait abnormalities, caudal abdomen discomfort, testicular pain, infertility
What are the findings of rectal palpation in chronic bacterial prostatitis?
Asymmetric, firm and irregular prostate gland
What imaging techniques can be used to evaluate the prostate gland?
Radiographs, CT, and ultrasound
What is the typical pattern seen on ultrasound examination of the prostate gland in chronic bacterial prostatitis?
Heterogeneous pattern of mixed echogenicity
How is prostatic fluid evaluation obtained?
By prostatic wash/brushing
What confirms the diagnosis of chronic bacterial prostatitis?
Evidence of suppurative inflammation in prostatic fluid evaluation
What is the recommended antibiotic therapy duration for chronic bacterial prostatitis?
A minimum of 4-6 weeks
What is the recommended timing of castration in the treatment of chronic bacterial prostatitis?
5-7 days after starting antibiotic therapy
What can cause prostatic abscessation?
Acute bacterial prostatitis or infection of prostatic cyst
What are the clinical signs and findings indicating prostatic abscess?
Lethargy, fever, pain on urination and defaecation, caudal abdominal pain, inflammatory leukogram, sepsis-induced hypoglycemia, ultrasound and CT findings
Why can prostatic fluid culture yield false-negative results in prostatic abscess?
Infection is well contained within the abscess capsule
What is the recommended duration of antibiotic treatment for prostatic abscess after drainage?
6 weeks
What are the recommended methods of draining prostatic abscess?
Surgical drainage or ultrasound-guided percutaneous aspiration
What is the recommended procedure following prostatic abscess drainage for lower recurrence and mortality rates?
Prostatic omentalisation with the placement of a Penrose drain
What can be done to promote rapid resolution of bacterial infection in prostatic abscess?
Castration or androgen suppression therapy
What should be monitored during post-treatment re-examination of prostatic abscess?
Resolution of the abscess and prostatic fluid cultured both during treatment and after antimicrobial therapy is discontinued
Where do paraprostatic cysts originate from?
Embryologic remnants of the uterus masculinus
How are paraprostatic cysts diagnosed?
They may be incidental findings or present with clinical signs of dyschezia, dysuria, and urinary incontinence
What are the clinical signs and physical examination findings of paraprostatic cysts?
Dyschezia, dysuria, urinary incontinence, and palpable mass depending on size
What is Feline Idiopathic Cystitis (FIC)?
FIC is lower urinary tract signs in cats without an obvious underlying cause.
What are the contributing factors for Feline Idiopathic Cystitis (FIC)?
The cause of FIC is unknown, but it is believed to result from multiple causes including bladder and neuroendocrine abnormalities.
What is another term for Feline Idiopathic Cystitis (FIC)?
Feline interstitial cystitis or ‘Bladder Pain Syndrome’ in human medicine.
What percentage of cats with lower urinary tract signs are diagnosed with FIC?
FIC is diagnosed in 27-73% of cats with lower urinary tract signs, depending on the study.
What are the layers of the urinary bladder wall?
The layers of the urinary bladder wall are urothelium, submucosal layer, muscle detrusor, and adventitia.
What are the possible causes of FIC?
The cause of FIC is unknown, but it is likely a result of complex interactions between the urinary bladder, neuroendocrine system, and environmental factors in cats.
What abnormalities are associated with the urinary bladder wall in FIC?
Abnormalities are found in the urothelium, submucosal layer, muscle detrusor, and adventitia of the urinary bladder wall in FIC.
What role does substance P play in FIC?
Substance P is believed to upregulate neurokinin receptors and contribute to the pathophysiology of FIC.
What changes are observed in the dorsal roots of the lumbosacral spinal cord in cats with FIC?
Cats with FIC may show abnormalities in the dorsal roots of the lumbosacral spinal cord.
How do adrenal glands appear in cats with FIC?
Adrenal glands in cats with FIC have been observed to be smaller.
