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ACVIM Specialty 2023 > Lower urinary tract disease > Flashcards

Lower urinary tract disease Flashcards

1
Q

What is the vesicoureteral valve?

A

A valve-like effect formed when the ureter enters the urinary bladder on the serosal surface and tunnels through the bladder wall obliquely to the mucosal surface. The intramural ureter has a “j hook” conformation, Turing from a caudal to cranial direction before entering the trigone

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2
Q

What three factors promote unidirectional flow of urine into the bladder?

A

Vesicoureteral valve, ureteral peristalsis, and a compliant bladder

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3
Q

What is vesicoureteral reflux?

A

Reflux of urine back up to the kidneys

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4
Q

What innervation is most important for neurogenically mediated ureteral contraction?

A

Sympathetic innervation - alpha-1 receptors predominate, but alpha-2, beta-adrenoreceptors all present

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5
Q

What drives normal ureteral peristalsis?

A
  • Myogenic in origin - not neurologic
  • When urine enters the ureter, it initiates electrical impulses that are conducted between smooth muscle cells => peristalsis propelled towards the bladder
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6
Q

During obstruction of a ureter, spasmodic contractions occur, which are mediated by what?

A

Sympathetic input

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7
Q

Stimulate of the ureter with alpha-adrenergic agonist causes what? With beta-adrenoreceptor agonists?

A

Alpha agonists: ureteral contraction
Beta agonist: ureteral relaxation

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8
Q

What is the most common ureterolith type in dogs and cats?

A

Calcium oxalate

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9
Q

Conservative medical management of ureteroliths may be attempted if:

A
  • There is minimal renal functional compromise
  • No evidence of infection
  • No evidence pf progressive ureteral dilation
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10
Q

What is the normal diameter of a cat ureter? Dog ureter?

A

Cats: 0.3-0.4 mm
Dogs: <2.7mm but varies with breed

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11
Q

In one study, medical management of ureteroliths was successful in what percent of cats?

A

8-13%

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12
Q

What is the mechanism of action of prazosin and tamsulosin?

A

Alpha-adrenergic antagonists

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13
Q

Medical management of ureteroliths consists of what therapies?

A

IV fluid administration, diuretics, alpha-adrenergic antagonists

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14
Q

If medical management of ureteroliths is attempted, what are indications to pursue surgical intervention instead?

A

Progressive enlargement of the ureter or renal pelvis, worsening renal function, uncontrollable pain, or no movement in 1-2 weeks

For cats, no movement in 24-48 hours

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15
Q

Name 4 urease producing bacteria that may be present with struvite uroliths

A

Staphylococcus, Proteus, Klebsiella, Corynebacterium, Mycoplasma

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16
Q

Why shouldn’t obstructive struvite ureteroliths be medically managed?

A
  • An obstructed stone is not being bathed in urine, so dissolution is not effective
  • Often results in obstructive pyelonephritis which has a high risk of urosepsis
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17
Q

What minimally invasive procedure can be used for the treatment of struvite ureteroliths in dogs?

A

Retrograde lavage of the renal pelvis and placement of a ureteral stent

Cats typically require surgical, antegrade placement and it’s more difficult

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18
Q

If a ureteral stent is used, when should it be removed or replaced?

A

Prior to discontinuing antibiotics (may harbor bacteria)

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19
Q

What is shock wave lithotripsy and what species can it be used in?

A

Uses shock waves generated outside the body and target at the uroliths using integrated fluoroscopy or ultrasonography - used to fragment uroliths in dogs

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20
Q

What percent of uroliths in dogs can be removed via shock wave lithotripsy?

A

80%, although 50% of dogs require 2+ treatments

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21
Q

Ureteral stents induce passive ureteral dilation, increasing the diameter of the lumen by how much?

A

3 fold

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22
Q

What is a circumcaval ureter?

A

Congenital anomaly characterized by ventral displacement or duplication of the caudal vena cava, which crosses over the ureter and results in compression of the proximal ureter - more commonly affects the right side

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23
Q

Uropathogenic E coli contain what adhesion molecule that is expressed by 100% of bacteria that cause pyelonephritis?

