Lower urinary tract disorders

What structures are included in the lower urinary tract (LUT)?

Urinary bladder and urethra

What are common clinical signs of lower urinary tract disease?

Dysuria, pollakiuria, stranguria, hematuria, inappropriate urination, and licking of the urogenital area

What are common differentials for dysuria and pollakiuria in dogs?

Bacterial UTI, urolithiasis, neoplasia, and prostatic disease

What are common differentials for dysuria and pollakiuria in cats?

Idiopathic cystitis, urolithiasis, bacterial UTI, and neoplasia

What does the term cystitis mean?

Inflammation of the urinary bladder

Why are many UTIs difficult to detect clinically?

Up to 80% of UTIs are asymptomatic

What components are included in a diagnostic approach to LUT disease?

Physical exam, urinalysis, bloodwork, imaging, and cystoscopy

Why is sediment evaluation preferred over dipstick testing in urinalysis?

Sediment is more accurate for detecting bacteria, cells, and crystals

What findings on urinalysis suggest infection?

Bacteriuria and pyuria

What defines a urinary tract infection (UTI)?

Abnormal bacterial colonization of the urinary tract

Which patients are more predisposed to UTIs?

Female dogs, intact male dogs, dogs more than cats, and cats over 10 years old

What are the most common bacterial causes of UTIs?

E. coli, Staphylococcus, Streptococcus/Enterococcus, Proteus, Klebsiella, Pseudomonas

What host defenses help prevent UTIs?

Normal micturition (action of urination), anatomy, mucosal barriers, urine composition, and immune response

What is the most common cause of FLUTD?

Feline idiopathic cystitis

What is feline idiopathic cystitis (FIC)?

An exclusion diagnosis causing LUT signs in young to middle-aged cats; infecting both males and females

What clinical signs are associated with feline idiopathic cystitis?

Pollakiuria, dysuria, stranguria, hematuria, and periuria (peeing outside litter box)

Why is client education critical in feline idiopathic cystitis?

There is no proven preventative therapy

What are uroliths?

Calculi formed within the urinary tract

How do uroliths form?

Oversaturation → precipitation → solidification

What factors influence urolith formation?

Diet, urine pH, urine volume, inhibitors/promoters, genetics, and metabolic disorders

Why does crystalluria not always indicate urolithiasis?

Crystals can be present without stone formation

Which bacteria are associated with infection-induced struvite stones?

Staphylococcus and Proteus species

What are the main types of uroliths? (in order of most-least common)

Struvite, calcium oxalate, urate/xanthine, cystine, silica

What are characteristics of calcium oxalate uroliths?

Form in acidic to neutral urine, cannot be medically or dietarily dissolved, high recurrence

Which breeds are predisposed to calcium oxalate uroliths?

Miniature Schnauzer, Miniature Poodle, Shih Tzu, Bichon, Yorkie, Persian, Burmese

What are characteristics of struvite uroliths?

Form in neutral to alkaline urine and may be infection-induced in female dogs

What percentage of feline urethral plugs are struvite?

Approximately 85-90%

How are struvite uroliths medically dissolved?

Urine acidification, increased water intake, antibiotics, and strict diet adherence

What is transitional cell carcinoma (TCC)?

-A malignant tumor arising from transitional epithelium of the urinary tract

-in ureters, bladder, prostate gland, proximal urethra

Where does TCC most commonly originate?

The trigone of the bladder

Why is TCC difficult to manage clinically?

High metastatic rate and frequent UTIs

What causes lower urinary obstruction?

Uroliths, urethral plugs, strictures, malignancy, or urethral spasm

Why is urinary obstruction an emergency?

It causes postrenal azotemia, metabolic acidosis, hyperkalemia, and possible uremic death

What are common causes of obstruction in male cats?

Urethral plugs, uroliths, urethritis, or functional spasm

What is the SAFE approach to managing urinary obstruction?

• Stabilize first

• Accurate diagnosis

• Flush don't force

• Extend urethra properly

What is decompressive cystocentesis used for?

Temporary relief of bladder pressure during obstruction

What is retrograde urohydropropulsion?

Flushing stones from the urethra back into the bladder

What is voiding urohydropropulsion (VUH)?

Bladder gets maximally distended, agitated and compressed digitally to initiate voiding

When is VUH appropriate?

When uroliths are smaller than the dilated urethra

What nursing considerations are important for urinary catheter care?

Keep collection system below patient, check patency hourly, clamp when moving

Why should antibiotics not be given prophylactically with urinary catheters?

They do not prevent infection and promote resistance

What is urinary incontinence?

Inability to voluntarily control urination

Which animals are most affected by urinary incontinence?

Female dogs, especially spayed females

What is the most common cause of urinary incontinence in dogs?

-Urethral sphincter mechanism incompetence (USMI)

-ectopic ureters

-neurologic disease

What is USMI? (urethral sphincter mechanism incompetence)

-Failure of urethral closure pressure, commonly in spayed female dogs

*most common cause of incontinence

How is USMI treated medically?

Alpha-agonists (phenylpropanolamine; PPA or Proin) ± estrogen therapy (estriol)

What is an ectopic ureter?

A ureter that opens outside the normal trigone location

Which patients are predisposed to ectopic ureters?

Young female dogs with congenital abnormalities

What is reflex dyssynergia?

-Incoordination between bladder contraction and urethral relaxation

-mostly in middle-aged large to giant male dogs

What clinical sign is characteristic of reflex dyssynergia?

Initiates urination but cannot maintain a urine stream

How is reflex dyssynergia treated?

Intermittent catheterization, urethral relaxants, and bladder stimulants

What are concurrent abnormalities with ectopic ureter?

-hydroureter/hydronephrosis

-renal agenesis

-presistant paramesonephric septal remnant

-USMI