What is the most common cause of feline lower urinary tract disease?
Feline idiopathic cystitis (FIC) is the most common cause of feline lower urinary tract disease in cats.
What is the significance of paraprostatic cysts?
Paraprostatic cysts are important to recognize and can be treated.
What neoplasms can affect the lower urinary tract in dogs and cats?
Transitional cell carcinomas and other less common neoplasms can affect the lower urinary tract in dogs and cats.
What are the clinical signs associated with acute prostatitis?
The clinical signs of acute prostatitis include fever, pain, altered urination, and prostatomegaly.
What are the clinical signs associated with chronic prostatitis?
The clinical signs of chronic prostatitis include recurrent cystitis, stranguria, hematuria, and prostatic nodules.
What are the treatment options for cats with FIC?
The short-term treatment options for cats with FIC include analgesia, environmental enrichment, and antianxiety medication.
What are the long-term treatment options for cats with FIC?
The long-term treatment options for cats with FIC include dietary modification, stress reduction, and monitoring for recurrent episodes.
What can be done to diagnose FIC?
To diagnose FIC, a thorough physical exam, urinalysis, urine culture, imaging studies, and ruling out other possible causes are usually performed.
What is benign prostatic hyperplasia (BPH)?
BPH is a nonmalignant enlargement of the prostate gland in intact male dogs.
What are the clinical signs associated with BPH?
The clinical signs of BPH include stranguria, hematuria, and prostatomegaly.
What are the treatment options for BPH?
Treatment options for BPH include medical management, castration, and surgical intervention.
How can prostatic abscessation be treated?
Treatment options for prostatic abscessation include drainage, antibiotics, and supportive care.
What are the clinical signs associated with lower urinary tract neoplasms?
The clinical signs of lower urinary tract neoplasms include hematuria, dysuria, pollakiuria, and weight loss.
What are the steps required to diagnose patients with transitional cell carcinomas?
Diagnosis of transitional cell carcinomas requires imaging studies, cytology, histopathology, and ruling out other possible causes.
What treatment options are available for transitional cell carcinomas?
Treatment options for transitional cell carcinomas include surgery, radiation therapy, chemotherapy, and palliative care.
What are some less common neoplasms of the lower urinary tract in dogs and cats?
Less common neoplasms of the lower urinary tract in dogs and cats include nephroblastoma, leiomyosarcoma, and squamous cell carcinoma.
What effect does environmental enrichment have on cats with FIC?
It may have a beneficial effect, as catecholamine concentrations and urinary bladder permeability decreased during the enrichment phase.
What were the significant reductions found in cats with FIC after 10 months of environmental enrichment treatment?
Significant reductions in lower urinary tract signs, fearfulness, and nervousness were observed.
What is Feliway and how is it used for cats?
Feliway is a combination of synthetic feline facial pheromone and valerian, used to provide a calming effect on cats.
What did a systematic review of the scientific literature conclude about the use of Feliway for FIC management?
Insufficient evidence was found to support its use for FIC management.
Do feline facial pheromones in Feliway decrease stress in hospitalised cats or calm cats in unfamiliar surroundings?
No, Feliway does not seem to decrease stress in hospitalised cats or calm them in unfamiliar surroundings.
What types of analgesics have been recommended for cats with FIC?
Buprenorphine, acepromazine, or a fentanyl patch depending on the severity of pain.
What caution should be taken when using NSAIDs in dehydrated patients with FIC?
They should be used with caution due to the increased risk of acute kidney injury.
What has been suggested as a potential treatment for cats with FIC based on its usefulness in women with interstitial cystitis?
Treatment with glycosaminoglycans (GAGs) like pentosan polysulphate, glucosamine, and chondroitin sulphate.
Which compounds have been investigated for managing stress-related behaviors and anxiety in cats?
L-Tryptophan and α-casozepine have been evaluated for these purposes.
What tricyclic antidepressants have been used to treat severe FIC in cats?