A

Type 1 fimbriae that bind mannose targets on the urothelium

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24
Q

Why are gram negative organisms more likely to cause pyelonephritis than other organisms?

A

Express adhesion molecules with high affinity for kidney tissue - not typically expressed in other organisms

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25
Q

Rod shaped bacteria are visible on urine sediment examination when the colony count exceeds what number? Cocci bacteria?

A

Rods: visible if colony count >10,000
Cocci: visible if colony count >100,000

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26
Q

What percent of positive urine cultures are positive for E coli?

A

Dogs 44-45%
Cats 37%

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27
Q

What substance in cranberries has anti-adherence properties?

A

Proanthocyanidins with type A linkages - anti-biofilm properties and prevent P-fimbriated UPEC from binding to uroepithelial cells

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28
Q

How is D mannose anti-adherent?

A

Disrupts bacterial adhesion by blocking the ability of lectins on the tips of type 1 fimbriae to interact with carbohydrate moieties on urothelial cells

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29
Q

How might instillation of glycosaminoglycans into the urinary bladder help prevent UTIs?

A

E coli virulence factors injury the protective GAG barrier overlying the urothelium. Exogenous GAG may adhere to the urothelium or bind invading bacteria, thus preventing bacteria induced injury

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30
Q

How might estrogen help prevent UTIs in females?

A

Alters the urinary microenvironment by promoting vaginal Lactobacillus growth, lowering vaginal pH, and restoring atophic mucosa in the urethra - proven in humans, but not dogs

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31
Q

What is the basis of prophylactic antibiotic therapy?

A

Provide 1/3 to 1/2 the total daily dose of an antibiotic, usually at night after the last void of the day. Antibiotic concentrates in the urine overnight, preventing colonization

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32
Q

How long is prophylactic antibiotic therapy continued?

A

For 6 months with monthly cultures
At 6 months if the urine is sterile, discontinue antibiotics and monitor for relapse

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33
Q

What is sporadic cystitis (previously called uncomplicated UTI)? What animals should not be managed as sporadic cystitis?

A
  • Bacterial infection of the urinary bladder resulting in compatible lower urinary tract signs in dogs or cats.
  • Intact male dogs rarely have sporadic bacterial cystitis - usually bacterial prostatitis is present - treat for this
  • Dogs with >3 episodes of cystitis in 12 months should be managed as recurrent bacterial cystitis
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34
Q

A urine culture is preferred in all cases of suspected bacterial cystitis. However, empiric therapy could be considered in what cases?

A

In dogs with sporadic cystitis that have limited prior antimicrobial exposure

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35
Q

What causes the clinical signs of a UTI? What treatment should be considered in the first few days of UTI treatment?

A

Inflammation - consider prescribing an NSAID and adding antimicrobials 3-4 days later if clinical signs persist or when the urine culture results are back

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36
Q

If empiric antibiotics are being prescribed for a UTI, what drugs can be used?

A

Amoxicillin ideally, Clavamox if plain amoxicillin is not available
TMS

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37
Q

How long should sporadic bacterial cystitis be treated? When should a response be seen?

A
  • 3-5 days
  • If no improvement in 48 hours, re-evaluate what’s going on
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38
Q

Should a repeat urinalysis or urine culture be performed for sporadic bacterial cystitis?

A

No as long as the clinical signs have resolved

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39
Q

What is the definition of recurrent bacterial cystitis?

A

3 or more episodes of bacterial cystitis in the prior 12 months or 2 or more episodes within the prior 6 months

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40
Q

What should be performed for all cases of recurrent cystitis?

A

Urine culture
- If the pathogen isolated is different from previous organisms, reinfection is likely - identify and address underlying factors
- If a relapsing or refractory infection is present, review the drug, dosing, timing, and client compliance. Then look for underlying factors

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41
Q

For recurrent cystitis cases where re-infection is suspected, how long should antibiotics be prescribed? Should re-culture be performed?

A

3-5 days - no need to repeat culture/urinalysis if clinical signs resolved

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42
Q

For recurrent cystitis cases where persistent or relapsing infection is suspected, how long should antibiotics be prescribed?

A

7-14 days

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43
Q

For recurrent cystitis cases where persistent or relapsing infection is suspected, when should the urine be re-cultured?

