Urology

Define pollakiuria, hematuria, stranguria, and urinary incontinence

• Pollakiuria = ↑ frequency

• Hematuria = blood in urine

• Stranguria = difficulty urinating

• Incontinence = leaking urine/puddles

What key physical exam components are needed in dysuria cases?

Bladder palpation, perineal exam, rectal exam, penis/prepuce exam, vulvar palpation

What are the major differentials for dysuria in dogs?

Bacterial cystitis, urinary stones, and neoplasia(urithelial cell carcinoma - used to be called TCC)

How common is bacterial cystitis in dogs and cats?

• Common in dogs, especially females(short & wide urethra) 

• Rare in intact males unless prostatitis

• Very rare in cats (<2% LUTD), except older cats with CKD

What organisms commonly cause UTIs in dogs?

• Most common: E. coli

• Others: Staph, Strep, Enterococcus, Enterobacter, Proteus, Klebsiella, Pseudomonas

• Usually one organism; 20–30% mixed infections

• Normal source = intestinal or skin flora

What are the updated diagnostic highlights?

• Need clinical signs + pyuria

• Culture recommended for all suspected bacterial cases

Define bacteriuria, subclinical bacteriuria, and bacterial cystitis

• Bacteriuria: bacteria present in urine

• Subclinical bacteriuria: bacteria without clinical signs

• Bacterial cystitis: bacteria + clinical signs of LUTD

How are bacterial cystitis types classified?

• Sporadic: <3 UTIs/year

• Recurrent: ≥4 UTIs/year

Is UA necessary?

This slide prompts the question—later slides elaborate. Answer: yes, UA is part of standard workup

How reliable is a urine dipstick in dogs?

• Cheap & available

• Only reliable for ketones & protein

• NOT reliable for USG, pH, neutrophils

• Not reliable to detect infection

What does urine sediment tell us?

• Pyuria = inflammation can be bacteria, stones, or cancer

• Pyuria + bacteriuria → infection likely

• Bacteriuria alone ≠ cystitis

• Epithelial cells ≠ tumor

When is urine culture recommended?

• Recurrent suspected UTI

• Multiple recent antibiotic courses

• Multiple hospitalizations

• Raw food diet (higher resistant organism risk)

What can radiographs detect in dysuria cases?

• Bladder size

• Radio-opaque stones (CaOx & struvite)

  • 90% visible on digital radiography

• Pull forelimbs forward → better urethra view

What are radiograph limitations, and when do we use contrast?

Limitations:

• Can't determine stone type

• Urethra obscured by bone

• Tumors not seen unless mineralized
  

Contrast studies: Urethrocystogram under GA with catheterization

What can ultrasound evaluate?

• Bladder stones, mass, wall, Upper urinary tract
  Limitations:

  • Urethra obscured by bone

  • Overestimates stone size

When do you need imaging?

• High suspicion of stones

• Possible obstruction

• Systemic illness

When is bloodwork needed?

Only if:

• Systemic signs (fever, pyelonephritis, obstruction)

• Low USG suggesting kidney disease

What human evidence supports NSAIDs alone?

• RCT: ibuprofen vs ciprofloxacin in women

• 2/3 recovered without antibiotics

• No difference in relapse or symptom resolution
  → UTIs often self-limiting in women; symptom control sometimes enough

When can we consider NSAIDs instead of antibiotics in dogs?

• Extremely reliable owners

• Dogs that cannot tolerate antibiotics

What are first-line antibiotics for cystitis?

• Amoxicillin 11–15 mg/kg q12h, less likely to cause D

• Amoxicillin-clavulanate 12.5–25 mg/kg q12h

• TMS 15–30 mg/kg q12h (risk of side effects but acceptable short-term) can get KCS, or acquired endocrine problems

When are fluoroquinolones or 3rd gen cephalosporins appropriate?

When first-line drugs not options → for Gram -

• When PO or q12h dosing not possible

• If concurrent tissue infection(like prostate)

• IMPORTANT → differentiate need vs convenience

When is empirical treatment reasonable?

• Reasonable: 1st episode

• NOT recommended:

  • 2nd episode

  • Multiple antibiotics

  • Multiple hospitalizations

  • Raw food diet

How long should cystitis be treated?

• Sporadic: 3–7 days

• Recurrent: longer, individualized

• Stop when: clinical signs resolve, sediment normal, negative culture (if performed)

What determines when to stop antibiotics?

• Symptom resolution

• Sediment normalization

• Negative culture (if used)

How fast should improvement occur on correct antibiotics?

