Lower Urinary Tract Diseases

Question 1

Which parts of the urinary tract are considered the ‘lower’ parts?

Answer 1

Bladder and urethra (and prostate in males)

Question 2

What is cystitis?

Answer 2

Inflammation of the bladder

Question 3

What is dysuria?

Answer 3

Difficulty urinating

Question 4

What is stranguria?

Answer 4

Straining to urinate

Question 5

What is stranguria often misrecognised as?

Answer 5

Constipation (esp cats)

Question 6

What is haematuria?

Answer 6

Blood in the urine

Question 7

What is pollakuria?

Answer 7

Increased frequency of urination

Question 8

What is periuria?

Answer 8

Urine voiding in inappropriate places

Question 9

What are some of the clinical signs of cystitis?

Answer 9

Dysuria 
Stranguria 
Haematuria 
Pollakuria 
Periuria 

Vocalisation, licking prepuce, inappetence, lethargy

Question 10

What are some of the causes of cystitis?

Answer 10

Feline idiopathic cystitis

Bacterial UTI (females)

Urolithiasis

Neoplasia

Drug-induced

Implants/indwelling devices (e.g. catheters)

Question 11

When is a lower urinary tract condition considered an emergency?

Answer 11

If the animal is not able to pass urine (urinary obstruction)

Question 12

What is the difference between uroliths and crystals?

Answer 12

Uroliths are urinary stones (crystal aggregates), crystals are microscopic mineral precipitates (room temp)

Question 13

What is crystalluria?

Answer 13

Presence of crystals in the urine

Question 14

If an animal has both crystals and uroliths, will they be made of the same constituents?

Answer 14

Not necessarily

Question 15

What type of crystals are these?

Answer 15

Struvite

Question 16

What type of crystals are these?

Answer 16

Calcium oxalate dihydrate

Question 17

What type of crystals are these?

Answer 17

Urate

Question 18

What is the relationship between urine dilution and risk of precipitation?

Answer 18

More dilute urine = lower risk of uroliths

Question 19

Is all crystalluria abnormal?

Answer 19

No - only some types

Question 20

Are all uroliths abnormal?

Answer 20

Yes - need treating if symptomatic

Question 21

What are uroliths of the kidneys called?

Answer 21

Nephroliths

Question 22

What are the symptoms of nephroliths?

Answer 22

Abdominal pain - anorexia/inappetence, lethargy

Haematuria

Pyelonephritis (kidney infection)

Question 23

What are the symptoms of ureteroliths?

Answer 23

May cause ureteric obstruction –> post renal azotemia symptoms

Question 24

What is the main sign of urethroliths?

Answer 24

Unproductive/minimally productive urination

Question 25

What are cystoliths?

Answer 25

Stones in bladder

Question 26

What are the symptoms of cystoliths?

Answer 26

``` Cystitis signs - Pollakuria Stranguria Dysuria Haematuria ```

Question 27

What are the general principles for urolith management?

Answer 27

Encourage water intake - aim for dilute urine Encourage voiding Avoid obesity

Question 28

What is the ideal USG of urine for cats and dog?

Answer 28

<1.030 cats | <1.020 dogs

Question 29

Why is dietary dissolution of stone via food not suitable for long term use or use in growing/lactating animals?

Answer 29

Severely protein restricted

Question 30

What are the nursing considerations for a patient with urolithiasis?

Answer 30

Vigilance about urine monitoring Maintain hydration/urine dilution/output Urinary catheter care and management Analgesia requirements

Question 31

In which cats is feline idiopathic cystitis more commonly found?

Answer 31

``` 2-7 years old Overweight/inactive Indoor cats Multi-animal household Nervous disposition Stressors Dry diet ```

Question 32

What physiological factors make a cat more susceptible to FIC?

Answer 32

Neuroendocrine modulation GAG layer hypofunction Environmental stress manifests as FLUTD

Question 33

How is FIC diagnosed?

Answer 33

Urinalysis to exclude UTI Radiographs for uroliths and masses Ultrasonography to visualise structural architecture of upper UT If nothing found = FIC

Question 34

How does non-obstructed FIC present?

Answer 34

Pollakuria/dysuria/haematuria Still able to void Often self-limiting May experience recurrent episodes

Question 35

How does obstructed FIC present?

Answer 35

Urethral spasm or plug = Unproductive efforts to urinate (emergency) More common in males, high recurrence rate

Question 36

What are the symptoms of an obstructed cat?

Answer 36

Unproductive attempts to urinate Back pressure on kidneys --> post-renal azotemia Hyperkalaemia --> bradydysrhythmia Agitated/depressed

Question 37

What nursing considerations should be taken post-catheterisation?

Answer 37

Monitor urine output/hydration/electrolytes Examine urine sediment/cytology daily for evidence of infection

Question 38

What is involved in the medical management of FIC?

Answer 38

Analgesia - buprenorphine, NSAIDs, gabapentin (if severe)

Question 39

What environmental modifications can be made to reduce risk of FIC?

Answer 39

Alleviate predisposing stressor Address negative cat-cat interactions Consider resource availability (esp toileting) Feliway

Question 40

How can we promote urinary health in cats?

Answer 40

Encourage water intake Dietary modifications Avoid obesity GAG supplementation

Question 41

What is urinary incontinence?

Answer 41

Loss of normal, voluntary control of micturition

Question 42

What are the symptoms of an upper motor neurone lesion (causing urinary incontinence)?

Answer 42

Spastic bladder (high muscle tone) - difficult to express

Question 43

What are the symptoms of a lower motor neurone lesion (causing urinary incontinence)?

Answer 43

Flaccid bladder, easy to express

Question 44

What are the non-neurogenic causes of incontinence?

Answer 44

USMI Anatomical defects Urge incontinence Dyssynergia

Question 45

What is dyssyngergia?

Answer 45

Failure of coordination of bladder contraction with urethral relaxation

Question 46

What is the treatment for urethral sphincter mechanism incompetence?

Answer 46

Tighten sphincter with either: a-agonists Oestrogens Urethral cuffs OR surgical repositioning of bladder