A

After 5-7 days of treatment
- Positive culture: evaluate compliance, further diagnostic testing to determine why the bacteria is not cleared
- Negative culture: can determine when to stop therapy

Then 5-7 days after cessation of antimicrobials to help differentiate relapse/persistent infection vs re-infection

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44
Q

For animal with suspected pyelonephritis, when should blood cultures be considered?

A

In immunosuppressed or febrile animals - perform at the same time as urine culture

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45
Q

When interpreting susceptibility data for pyelonephritis or prostatitis cases, look at the antimicrobial breakpoints for what?

A

Serum, rather than urine

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46
Q

What should the initial treatment for pyelonephritis be, while waiting for culture results?

A
  • Drugs that have efficacy against Enterobacteriaceae - fluoroquinolone or cefpodoxime reasonable
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47
Q

A diagnosis other than pyelonephritis should be considered if there is no improvement after what time frame?

A

72 hours of antibiotics, if the culture results say that antibiotic is appropriate

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48
Q

How long should pyelonephritis be treated? What should the follow up be?

A
  • 10-14 days
  • Repeat PE, chemistry, UA, and UC 1-2 weeks after stopping antibiotics
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49
Q

What drugs can be used to treat bacterial prostatitis?

A

TMS, enrofloxacin

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50
Q

What drugs can penetrate the prostatic barrier, but should not be used as empiric treatment as they are not effective against gram negative bacteria?

A

Clindamycin and macrolides

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51
Q

How long should bacterial prostatitis be treated?

A

4 weeks in acute cases, 4-6 weeks for chronic disease

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52
Q

Apart from antibiotics, what medical treatments should be considered for dogs with prostatitis?

A
  • Ultrasound guided percutaneous drainage of prostatic abscesses
  • Castration or finasteride
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53
Q

Subclinical bacteriuria is defined by what? What does not define it?

A

Bacteria in the absence of clinical signs
These things do not define it and do not indicate the need for treatment:
- Heavy growth (>100,000 CFU/mL) can be observed
- Pyuria can be observed
- MDR bacteria can be observed

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54
Q

When might you consider treating subclinical bacteriuria?

A
  • Presence of plaque forming (Corynebacterium) or urease producing bacteria due to their ability to cause encrusting cystitis or struvites
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55
Q

Name 5 situations where urine culture may be indicated in animals without lower urinary tract signs

A
  1. Suspected pyelonephritis
  2. Investigation of the bladder as a source of septicemia
  3. Patients that are to undergo a surgical or minimally invasive procedure that will involve entering the urinary tract
  4. Suspected struvite stones
  5. Difficult to regulate diabetics
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56
Q

Prior to cystoscopy or urologic surgery, what should be performed?

A

Urine culture - if positive, treat based on susceptibility for 3-5 days before the procedure

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57
Q

Should peri-operative antibiotics be used in cystoscopy or urologic surgery?

A

Only for stone manipulation or open surgical procedures IF the pre-procedure culture was positive for bacterial growth

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58
Q

If peri-operative antibiotics are indicated, when should they be given and what drugs are appropriate?

A

60 minutes before the procedure, then re-dosed intra-operatively after 2 half lives of the drug have passed

A 2nd generation cephalosporin is appropriate or continue the antimicrobial the patient was already on

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59
Q

All patients with uroliths should have a urine culture performed. How should you act on the results?

A
  • If a urease producing bacteria is identified, treat according to susceptibility - the ISCAID consensus does not recommend treating for the entire course of dissolution
  • If a non-urease bacteria is present and the patient has clinical signs of cystitis - treat like a sporadic cystitis
  • If no clinical signs, treat like a subclinical bacteriuria
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60
Q

Uroliths smaller than what diameter may not be visible on radiographs, even if they are a radio-opaque stone?

A

<2mm

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61
Q

At what pH do struvite uroliths form?

A

> 7

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62
Q

Are calcium oxalate stones more common in males or female? Struvite?

A

CaOx: males - 78%
Struvite: females - 82%

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63
Q

Uroliths that are typically considered radiolucent may be visible on radiographs if they are larger than what diameter?

