ADVERSITY “No pressure, no diamonds.” -Mary Case DISEASES OF THE URINARY SYSTEM Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence COMPONENTS OF THE URINARY SYSTEM and ITS FUNCTIONS • Functions of the kidneys – Produce urine:___________ – Maintain homeostasis • Blood filtration, reabsorption, secretion • Fluid balance regulation • Acid-base balance regulation • _____________ production DISEASES OF THE URINARY SYSTEM • URINARY SYSTEM IS NORMALLY STERILE AND RESISTANT TO BACTERIAL INFECTION – Voiding of urine – Urethral/ureteral peristalsis – _____________________ in the surface mucosal layer – pH RECOGNIZING URINARY SYSTEM DISORDERS About 4 million cats a year are destroyed for “elimination problems”. DIAGNOSING URINARY SYSTEM DISORDERS • DIAGNOSTIC TESTS THAT MAY BE DONE IN PATIENTS WITH URINARY DISEASE: ________________________ Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence Feline Idiopathic (Interstitial) Cystitis FUS/ FLUTD FACTS: -Occurs in cats 2-6 yrs old -Occurrence in males > females -cause unknown, multi-factorial -not caused by_________________ -recurrence is likely Feline Idiopathic (Interstitial) Cystitis • Signs – pollakiuria – _____________ – Dysuria – Periuria (sinks, tubs, carpet, etc.) • Diagnostics – Urinalysis/culture to r/o bacteria as cause – Radiographs to r/o calculi; • contrast studies may show _________________ Feline Idiopathic (Interstitial) Cystitis • Treatment – Avoid unnecessary ___________ – Change diet from dry to __________ • Or salt food to ↑ water intake – Reduce stress from other cats, kids, etc • Provide hiding places • ______________________________ – Behavior modification drugs (may also have pain reducing effects • Amitryptilline (tri-cyclic antidepressant) • Clomipramine – Glycosaminoglycan replacement • _______________for cats • Adequan Feline Idiopathic (Interstitial) Cystitis • Client info – Disease is ________________ • As many as 85% of cats will have resolution of clinical signs in 7-10 days – May be recurring problem – No definitive cure – Reduce stress Canine Bacterial Cystitis • Cause: ______________up the urethra • Signs – – – – ↑ frequency of urination Hematuria Dysuria Cloudy urine, abnormal color – Frequent licking of vaginal/urethral area Canine Bacterial Cystitis • Diagnostics – Urinalysis: • ____________, bacteria • Common bacteria: E.coli, Proteus spp. – Urine culture/sensitivity • Collect by _________________ – Or mid-stream collection Canine Bacterial Cystitis • Treatment – Antibiotics according to sensitivity • Treat acute infections x 10-14 d • Subsequent infections x 4-6 w – Avoid trauma to urinary tract during surgery – Patients needing indwelling catheters should have a __________________ Closed Urinary Catheter System Canine Bacterial Cystitis • Client info – Many uncomplicated urinary tract infections resolve without ______________ – Give antibiotics as directed for the time prescribed • Relapses are common due to inadequate treatment – ___________ may be source of recurring infections in male dogs – Urine cultures should be repeated during treatment to assess effect Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence Feline Uroliths and Urethral Plugs Feline Uroliths and Urethral Plugs “Plugged” or “Blocked” male cats are commonly seen in small animal practice and can be fatal if not relieved – The two most common causes of urethral blockage are uroliths and urethral plugs • UROLITHS: composed of _______________ and a small amount of matrix • URETHRAL PLUGS: composed of small amount of minerals and large amount of _________________ Photo 1: Three different types of struvite that may occur in cats: A and B, sterile urocystoliths; C, infection-induced urocystolith; D, matrix-struvite urethral plug. Feline Uroliths and Urethral Plugs • Signs (more severe if complete obstruction has occurred) – – – – – _________________ Dysuria Periuria Anorexia, vomiting Collapse, death • Non-specific signs: – Hiding – Crying while urinating – Frequent trips to the litterbox Feline Uroliths and Urethral Plugs • Uroliths (bladder stones) found anywhere in urinary tract – Formed from minerals in diet – Some are radiopaque (Ca++ oxalate, urate, struvite) and can be seen on x-ray – Some are _________ and require double contrast (cystine: air, dye) Pneumocystogram Feline Uroliths and Urethral Plugs • Uroliths damage bladder, making it more susceptible to bacterial infection, hematuria • Uroliths can cause blockage of the urethra of males – Bladder will fill with urine – ____________ will stop working – Blood/body will become toxic (azotemic) Feline Uroliths and Urethral plugs Feline Uroliths and Urethral Plugs • Dx – Palpation of bladder • Obstructed bladders are full and tight – Radiographs may show uroliths on routine films • Double contrast studies may be indicated – Ultrasonography can locate position of urolith – _________________ is necessary to determine its constituents Feline Uroliths and Urethral Plugs Normal double-contrast cystogram Double-contrast cystogram with stones pneumocystogram Ultrasound of bladder stone Feline Uroliths and Urethral Plugs • Treatment – Medical treatment (chronic, nonobstructed) • Dissolve _____________uroliths (most common- ~60%) by acidifying urine and feeding diet low in Mg (Hill’s S/D, c/d, others) – Should resolve in 4-8 wk – Re-radiograph, and continue diet 1 mo after uroliths gone • _____________ to remove stones • Antibiotics according to culture/sensitivity Feline Uroliths and Urethral Plugs Feline Uroliths and Urethral Plugs • Medical treatment (obstructed) – This is a medical emergency – Anesthetize (short acting) • ***USE LESS ANESTHESIA IN AZOTEMIC CATS*** – Pass Tom cat catheter and back flush – Sew catheter in place for 1-3 d, using a closed system Feline Uroliths and Urethral Plugs Closed Urinary Catheter System Feline Uroliths and Urethral Plugs • Surgical treatment (chronic obstructers) – _____________________ • New opening for urethra is created proximal to narrowing • Urethral opening looks similar to female anatomy *Goal of surgery is to decrease the likelihood of life-threatening obstruction* Feline Uroliths and Urethral Plugs: Perineal Urethrostomy Feline Uroliths and Urethral Plugs: Perineal Urethrostomy Canine Urolithiasis Os Penis Canine Urolithiasis Uroliths damage mucosa of urinary tract making it susceptible to infection Uroliths can obstruct urine flow in males • Signs – pollakiuria – Dysuria – Hematuria • Dx – Urinalysis • Crystalluria • Hematuria • _____________________ – Radiographs • double contrast if necessary Canine Urolithiasis Canine Uroliths Urolith Breed Struvite min sch cats (Mg Ammonium Phos) Sex female (80%) Contributing factors alkaline urine Rx acidify urine bacteria→urease→↑pH antibiotics minerals (diet) Only Hill’s s/d (dissolve) ↓protein (ammonia) ↑H2O intake (flush stones) acidy urine Calcium Oxalate (30-50% of min sch all stones) Urates cats males Lhasa, Yorkie min poodle Shih Tzu Dalmatians males E bulldogs min schnauzer Shih Tzu Yorkshire terrier diet high in protein hypercalcemia Cushing’s Dis use of cortisone acid urine Sx removal (only Rx) ↓ dietary Ca Hill’s u/d, w/d, k/d ↑ uric acid from kidneys Allopurinol acid urine (gout in humans) K+ Citrate (↑ urine pH) Hill’s u/d, Canine Uroliths Struvite Calcium Oxalate Urate Type of stone cannot be determined by appearance; chemical analysis is required Urolithiasis (Canine) • Treatment – Medical (objective is to dissolve stones if Struvite) • ______________________ • Acidify urine – Urinary acidifiers (methionine, Methogel) • ↑ urine output – Add salt to diet – Antibiotics for bacterial infection – Surgical removal (for Ca Oxalate) • Some uroliths are not amenable to Medical Rx • However, the cause of uroliths must be dealt with medically (prevention) • _____________________ IS VITAL FOR APPROPRIATE TREATMENT Cystotomy Canine Urolithiasis: Cystotomy for stone removal Canine Urolithiasis What do you see? How many? Canine Urolithiasis What do you see? Flush toward bladder (8 times) Saline flush One in bladder, 2 in urethra Canine Urolithiasis What do you see? Canine Urolithiasis • Client info – Special diet may be required for ____________ – Table scraps/treats should be limited – Long-term antibiotics may be required – Uroliths may recur at any time – Always provide plenty of ______________ – Allow plenty of bathroom time and frequency References • Alleice Summers, Common Diseases of Companion Animals • http://veterinarymedicine.dvm360.com/vetmed /article/articleDetail.jsp?id=738082