37. Diseases of the urinary bladder and prostate in dogs and cats Flashcards
Lower urinary tract disease?
Cystitis?
Cystitis
Infectious: Bacteria (dogs) (Mycoplasma spp./ Capillaria plica);
Polypoid cystitis (chronic bacterial inflammation; DDx: Tumour)
Sterile: Interstitial; Idiopathic[Fe.]
Primary/Secondary: Tumour; Stone
DDx: Stone; Tumour; Prostatic disease; Anatomical abnormalities;
Bleeding disorders; Haemoglobinuria; Myoglobinuria
Bacterial Cystitis?
BACTERIAL CYSTITIS
Predisposed: Older animals; Dogs > Cats; Females > Males
Causes
E. coli; Staphylococcus spp.; Streptococcus spp.; Proteus spp.
Multi-drug resistance: Corynebacterium ureolyticum + contributing
factors (those affecting bacterial virulence; Abnormal host defence
mechanism – See previous topic)
Clinical signs
§ Pollakiuria § Dysuria
§ Urge incontinence § Haematuria
§ Distended bladder § Painful bladder
§ Thick bladder wall § Bladder mass
§ Stranguria § Small bladder
§ Periuria § Urolithiasis
Diagnosis - Lab. D
Macroscopic changes: Haematuria or pyuria
Sediment: Bacteria; RBCs; WBCs; Epithelial cells; ± Struvite
Alkaline or normal pH; Culture & sensitivity by cystocentesis
Treatment
Abx Treatment
§ Simple infection: 7-10 days
§ Complicated cases 3-6 weeks
§ Good penetration into urine:
§ Amoxiclav
§ Cephalosporin
§ Fluroquinolones
§ Trimethoprim sulphonamides
Pain management: NSAIDS & Opioids
Spasmolytics; Cranberry products (act as an analgesia)
SUBCLINICAL BACTERIURIA
When there is a positive bacterial culture but with Ø CSx of cystitis.
Ø Tx; Only a follow-up is needed if asymptomatic; If +++ bacteria
→ Abx treatment
FLUTD(feline lower urinary tract disease)?
FLUTD(FELINE URINARY TRACT DISEASE)
Group of diseases with the same symptoms but different aetiology
Aetiology
FIC (Feline idiopathic cystitis) → 60-70% of cases
Stones → 20% of cases
Bacterial cystitis → 1-3%
Tumour; Anatomical disorder; Trauma; Stricture
Clinical signs
§ Dysuria
§ Haematuria
§ Periuria
§ Urethral obstruction
Physical exam: Good general condition; Bladder → Small & painful
Diagnosis
Urinalysis
Sediment: RBCs (typically seen in FIC); WBCs (typically seen in bacterial cystitis); Crystals ≠ Urolithiasis!
Culture: Used to rule out/confirm bacterial cystitis
Imaging: Reveals urolithiasis, tumours & anatomical disorders
Dx of FIC is by Dx of exclusion
Urethral Obstruction(“the blocked cat” ?
URETHRAL OBSTRUCTION (“THE BLOCKED CAT”)
Male cats are predisposed: Uroliths; Crystals; Thrombus; Urethral plug (mineral & organic complex); Urethral spasm alone
Physical exam: Extremely filled, tense & painful bladder (Ø
Expressible)
Clinical signs: Lethargy; Dehydration
Life-threatening condition – Bladder rupture; Postrenal azotaemia
Treatment:
§ Emergency catheterisation (this can be combined with
decompressive cystocentesis
Feline Idiopathic cystitis?
FIC (FELINE IDIOPATHIC CYSTITIS)
Maladaptive response to environmental stressors (including
boredom) → Sterile cystitis
General exam: CSx of cystitis; Good general condition; May be associated with macroscopic sediment (sand)
Presentation: Acute, self-limiting episodes (3-5 days) → 80-95%
Predisposition
§ Stray cats § Orphans
§ Indoor cats § Boring environment
§ Dry food § Low water intake
§ New baby/pet § Travel of owner
§ Cats from shelters § Multi-cat households
§ Obesity § Changes of routine
Treatment
§ ↑ water intake
§ Medication: Opioids; NSAIDS; Spasmolytics; Gabapentin
(Remember that giving pills acts as a stressor)
§ Stress medication: Tryptophane; Pheromone diffuser
§ Bladder mucosa protectants
§ Diet: Urinary prescription diet (Hills c/d urinary stress)
§ Environmental enrichment acts as a great preventor
Pathogenesis of fic adrenal and hormonal pathway diagram?
Lower Urinary tract tumour?
Lower Urinary Tract Tumour
Transitional cell carcinoma (TCC) → Trigonum area (dogs);
Rhabdomyosarcoma
Diagnosis
§ Imaging
§ Urine sediment
§ Biopsy
DDx: Polypoid cystitis (pedunculated masses); Blood clot; Cystitis;
Urolithiasis
Treatment: Piroxicam
Urinary bladder rupture?
Urinary bladder Rupture
Leads to Postrenal azotaemia
Causes: Trauma; Cystitis; Tumour; Urolithiasis
Diagnosis: Imaging; Abdominal:Serum creatinine (>2:1)
Prostatic diseases clinical signs diagnosis and prostatic hypertrophy?
Prostatic diseases
Predisposed: Older dogs
CLINICAL SIGNS
Urethral bleeding; Tenesmus; UTI; Haematuria
DIAGNOSIS
§ Rectal digital palpation: Size; Shape; Symmetry;
Consistency; Pain
§ Imaging: X-ray; US
§ Urinalysis; Cytology; Biopsy
§ Examination of prostatic fluid & semen
PROSTATIC HYPERTROPHY
Symmetrical enlargement with/without cavitary lesions (seen on US)
Treatment: Symptomatic; Castration; Antiandrogens (+
progesterone)
Prostatitis?
PROSTATITIS
Acute/chronic bacterial infection with/without abscessation
Prostatic hypertrophy predisposes to prostatitis
Clinical signs
May be severe
§ UTI signs
§ General signs
§ Shock
Treatment
§ Treat for shock
§ Abx
§ Drainage (surgical/US-guided)
§ Castration
Paraprostatic cyst and prostate tumour?
PARAPROSTATIC CYST
Müllerian duct remnant or retention cyst; Large in size
Treatment: Castration; Surgical removal
PROSTATE TUMOUR
Adenocarcinoma (more common in old & neutered dogs)
Metastatic & urethral compression may be seen
Treatment:
§ Castration
§ TCC Tx: Surgery & NSAID (Piroxicam)