A

> 5 mm

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64
Q

50% of CaOx stones are identified in 6 breeds. Name them

A

Miniature Schnauzer, Shih Tzu, Yorkshire Terrier, Chihuahua, Bichon Frise, Maltese

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65
Q

What breed is over-represented for both cystine and urate uroliths?

A

English Bulldog

66
Q

96% of Dalmatians with uroliths have what stone type?

A

Urate

67
Q

If uroliths are <3mm, they can be retrieved via what methods?

A

During voiding or catheterization

68
Q

What types of uroliths should be medically dissolved, unless they are causing severe clinical signs or obstruction?

A

Struvite, urate, cystine

69
Q

What percent of dogs with CaOx uroliths will have stone recurrence within 2 years of removal?

A

50%

70
Q

Name 3 strategies used to prevent the recurrence of CaOx stones

A
  1. Feed a high moisture food to reduce USG <1.020 (dogs) or 1.025 (cats)
  2. Avoid urinary acidification with diet or potassium citrate
  3. Add hydrochlorothiazide diuretics if needed
71
Q

How does potassium citrate work to prevent CaOx stones? What is the goal pH?

A

Augments renal excretion of citrate, which binds calcium and reduces CaOx formation. Goal is a urine pH 7-8

72
Q

How does hydrochlorothiazide work to reduce CaOx formation?

A

Increases renal tubular resorption of calcium

73
Q

Struvite uroliths should be treated with an appropriate dissolution diet and antibiotics. When should rechecks be performed?

A

4-6 weeks after starting therapy, UA and radiographs are taken
- If USG <1.020, pH <6.5, and the stones have reduced in size by 20% continue therapy and repeat monitoring in 4-6 weeks

74
Q

To determine an accurate urine pH, it should be measured when?

A

Just prior to meals or >8 hours after a meal (postprandial alkalinuria is a thing apparently)

75
Q

Once radiographic resolution of struvite stones has been achieved, how long should you continue therapy?

A

2-4 weeks

76
Q

Describe the metabolic pathway of purine degradation?

A
77
Q

What is tiopronin (Thiola) and how does it reduce the formation of cysteine stones?

A

Binds to cysteine to form a more soluble complex than the cysteine dimer (aka cystine)

78
Q

What cat breeds are overrepresented in urate stones?

A

Egyptian Maus, Birman, Siamese

79
Q

What cat breeds are at higher risk of calcium oxalate uroliths?

A

Persian and Himalayan

80
Q

What type of crystal is this?

A

Struvite

81
Q

What is the composition of diets designed to dissolve struvite stones?

A

Moderate protein, lower phosphorus and magnesium, promote acidic urine (pH <6.5)

82
Q

How rapidly do feline struvite stones dissolve and when should they be rechecked?

A

Faster than dogs - 6-28 days
Recheck 2-4 weeks after starting diet

83
Q

If a patient with struvite stones will not eat the therapeutic diet, what drug can be used to acidify the urine and assist in stone dissolution?

A

dl-methionine

84
Q

What is the composition of diets designed to prevent calcium oxalate stones?

A
  • Avoid over-acidification
  • Avoid high sodium (increases Ca elimination)
  • Avoid high protein (promotes acidic urine, lower protein promotes diuresis)
  • Avoid low phosphorus foods (may stimulate vitamin D production and calcium absorption)
85
Q

What is the composition of diets designed to prevent cystine stones?

A
  • Avoid over-acidification
  • Avoid diets rich in methionine (precursor to cystine - consider low protein or reduced animal protein diets)
  • Avoid high sodium diets (enhances cystinuria)
  • Can use u/d, jd/, t/d, g/d
86
Q

What percent of urate stones in Dalmatians were successfully dissolved with diet and allopurinol?

A

40% dissolved, 30% partially dissolved

87
Q

When should nephroliths be treated?

A
  • Contributing to outflow obstruction
  • Causing recurrent infection
  • Causing pain
  • Enlarging to the point of causing renal parenchymal compression
88
Q

What percent of nephroliths in cats are calcium oxalate?

A

90% - do not attempt dissolution in feline nephroliths

89
Q

What percent of cats with ureteroliths have concurrent stricture?