Within 1–2 days

What questions should be asked on recurrence?

• Did bacteria evade treatment?

• Did bacteria easily enter?

• Did we treat long enough?

• Could it be stones or tumor instead?

What are pros and cons of cystocentesis?

Pros: avoids contamination
Contraindications: bladder tumor, thrombocytopenia, coagulopathy

What colony counts indicate infection per collection method for urine culture?

• Cystocentesis: ≥1000 CFU/mL

• Catheter (male/female): ≥100,000 CFU/mL

• Voided: not recommended

Are voided samples reliable for urine culture?

Only if no other option—must evaluate growth level, species, purity, cytology, and clinical signs

How should urine samples be stored?

• Cysto: process <24h refrigerated

• Voided: <12h refrigerated

How to treat the 2nd episode of UTI?

• Start antibiotics

• Often same drug until results

• Duration usually longer

What interpretation questions should be asked after culture?

• Does organism fit with patient?

• Does result match clinical response?

• What drugs are appropriate?

• Do we need systemic therapy?

What if culture shows intermediate, resistant, or sensitive bacteria?

• Intermediate:

  • Clinical response → continue

  • No response → switch drug

• Resistant:

  • Clinical response → continue

  • No response → reconsider compliance/diagnosis

• Sensitive:

  • If no clinical response → check compliance first

Should subclinical bacteriuria be treated?

No, even in systemic disease or immunosuppression

Should multidrug-resistant bacteriuria be treated?

Not if asymptomatic — resistance alone is not an indication

How should recurrent UTIs be approached?

• Incomplete response → investigate underlying cause

• Reinfection (new pathogen) → look for predisposing factors

• Relapse (same pathogen) → reevaluate dose, regimen, compliance

• Treatment:

  • Reinfection: short course 3–5 days

  • Relapse/persistent: 14+ days, choose tissue-penetrating antibiotics

When should intra-therapy or post-therapy cultures be done?

• Only for long treatments >2 weeks

• Intra: day 5–7

• Post: 5–7 days after stopping antibiotics

• Sporadic cystitis with resolved signs → no post-culture needed

Should asymptomatic bacteriuria be treated before elective surgery (e.g., CCL repair)?

No.
Study showed:

• SBU 6.5% prevalence

• No difference in surgical site infections

• SSI organisms differed from urine isolates
  → Screening and treating SBU is not beneficial

What are the most common canine urolith types and their proportions?

85–91% are struvite(can dissolve with diet) + calcium oxalate(will not dissolve, need sx)

• CaOx: 42–45% (98% of feline and 50% of canine upper-tract calculi)

• Struvite: 43–44%

• Purine: ~5%

• Ca phosphate: 1%

• Cystine: ~1% (increasing)

• Silicate: <1%

What factors help estimate urolith type?

• Age/sex

  • struvite → young animals, females due to infection

  • calcium oxylate → older animals, males

• crystals, urine pH, stone shape, breed, underlying disease, and presence of infection

Which stones show strong sex predispositions?

• CaOx much more common in males

• Struvite far more common in females

• Urate more male-associated

• Cystine overwhelmingly male

Does finding crystals on UA mean the dog has stones?

No. Crystals do not reliably indicate stones

Why are urinary crystals unreliable diagnostically?

They vary with diet, infection, storage time, temperature, pH, contaminants, and iatrogenic causes (contrast, allopurinol). Fresh, unrefrigerated urine is needed; crystals are rarely clinically significant

Which stones form in acidic vs alkaline urine?

Alkaline (>7): Struvite, Ca phosphate (rare)

Acidic (<7): CaOx, ammonium urate, cystine, silicate, uric acid

Also note: urine pH at stone formation may differ from pH at time of exam

What are typical appearances of CaOx, cystine, struvite, and urate stones on imaging?

Images show:

• CaOx: highly radiopaque, irregular

• Cystine: moderately opaque, smoother

• Struvite: opaque, smooth

• Urate: less radiopaque/variable

Which breeds are predisposed to which stones?

• Urate: Dalmatian, Bulldog, Pitbull, Russian terrier, Giant Schnauzer

• Struvite: Yorkie, Lab, Dachshund, Shih Tzu, Mini Schnauzer

• CaOx: Yorkie, Lhasa Apso, Mini Poodle, Shih Tzu, Schnauzer, Bichon

• Cystine: Bulldog, Dachshund, Newfoundland, Mastiff, Lab

• Silicate: Australian cattle dog, Chihuahua, Corgi, GSD, Collie

What important genetic mutations are linked to urate and cystine stones?

