Non-obstructed Lower Urinary Tract Disease

Question 1

What are the components of the lower urinary tract/

Answer 1

Bladder, urethra, prostate

Question 2

What history/clinical signs is consistent with lower urinary tract disease?

Answer 2

Dysuria 
Pollakiuria/periuria 
Stranguria 
Pigmenturia 
Incomplete voiding 
Urinary incontinence

Question 3

What are possible causes of dysuria/stranguria/pollakiuria ??

Answer 3

Irritation of bladder (bacterial/uroliths/interstitial cystitis)

Neurological disease

Secondary lower urinary tract disease

Neoplasia

Question 4

You have a history of dysuria, pollakiuria, stranguria and urinary incontience…
what should you include in your physical exam ?

Answer 4

General

Abdominal palpation
Rectal exam
Vaginal exam
Penile/preputial exam

Watch urination

Palate bladder after urination

Question 5

You have a history of dysuria, pollakiuria, stranguria and urinary incontience…

What further diagnostics would you like to do??

Answer 5

Collect urine on free flow and cysto

Sediment
Culture
Urethral cytology

Imaging -> radiograph/ US
Cystoscope
Bladder biopsy
Excretory contrast studies

Urethral profilometry (measure urethral pressure)

Question 6

Your urine is dark yellow/orange coloured. What is the pigment?

Answer 6

Bilirubin

Question 7

Your urine is red coloured. What is the pigment

Answer 7

Hematuria
Pigmenturia
-> hemoglobin/myoglobin

Question 8

What are causes of hematuria?

Answer 8

Renal dz
Lower urinary tract dz
Reproductive (prostatic, vaginal, uterine dz)
Systemic dz (bleeding disorder/hypertension/hyperviscosity)

Question 9

What species more commonly have urinary tract infections??

Answer 9

Dogs (14% are affected during lifetime)

Females >males

Question 10

Wha are the normal host defenses against UTI?

Answer 10

Normal micturition 
Anatomy 
Mucosal defenses 
Urine properties 
Systemic immune system

Question 11

What endocrine disorders can predispose to UTI?

Answer 11

Diabetes mellitus

Cushings

Question 12

What abnormal anatomy can predispose an animal to UTI?

Answer 12

Hooded vulva
Recessed vulva

Urachal diverticulum

Question 13

What microbial isolates are most common in UTI?

Answer 13

Ecoli

Question 14

What are the possible microbial isolates of UTI?

Answer 14

Ecoli

Gram positive cocci

Proteus 
Klebsiella 
Pseudomonas 
Mycoplasma 
Pasturella 
Cornybacterium

Question 15

T/F: most UTIs are due to multiple microbial organisms

Answer 15

False

- usually a single species

Question 16

Which is the most common route of infection causing UTI?

Answer 16

Ascending

Hematogenous infections are uncommon

Question 17

What is the best therapy for an uncomplicated UTI??

Answer 17

Empirical antibiotics

Amoxicillin, cephalosporins, and TMS
-> excreted in urine

Enrofloxacin should not be first line —> can lead to multidrug resistance

Question 18

UTI
Culture and sensitive is positive with a new organism at > 7days after last treatment of antibiotics

What type of UTI is this?

Answer 18

Complicated UIT —> reinfection

Question 19

UTI
Culture and sensitivity is postive with an new organism at day 7 after starting antibiotics

What type of UTI is this?

Answer 19

Complicated UTI

—> superinfection

Question 20

UTI
Culture and sensitivity is positive with the same organism 7 days after the last treatment course

What type of UTI is this?

Answer 20

Relapse

Question 21

What should you do if you have a recurrent UTI??

Answer 21

Determine cause
-imaging, culture, check for underlying dz, search for nudus

Review antimicrobial history
-drug choice, dose, freq, duration, compliance

Urine concentration
Culture - pretherapy/ during/ post

Extended course (4-6wks)

Question 22

When might you concider prophylactic therapy for ruecurent UTIs?

Answer 22

Once infection eradicated

Drug that concentrates in urine with few side effects
Once daily at bedtime

Nitrofurans
Regular microbiology

If C&S is neg for 6 months -discontinue

Question 23

Alternative therapies for UTI??

Answer 23

Cranberry extract
Probiotic (restore vaginal flora)
Polysulfated glycosaminoglycans (form coating on bladder wall)
Fosfomycin -> MDR Ecoli

Question 24

What should you check for if you have a fungal UTI??

Answer 24

Underlying dz

• diabetes
• excess glucocorticoids