A

20-25%

90
Q

Hereditary mutations in CaOx1 result in calcium oxalate stone formation. Why?

A

Gene that produces Tann-Horsfall protein (uromodulin)
- A glycoprotein that is produced by cells in the DCT
- Regulates urinary Ca reabsorption and inhibits urinary crystallization

91
Q

Mutations in CaOx1 are inherited in what manner? What breeds are predisposed?

A

Autosomal recessive
- English bulldogs (63%)
- A bunch of other breeds

92
Q

The prevalence of CKD was how much higher in cats with uroliths than cats without uroliths?

A

56% vs 30% - screen cats with uroliths for CKD

No association with stage of CKD

93
Q

Feline cystinuria is associated with a missense mutation in what gene?

A

SLC3A1

94
Q

Looking at the trends in feline urolith composition over time, what urolith type has decreased in frequency?

A

Calcium oxalate - 50% in 2005 to 38% in 2018

95
Q

Looking at the trends in feline urolith composition over time, what urolith type has increased in frequency?

A

Struvite = from 42% in 2005 to 55% in 2018

96
Q

What metabolic derangement is associated with CaOx formation?

A

Hyperlipidemia - odds increased by 4 for every mmol/L of TG (excluded Miniature Schnauzers)

97
Q

What is the mean age of first CaOx urolith diagnosis?

A

8.4 years - recommend screening high risk breeds starting at 5-6 years of age

98
Q

Polymorphisms in what gene are associated with an increased risk of CaOx urolithiasis and increased urinary excretion of calcium?

A

Vitamin D receptor polymorphisms

99
Q

A small subset (32%) of dogs with CaOx stones had what change in vitamin D metabolites?

A

Decreased conversion of 25(OH)D to 24,25(OH)2D

100
Q

In a retrospective study of dogs treated for struvite dissolution, what percent achieved full stone dissolution in a median of 35 days?

A

58%
- Maximum stone diameter, number of stones, and initial pH did not influence outcome

101
Q

In a retrospective study of dogs treated for struvite dissolution, stones that did not successfully dissolve commonly had what composition?

A

> 10% non-struvite mineral

102
Q

In a retrospective study of dogs treated for struvite dissolution, dissolution was more likely in dogs receiving what therapy other than diet?

A

Antimicrobials (OR 16)

103
Q

In a retrospective study of dogs treated for struvite dissolution, what percent of dogs experienced adverse effects?

A

18% - urethral obstructions most common but 3/4 obstructed before trial initiation

104
Q

Persistent cystotomy site thickening can be present on ultrasound for how long after cystotomy?

A

3 months

105
Q

Following cystotomy for stone removal, hyperechoic foci were visible in the bladder on ultrasound in what percent of dogs and when?

A

61%, median of 17 days post-op :(

106
Q

Looking at the trends in canine urolith composition over time, what urolith type has decreased in frequency?

A

CaOx - 50% in 2006 to 42% in 2018

107
Q

Looking at the trends in canine urolith composition over time, what urolith type has increased in frequency?

A

Cystine - from 1.4% in 2006 to 8.7% in 2018

108
Q

Looking at the trends in canine urolith composition over time, what percent of cystine uroliths were from intact male dogs?

A

70%

109
Q

In a retrospective study of ureteroceles, what percent were ectopic? What percent had stenotic or imperforate openings?

A

Ectopic - 70%
Stenotic - 92%

110
Q

In dogs with idiopathic renal hematuria treated with ACEi or ARB, what percent had complete resolution of hematuria?

A

42%, partial improvement in 26%

111
Q

In dogs with recurrent UTI, what were the most common cystoscopic findings?

A

Mucosal edema, vestibulovaginal septal remnant, lymphoid follicles, short urethra, and ectopic ureters

112
Q

In dogs with recurrent UTI, what percent of dogs had abnormalities on cystoscopy?

A

85%

113
Q

In a study of antibiotic resistance among E coli, bacteria isolated from cat urine were 100% resistant to what antibiotics?

A

Amoxicillin and Clavamox

114
Q

In a study of antibiotic resistance among E coli, bacteria isolated from dog urine had what susceptibility to amoxicillin and Clavamox?