• Urate: SLC2A9 mutation (Dalmatians; autosomal recessive).

• Cystine: SLC3A1 or SLC7A9 mutations depending on breed.

• Type III cystinuria: androgen-dependent, only males, improved by castration, no gene mutation identified.
  Testing available via PennGen

What systemic diseases predispose dogs to specific uroliths?

• Cushing → CaOx

• Hyperparathyroidism → Ca phosphate

• Portosystemic shunt → urate

• Renal hematuria → dried blood “stones”

• Bacterial cystitis → struvite

What non-disease factors influence stone formation?

Prior surgery (≈9.5% recurrent stones are suture-induced; increased to 18.5% in 2018, stones grow on sutures in bladder), obesity (not proven), water mineral content, lack of Oxalobacter formigenes

What is required for struvite formation in dogs?

Usually secondary to urease-producing UTIs (Staph pseudintermedius, Pseudomonas, Klebsiella, Ureoplasma, Proteus, Corynebacterium). E. coli UTIs have low struvite risk so don’t treat subclinical bacteremia

How does location and suspected type guide treatment?

• Bladder + likely struvite → dissolution first

• Bladder + NOT struvite → removal

• Urethral obstruction → urgent removal

For which stones is medical dissolution effective, and what are the goals?

• Very effective for struvite

• Moderate for urate and cystine
  

Goals: reduce calculogenic salts, increase urine volume.
Requirements vary by type (low purine diet, thiola, antibiotics if infected, K-citrate etc.)

What are the key decision points in struvite dissolution flowchart?

Sex → infection status → presence of urease-producing bacteria → contraindications → dissolution vs removal → rechecks every 4–6 weeks

Does size affect dissolution success?

No

Should all stones be submitted for analysis?

Yes—always submit, even recurrences; results in ≤2 weeks

What are the main removal techniques and their pros/cons?

• Surgery: invasive, long anesthesia, risk of incomplete removal (14%), suture-induced stones.

• Non-invasive (preferred): voiding urohydropropulsion, endoscopic removal, lithotripsy → shorter stay, less pain

When is voiding urohydropropulsion indicated/contraindicated?

Indications: stones < urethral diameter, mainly females.
Contra: large or jack-shaped stones, male cats

What are advantages and limitations of cystoscopy and lithotripsy?

• Diagnoses strictures, bleeding sources, ectopic ureters; can remove/fragment stones.

• Not feasible in male cats; >3kg females OK.

• Laser lithotripsy effective in all females and most males; best in female dogs >4kg and male dogs >7kg

What is typical lithotripsy postoperative care?

5 days NSAIDs, same-day discharge, send stones for analysis

What is Percutaneous Cystolithotomy (PCCL) used for?

Minimally invasive percutaneous cystolithotomy for male dogs & cats under GA via small incision at bladder apex

What are differentials when dysuria persists with normal imaging & culture?

Urethral diseases: infiltrative disease, inflammation, or stricture; imaging may miss these; urethrogram or cystoscopy needed. Biopsy essential to differentiate TCC/SCC/leiomyoma vs proliferative urethritis

What is the role of Liquid Biopsy & BRAF testing in urinary tract tumors?

Detects cfDNA mutations in free-catch urine; >85% sensitivity, 100% specificity for urothelial & prostatic carcinoma; mutation present in 43–87% of UC cases

• needs lots of urine, very good for diagnosing carcinoma, can do in general practice

Does BRAF mutation status affect survival?

In a 79-dog retrospective study, BRAF status did not significantly influence overall survival, though treatment type and tumor location did

What are features of proliferative urethritis in dogs?

Uncommon, mainly female dogs, presents as obstruction; 73% have UTI history; treatments include piroxicam/steroids; recurrence common; balloon dilation/stenting prolongs time to recurrence.

• Can dx by vaginal or rectal exam, may be able to feel abnormal structure of urethral papilla.

Why might a male dog still obstruct after complete stone removal?

Possible urethral stricture—catheter won’t pass despite no stones

What can cause overflow incontinence following dysuria?

Male dog with urinary incontinence → Partial obstruction → enlarged bladder → detrusor atony(extreme) → overflow; requires imaging/cystoscopy

What are differentials for acute hematuria with a bladder mass on ultrasound?

Bladder tumor vs bladder hematoma

What are the major differential categories for dysuria?

Urethral disease: stones, stricture, tumor, proliferative urethritis
Bladder disease: cystitis, stones, mass/infiltration, hematoma