Amitriptyline and clomipramine have been used but should be used with caution.
What are the five most common pathologies of the canine prostate gland?
- Benign prostatic hyperplasia; 2. Acute and chronic bacterial prostatitis; 3. Prostatic abscessation; 4. Paraprostatic cysts; 5. Prostatic neoplasia
What percentage of dogs with other diseases have concomitant prostatic pathology?
76% of dogs dying of other diseases have concomitant prostatic pathology.
Is benign prostatic hyperplasia more common in castrated dogs or entire males?
Benign prostatic hyperplasia is more common in intact male dogs.
What breed of dogs tend to suffer from a more severe form of benign prostatic hyperplasia?
Scottish Terriers tend to suffer from a more severe form of benign prostatic hyperplasia.
What can benign prostatic hyperplasia progress to and what can it predispose dogs to?
Benign prostatic hyperplasia can progress to cystic BPH and can predispose dogs to chronic bacterial prostatitis, cystitis, epididymitis, and orchitis.
Do most dogs with benign prostatic hyperplasia show clinical signs?
No, most dogs have no clinical signs and BPH is usually an incidental finding.
How is the prostate gland commonly found on rectal palpation in dogs with BPH?
The prostate gland is commonly found symmetrically enlarged, moderately firm, and not painful on rectal palpation.
When do clinical signs of BPH occur?
Clinical signs occur mostly in advanced stages, when the enlarged prostate compresses the colon dorsally and dogs have problems defecating.
What are the signs that can be included in the diagnosis of Feline Idiopathic Cystitis?
Routine urinalysis, imaging, and behavioral history.
What are the short-term treatment options for cats with Feline Idiopathic Cystitis?
Antibiotics are not warranted, analgesic therapy may be indicated, and enrichment of the kennel is recommended.
What is the importance of water consumption in the management of Feline Idiopathic Cystitis?
Increasing water consumption may dilute potential noxious stimulants to the urothelium.
What is the potential benefit of feeding moist food to cats with Feline Idiopathic Cystitis?
Moist food may reduce the recurrence of clinical signs and have a positive impact on the cat’s well-being.
Is urine acidification and controlling magnesium and phosphorus intake beneficial for cats with nonobstructive Feline Idiopathic Cystitis?
There is no known benefit, but it may help prevent urethral obstruction in male cats.
What is the role of omega-3 fatty acids and antioxidants in the management of Feline Idiopathic Cystitis?
Their optimal therapeutic dose is unknown, but a recent study found benefits in cats with FIC, possibly related to their anti-inflammatory properties.
What is the recommended diet for cats with Feline Idiopathic Cystitis?
Transitioning to a multipurpose therapeutic urinary food, such as Hill’s Prescription Diet c/d Multicare, is recommended if the cat tolerates the change.
What is the single most important method used to decrease stress and manage Feline Idiopathic Cystitis cases?
Environmental enrichment.
What are some strategies for environmental enrichment for cats with Feline Idiopathic Cystitis?
Enhancing interactions with owners, minimizing conflict with other pets, using toys and play activities, and providing various places for drinking, feeding, scratching, elimination, and resting throughout the home.
What is the source of evidence supporting the benefits of environmental enrichment in Feline Idiopathic Cystitis?
A controlled laboratory study.
What is a healthy urothelium a barrier to?
A healthy urothelium is a tight barrier to solutes and ions present in the urine.
What is the relationship between decreased GAG concentration and urothelial protection?
Decreased GAG concentration in biopsies of cats with FIC was associated with decreased urothelial protection.
What is the association between a prominent mast cell population and FIC cases?
A prominent mast cell population has been observed in 20% of FIC cases.
What did the increased sympathetic neuron density in cats with FIC lead to?
Increased sympathetic neuron density in cats with FIC is responsible for hyperalgesia.
What can changes in urine pH and electrolyte concentration contribute to?
