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Module 17-Urinary, Endocrinology, Oncology > Approach to and Management of LUT and Prostatic Disease > Flashcards

Approach to and Management of LUT and Prostatic Disease Flashcards

1
Q

Dysuria

A

Difficult and/or painful urination

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2
Q

Stranguria

A

Slow & painful urination or straining to pass urine

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3
Q

Pollakiuria

A

Abnormally frequent passage of small volumes of urine

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4
Q

Two processes cause dysuria

A

Mucosal irritation or inflammation (cystitis)
Narrowing or obstruction of the urethra or bladder neck

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5
Q

Why do we need to look at biochemistry when animal has stranguria

A

Obstruction or bladder rupture causes:
Post-renal azotaemia
Hyperkalaemia
Metabolic acidosis
Calcium containing uroliths can be due to hypercalcaemia

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6
Q

2 reasons for urine retention

A

Obstruction
Structural problem (more common)

Functional problem
Failure of relaxation of urethral sphincter (eg. UMN lesion)
Failure of detrusor muscle contraction (detrusor atony)
Dyssynergia

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7
Q

Causes of urinary incontinence

A

Pressure in bladder > urethra
↓ detrusor compliance
- Detrusor instability (primary rare)
↓ urethral tone
- Bladder/urethral neoplasia
- UTIs
- Prostatic problems
- Overflow incontinence (pu/pd)

Anatomical abnormality bypassing urethral sphincter mechanism

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8
Q

Urinary incontinence

A

Involuntary leakage of urine through urethra

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9
Q

Signs of LUT infections

A

Urgency, haematuria, dysuria, pollakiuria & stranguria
Urinary incontinence
(Urinary retention)
Bladder may be small & thickened

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10
Q

When to suspect a UTI

A

History & clinical signs of bladder inflammation
Protein, blood, WBCs, pH ↑ on urinalysis
Imaging – thickening of bladder wall

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11
Q

When to culture urine

A

All animals with LUT signs
All animals with renal disease
Animals with non-specific/vague signs

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12
Q

Sporadic bacterial cystitis

A

Sporadic bacterial infection of the urinary bladder with compatible LUT signs
<3 episodes of cystitis in previous 12 months

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13
Q

Recurrent bacterial cystitis

A

Animals that have had 3 or more episodes of clinical bacterial cystitis in previous 12 months OR 1 recurrence in previous 3 months
May be relapsing, recurrent or persistent

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14
Q

Asymptomatic bacteriuria

A

Animals with bacteriuria in the absence of clinical signs

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15
Q

Treatment – sporadic bacterial cystitis

A

3-5 days treatment
Ideally based on culture & sensitivity
Amoxycillin or amoxycillin-clavulanate if:
- Cocci
- Small paired rods in alkaline urine (proteus)
Not predictable if rods in non-alkaline urine
- Consider – amoxicillin, cephalexin, TMPS

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16
Q

Treatment – recurrent bacterial cystitis

A

Urine culture should always be performed
Analgesia
Investigations for nidus of infection (relapsing/persistent) or reason for susceptibility (reinfection)
Ultrasound, radiography, cystoscopy may be considered
Review previous choice of antimicrobials
follow-up bacterial culture (5-7d after tx):To help differentiate relapse, re-infection, persistent infection

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17
Q

Complications of UTIs

A

Polypoid cystitis
- Can occur due to chronic UTIs
- Consider partial cystectomy

Emphysematous cystitis- Gas in the lumen & wall of bladder
- Glucose-fermenting bacteria (usually E.coli)
- Treat cause of glucosuria

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18
Q

List common benign bladder masses

A

Polypoid cystitis – inflammatory lesion
Leiomyoma

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19
Q

List malignant bladder masses

A

Transitional cell carcinoma
Squamous cell carcinoma
Leiomyosarcoma
Rhabdomyosarcoma
Prostatic neoplasia
Metastatic neoplasia

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20
Q

What dog breed is predisposed to transitional cell carcinoma

A

Scottish Terriers

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21
Q

Presentation of transitional cell carcinoma

A

Signs of lower urinary tract inflammation
Can cause urine retention
Can cause urinary incontinence (rare)