A

Amoxicillin - only 53% were susceptible
Clavamox - 92% susceptible

115
Q

In a study evaluating the effects of USG and pH on E coli growth, E coli grew best in what conditions?

A

Neutral to acidic urine, diluted urine

116
Q

Dogs with recessed vulvas had what other PE finding compared to dogs without recessed vulvas?

A

Higher BCS and body weights

117
Q

Dogs spayed at <1 year of age were how many times more likely to have vulvar recession?

A

3x

118
Q

In one study, were recessed vulvas associated with clinical signs?

A

No - no association with UTIs, LUT signs, or perivulvar dermatitis in 36 dogs

119
Q

What percent of dogs with CKD had a positive urine culture? What percent were symptomatic?

A

32% positive, 8% symptomatic

So high frequency of bacteriuria, but likely subclinical

120
Q

What were the risk factors for a positive urine culture in dogs with CKD?

A

Female, isosthenuria

121
Q

What endocrine disease is NOT a risk factor for subclinical bacteriuria in cats?

A

Hyperthyroidism

122
Q

In cats with SUBs or ureteral stents, what percent develop positive urine cultures in the 200 days post-operatively?

A

25% - almost all clinical (UTI or pyelo vs subclinical bacteriuria)

123
Q

In cats with SUBs or ureteral stents, what was the most commonly identified bacteria?

A

Enterococcus

124
Q

What is a risk factor for the development of Candida UTI in dogs and cats?

A

Antibiotic administration in the prior 30 days

125
Q

What are the risk factors for Enterococcus UTI?

A
  • Recurrent bacteriuria was more common with Enterococcus infection compared to E coli
  • LUT anatomic abnormalities, neoplasia, or urolithiasis
126
Q

Cats with subclinical bacteriuria are more likely to have what risk factors?

A

Female in multiple studies
CKD in one study, hepatic disease in another study

127
Q

What nerve provides parasympathetic innervation to the detrusor muscle and where does that nerve arise? What type of receptor is involved?

A

Pelvic nerve - S1-S3
M3 muscarinic receptors

128
Q

What effect does parasympathetic stimulation have on the bladder?

A

Leads to contraction of the detrusor and emptying of the bladder

Parasympathetic = Pee

129
Q

Inappropriate dysfunction of the pelvic nerve leads to what conditions?

A
  • Inappropriate stimulation - overactive bladder
  • Inappropriate blockage - bladder atony and urine retention
130
Q

What nerve provides sympathetic innervation to the detrusor muscle and where does that nerve arise? What type of receptor is involved?

A

Hypogastric nerve - L1-L4
Beta-3 adrenergic signaling

131
Q

What effect does sympathetic stimulation have on the bladder and urethra?

A
  • Detrusor relaxation and filling
  • Contraction of the urethral sphincter and continence

Sympathetic and somatic = storage

132
Q

Inappropriate dysfunction of the hypogastric nerve leads to what conditions?

A
  • Inappropriate stimulation - Urine retention
  • Inappropriate blockage - decreased bladder compliance and increased filling pressure; open urethra and incontinence
133
Q

What nerve provides sympathetic innervation to the bladder neck and urethra? What type of receptor is involved?

A

Hypogastric
Alpha-1 adrenergic stimulation

134
Q

What nerve provides somatic innervation to the distal urethra and pelvic floor muscles and where does that nerve arise? What type of receptor is involved?

A

Pudendal - S1-S2
Nicotinic receptors

135
Q

What effect does somatic stimulation have on the bladder/urethra?

A

Conscious or reflex contraction and continence

Sympathetic and somatic = storage

136
Q

In the male dog, what type of muscle predominates in the prostatic urethra? The rest of the urethra?

A

Prostatic urethra = smooth muscle
Rest of the urethra
>50% skeletal muscle
9% smooth muscle

137
Q

In the female dog, what type of muscle predominates in the urethra?

A
  • The internal sphincter is smooth muscle and extends distally to the cranial half of the urethra
  • Striated muscle comes in caudal to the vagina
138
Q

In the male dog, where are the internal and external urethral sphincters located?

A
  • Internal: between the trigone and start of the prostate - innervated by the hypogastric nerve
  • External: at the caudal end of the prostate, innervated by the pudenal nerve
139
Q

During filling and storage, activation of stretch receptors in the bladder wall leads to what?