Changes in urine pH and electrolyte concentration may contribute to chemical, mechanical, and neural stimulation of the bladder wall.
How can decreased urine volume and frequency of urination complicate FIC?
Decreased urine volume and frequency of urination may allow increased contact time of highly concentrated urine with the urothelium, further complicating FIC.
What is Substance P and its relation to FIC?
Substance P is a sensory neurotransmitter peptide found in increased concentrations in unmyelinated neurons of the urinary bladder of cats with FIC.
What is the impact of neuroendocrine abnormalities on FIC development?
Neuroendocrine abnormalities lead to increased urothelium permeability in cats with FIC.
Why do cats with stress experience lower urinary tract signs?
The anatomical proximity of the micturition centre to the periaqueductal gray may place the neurological pathways at increased risk of activation in response to stress.
What are some identified risk factors for the development of FIC?
Some identified risk factors for the development of FIC include being overweight, belonging to a multicat household, showing nervous behavior, using a litter tray, decreased water intake, decreased hunting behavior, decreased activity levels, and living predominantly/exclusively indoors.
What is the diagnosis of FIC based on?
Feline idiopathic cystitis is a diagnosis of exclusion when other causes of lower urinary tract dysfunction have been eliminated.
What are some important differential diagnoses for cats with non-obstructive lower urinary tract signs?
Some important differential diagnoses for cats with non-obstructive lower urinary tract signs include urolithiasis, urinary tract infection, behavioral disorders, and anatomical defects.
Which evaluations are recommended for cats with non-obstructive lower urinary tract signs?
Diagnostic evaluations recommended for cats with non-obstructive lower urinary tract signs include…
What are some organisms that can cause prostatitis?
Klebsiella spp., Proteus mirabilis, Mycoplasma canis, Pseudomonas aeruginosa, Enterobacter spp., Streptococcus spp., Pasteurella spp., Haemophilus spp.
What are the signs of acute bacterial prostatitis in dogs?
Depression, anorexia, vomiting, fever, stranguria, tenesmus, caudal abdominal pain, urethral/preputial discharge, stiff or stilted gait
What are the diagnostic procedures for prostatitis?
History and physical examination, urinalysis, prostatic wash and brush sampling, imaging studies
Why should urine collected by cystocentesis be cultured?
Prostatic secretions flow retrograde into the bladder, and urine and prostatic fluid cultures are highly correlated
How can prostatic wash be performed?
Passing a rigid urinary catheter up to the prostate gland and flushing sterile saline while performing digital prostatic massage
How can prostatic brush sampling be performed?
Catheterizing the urethra with a cytobrush up to the prostate gland and rubbing the brush while performing digital prostatic massage
What imaging studies can aid in diagnosing prostatitis?
Radiography, ultrasonography, CT imaging
Why is fine needle aspirate of the prostate gland not recommended?
Risk of bacterial seeding along the needle tract
What is the recommended duration of antimicrobial therapy for acute bacterial prostatitis?
4-6 weeks
Why should castration be performed after medical treatment of the infection?
To reduce prostatic size
When is castration not recommended during the acute phase of infection?
When chronic infection of the spermatic cord stump may form
What is the recommended initial therapy for cases where castration is not desired?
Reversible androgen suppression therapy
What dogs are most commonly affected by chronic bacterial prostatitis?
Mature entire dogs or those that have only been recently castrated
What percentage of dogs with chronic bacterial prostatitis exhibit no clinical signs?
35%
What clinical sign is most commonly seen in dogs with chronic bacterial prostatitis?
Recurrent urinary tract infection
What are the imaging findings of paraprostatic cysts?
Cysts are usually seen arising from the craniolateral aspect of the prostate gland and tend to displace the urinary bladder cranially and the colon and rectum dorsally.
What is the treatment for paraprostatic cysts?
Most paraprostatic cysts do not require any treatment, but if clinical signs are present, treatment may include ultrasound-guided percutaneous drainage, surgical debridement, omentalisation, marsupialization and placement of surgical drains.