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22
Q

Diagnosis of bladder masses

A

Diagnostic imaging (ultrasound/radiographs)
- Thickening of bladder wall & mass lesions
- Mostly occur in trigone region (dogs)
Urine sediment analysis
- Neoplastic cells may be detected
Cystoscopy
- Abnormal irregular proliferation from bladder wall
Cytology or Biopsy
- For definitive diagnosis

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23
Q

Reflex dyssynergia and presentation

A

Loss of coordination between bladder & urethral sphincter muscles
Steam initiated but not maintained, large residual urine volume, difficult to express bladder

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24
Q

Dog breed predisposed to reflex dyssynergia

A

Labradors

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25
Treatment for reflex dyssynergia
Decreasing internal urethral sphincter tone using medications like prazosin/phenoxybenzamine Reducing external sphincter tone with drugs such as diazepam/dantrolene, Increasing detrusor contraction using bethanecol in the management of certain urinary conditions.
26
Bladder atony
Bladder atony is a condition characterized by loss of bladder muscle tone, leading to a distended, flaccid bladder, weak urine stream, and may be primary (neurological) or secondary to chronic overstretch
27
Treatment for bladder atony
Indwelling catheter – to rest detrusor Bethanechol – after obstruction removed
28
What is USMI
Urethral sphincter mechanism incompetence
29
Risk factors for USMI
Congenital or acquired Female > male Often within 3 years of spaying
30
USMI diagnosis
Intermittent urine leakage & incontinent at rest Can urinate normally Often presumptive (spayed bitches)
31
Summarise why diabetes can cause pu/pd
Due to elevated blood glucose levels leading to osmotic diuresis, resulting in increased urine output, and the body's compensatory mechanism to eliminate excess glucose by increasing thirst
32
Name 3 drugs used for USMI treatments
Phenylpropanolamine (Propaline) Estriol Ephedrine
33
Effect of Phenylpropanolamine (Propaline)
Type: α sympathomimetic. Effect: Increases internal sphincter tone. Onset: Several days Side effects: Restlessness, aggression, and hypertension.
34
Effect of Estriol
Type: Synthetic, short-acting estrogen. Effect: Upregulates α-adrenergic receptors, increasing internal sphincter tone. Contraindicated: in males, entire bitches, and patients with polyuria-polydipsia (PUPD)
35
Ectopic ureters
A congenital anomaly where ureters do not connect to the bladder correctly but may connect to the urethra or another part of the lower urinary tract. This condition, often seen in female dogs, can lead to urinary incontinence and recurrent urinary tract infections
36
Other USMI treatments besides drugs
Collagen injections Try drugs in combination Weight reduction Increase opportunities to urinate Surgery
37
Diagnosis for Ectopic ureters
History: young animals, especially females, may present with continuous urine leakage, Diagnostic approaches: Ultrasound, X-ray, IVU or retrograde vagino-urethrogram, and CT-IVU. Cystoscopy may be employed for direct visualization and identification of ectopic ureters
38
Treatment for ectopic ureters
Refer for surgery
39
Clinical presentations of prostate disease
Haematuria Haemorrhagic urethral discharge Tenesmus (a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness. ) Dysuria Recurrent UTIs Urinary incontinence Hindlimb stiffness Infertility
40
Diagnosis of prostate disease
Rectal palpation Haematology & biochemistry Urinalysis & culture Collection of prostatic fluid Radiographs Ultrasound (FNA)
41
Describe a normal prostate
Ventrally, smooth, bi-lobed, non-painful
42
Describe Benign prostatic hyperplasia (BPH)
Age related change Hypertrophy & hyperplasia of secretory & connective tissues Intraparenchymal fluid cysts
43
Presentation of benign prostatic hyperplasia
Often asymptomatic Haematuria, haematospermia, haemorrhagic urethral discharge Difficulty defaecating
44
Diagnosis of BPH
Palpation Enlarged (symmetrical) Non-painful Mobile Ultrasound: Diffusely hyperechoic Parenchymal cysts Histology needed for definitive diagnosis Response to treatment suggestive Care! Multiple diseases possible
45
Treatment of BPH