A

Reflex arc - increases urethral tone and relaxes the detrusor muscle via sympathetic pathways

140
Q

What occurs during the initiation of micturition (full bladder)?

A

Stretch receptors send afferent signals along the myelinated fibers of the pelvic nerve to the lumbar spinal cord and the pontine micturition center of the brain
- If urination is appropriate, parasympathetic pathways are activated to stimulate bladder smooth muscle contraction and sympathetic pathways are inhibited to relax the urethra

141
Q

Why do storage disorders occur?

A

Inability to maintain adequate urethral tone in the face of normal bladder pressure

142
Q

What is the mechanism of action of phenylpropanolamine?

A

Alpha-agonist - stimulates the receptors in the internal urethral sphincter to promote continence

143
Q

Why are DES or other estrogen products used to treat USMI?

A

Thought to increase the number and sensitivity of alpha-receptors in the urethral sphincter

144
Q

What percent of female dogs with respond to PPA? Males?

A

Females: 75-90%
Males: 40%

145
Q

What are the risks of estrogen compounds in males and in cats?

A

Males: risk of prostatic metaplasia - do not use
Cats: risk of mammary gland neoplasia, monitor closely

146
Q

Lesions in what part of the spinal cord lead to a lower motor neuron bladder?

A

S1-S2 - leads to weakness of the striated muscular sphincter, bladder atony and an easily expressible bladder

147
Q

What are other symptoms of a lower motor neuron bladder?

A

Decreased anal tone, poor perineal reflex

148
Q

What is detrusor hyperreflexia or overactive bladder?

A

Sudden urge to urinate and involuntary loss of urine associated with bursts of detrusor contraction at bladder volumes far below capacity

149
Q

How is detrusor hyperreflexia treated?

A

Antimuscarinic drugs - oxybutynin or imipramine

150
Q

How is detrusor hyperreflexia diagnosed?

A

Difficult in dogs - urodynamic studies and cystometrography or a therapeutic trial with a antimuscarinic

151
Q

What is thought to be the underlying cause of DUD?

A

A lesion in the reticulospinal tract, Onuf’s nucleus, or the caudal mesenteric ganglion => loss of inhibitory signals to the pudendal or hypogastric nerves and failure of the urethral sphincter to relax

152
Q

What is a normal residual bladder volume?

A

<0.5mL/kg

153
Q

What is the difference between prazosin and tamsulosin?

A

Prazosin: alpha1-specific antagonist with effect on both the internal and external urethral sphincter

Tamsulosin: alpha1A-specific antagonist - subtype found on the internal urethral sphincter

154
Q

If the external urethral sphincter is involved in DUD, what drugs can be used?

A

Diazepam or other skeletal muscle relaxants (acepromazone, methocarbamol)

155
Q

Damage to what part of the spinal cord leads to an upper motor neuron bladder?

A

Cranial to the sacral segment - usually thoracolumbar

156
Q

What causes an upper motor neuron bladder?

A

Loss of inhibitory signals to the hypogastric and pudendal nerves that prevents the sphincter to relax on voiding - difficult to express

157
Q

What is dysautonomia?

A

Degeneration of the neurons of the autonomic ganglia - leading to sympathetic and parasympathetic dysfunction

158
Q

In a retrospective study of 45 cats, what were the most common causes of urinary incontience?

A
  • Spinal cord trauma: 20%
  • Congenial anomalies: 18%
  • Urethral stricture: 13%
  • Inflammation associated detrusor dysfunction 13%
159
Q

In a retrospective study of 45 cats, what percent of cats had urinary incontience due to iatrogenic trauma?

A

22% - urethral stricture due to PU or catheterization most common

160
Q

In a retrospective study of 45 cats, what percent of cats with urinary incontience had UTIs?

A

39%

161
Q

In a retrospective study of 45 cats, what cats were more likely to have voiding disorders as a cause of urinary incontience?

A

Younger, males

162
Q

In a retrospective study of 45 cats with urinary incontience, what percent improved with treatment?

A

50%

ACVIM Specialty 2023 (38 decks)

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