Which prostatic tumors are more common in dogs?
The two most common prostatic tumors in dogs are adenocarcinoma and transitional cell carcinoma (TCC).
What are the clinical findings in dogs with prostatic neoplasms?
Common clinical findings in dogs with prostatic neoplasms include dysuria, macroscopic haematuria, dyschezia, hindlimb pain, ataxia, anorexia, and weight loss.
How is prostatic neoplasia in dogs diagnosed?
Diagnosis of prostatic neoplasia in dogs is usually based on history, clinical signs, prostatic imaging, and prostatic fluid analysis.
What are the radiographic and computed tomography changes consistent with the presence of a prostatic tumor?
Radiographic and computed tomography changes consistent with the presence of a prostatic tumor include asymmetric prostatomegaly, mineralization of the prostate, regional lymphadenomegaly, and pulmonary and bone changes.
What are the ultrasound findings associated with a prostatic tumor?
Ultrasound findings may include focal to diffuse hyperechoic areas of the prostate, prostate mineralization, and loss of normal prostatic capsule.
Why is castration a risk factor for prostatic cancer development in dogs?
Castration increases the risk of a dog developing prostatic cancer as it leads to increased occurrence of less-differentiated growth patterns in canine prostatic cancer.
What are the treatment options for prostatic adenocarcinomas or prostatic TCCs?
There is no consensus on the ideal treatment protocol, but treatment options include meloxicam or piroxicam to reduce the size of the prostatic neoplasia and bisphosphonate to control paraneoplastic hypercalcaemia.
What is the most common lower urinary tract neoplasm in dogs and cats?
Transitional cell carcinoma (TCC) is the most common lower urinary tract neoplasm in dogs and cats.
Which region of the lower urinary tract does TCC mostly affect in dogs?
TCC mostly affects the trigone region in dogs.
What are the possible locations of TCC in cats?
The location of TCC appears to be more variable in cats than in dogs, but the trigone region is still the most common location.
What is the aetiology of TCC?
Exposure to older generation ectoparasiticides and to lawn treatment is associated with the development of TCC.
What does Tis represent in the TNM staging system for bladder cancer?
Carcinoma in situ
What does T0 represent in the TNM staging system for bladder cancer?
No evidence of a primary tumour
What does T1 represent in the TNM staging system for bladder cancer?
Superficial papillary tumour
What does T2 represent in the TNM staging system for bladder cancer?
Tumour invading the bladder wall with induration
What does T3 represent in the TNM staging system for bladder cancer?
Tumour invading neighbouring organs (prostate, uterus, vagina and pelvic canal)
What does N0 represent in the TNM staging system for bladder cancer?
No regional lymph node involvement
What does N1 represent in the TNM staging system for bladder cancer?
Regional lymph node involvement
What does N2 represent in the TNM staging system for bladder cancer?
Regional lymph node and justaregional lymph node involvement
What does M0 represent in the TNM staging system for bladder cancer?
No evidence of metastasis
What does M1 represent in the TNM staging system for bladder cancer?
Distant metastasis present
What factors are taken into consideration for establishing a prognosis in bladder cancer?
TNM stage at diagnosis, age at diagnosis, prostatic involvement
Which treatment option for dogs with bladder cancer involves resection of the tumour with free margins?
Surgical Treatment
Which treatment option for dogs with bladder cancer has been studied as an adjuvant therapy to medical treatment?
Radiation therapy
Which drugs are commonly used for treatment of bladder cancer in dogs?
Vinblastine, piroxicam, cisplatin, mitoxantrone, deracoxib
What is the recommended treatment protocol for bladder cancer in cats?
Partial cystectomy and treatment with NSAIDs
What other tumours may develop in the lower urinary tract of dogs and cats?
Squamous cell carcinoma, rhabdomyosarcoma, lymphoma, haemangiosarcoma, fibroma, other mesenchymal tumours