Asymptomatic Not necessary Symptomatic Surgical castration- Resolution within 4 weeks Medical management- Osaterone (Ypozane) (inhibits testosterone uptake & receptor binding)Deslorelin (Suprelorin) (GnRH agonist) - implant
46
Bacterial prostatitis
Prostatic inflammation usually due to bacterial infection from urethra or haematogenous spread Entire male dogs more likely
47
Presentation of Acute prostatitis
Fever Depression Anorexia Vomiting Urethral discharge Tenesmus Constipation Dysuria Abdominal pain Gait changes
48
Presentation of chronic prostatitis
Purulent/ haemorrhagic urethral discharge Recurrent UTIs Mild haematuria Infertility
49
Diagnosis of prostatitis
palpation can reveal pain (indicative of acute issues) or be non-painful (suggestive of chronic conditions), and size and shape may appear normal. Evaluation often considers signalment, history, clinical signs, consistent imaging findings, urinalysis, urine culture, prostatic fluid cytology, and culture. Bacterial prostatitis should be investigated in intact males with bacteriuria or bacterial cystitis.
50
Treatment of prostatis
IV antibiotics empirically (fluoroquinolones, TMP-SMX) with characteristics able to cross the blood-prostate barrier; oral antibiotics (trimethoprim, fluoroquinolones, clindamycin, macrolides if susceptible) for 4-6 weeks, and consider castration,
51
Presentation of prostatic abcesses
Often similar to acute prostatitis Can cause chronic urethral obstruction Acute abdomen or septic shock
52
Diagnosis of prostatic abscesses
Palpation: Enlarged/ Asymmetric Ultrasound
53
Treatment of prostatic abcesses
Surgical Options: Surgical drainage and omentalisation or percutaneous drainage may be employed. Concurrent treatment for chronic prostatitis is recommended. Considerations: Due to the risk of serious complications, considering referral to specialized care is important.
54
Paraprostatic cysts
Large sacs of fluid adjacent to prostate & attached by stalk
55
Presentations of Paraprostatic cysts
Dysuria or tenesmus Perineal mass Occasionally systemic signs
56
Diagnosis of Paraprostatic cysts
Plain Radiographs Ultrasound Ultrasound-guided fluid aspirate
57
Treatment of paraprostatic cysts
Omentalisation Castration
58
Presentations of prostatic neoplasias
Entire or castrated dogs Tenesmus, dysuria, haemorrhagic urethral discharge, hindlimb lameness, chronic weight loss and/or anorexia
59
Palpation of prostatic neoplasia
Firm, irregular nodules Enlarged, asymmetric, firm, fixed +/- painful Enlarged sublumbar lymph nodes
60
Palpation of prostatitis
Palpation can reveal pain (indicative of acute issues) or be non-painful (suggestive of chronic conditions), and size and shape may appear normal.
61
Radiographs of prostatic neoplasia
Irregularly enlarged Mineralised opacities Lysis or proliferation on lumbar vertebrae or pelvic bones
62
Ultrasound of prostatic neoplasia
Focal or multifocal hyperechoic parenchyma Asymmetry Irregular contour Cavitatory lesions
63
Radiograph of paraprostatic cysts
May have thin mineralisation of wall (egg shell like)
64
Describe fluid aspirate of a paraprostatic cyst
Yellow-brown Small numbers of red & white blood cells & epithelial cells Usually sterile
65
Treatment of prostatic neoplasia
Prognosis grave No curative treatment
66
3 functional problems that can cause urine retention
Failure of relaxation of urethral sphincter (eg. UMN lesion) Failure of detrusor muscle contraction (detrusor atony) Dyssynergia
67
Most common bladder neoplasia
Transitional cell carcinoma
68
Diagnosis of TCC
U/S: Thickening of bladder wall and mass lesions in trigone area UA: Neoplastic cells may be seen Cystocopy: Abnormal irregular proliferation along bladder wall Cytology/biopsy: Definitive diagnosis- Traumatic catheterisation,cytoscopically,suction biopsy, laparoscopy
69
Treatment for TCC
Surgery but may not be viable Chemotherapy- Mitoxantrone/Carboplatin NSAIDS- Meloxicm- Antineoplastic effects and antiinflammatory
70
Prognosis for TCC
Guarded
71
What drug to give to decrease internal urethral sphincter tone
Prazosin/Phenoxybenzamine
72
What drug to give to decrease external urethral sphincter tone
Diazepam
73
What drug to give to increase detrusor contraction
Bethanecol
74

Module 17-Urinary, Endocrinology, Oncology (28 decks)

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