“No pressure, no diamonds.” -Mary Case 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 Double-contrast cystogram with stones Normal double-contrast cystogram pneumocystogram

Ultrasound of bladder stone

Feline Uroliths and Urethral Plugs Treatment Medical treatment (chronic, non-obstructed) 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 Signs Dx pollakiuria Dysuria Hematuria Urinalysis 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 _____________________ Radiographs double contrast if necessary

Canine Urolithiasis

Canine Uroliths Urolith Breed Sex Contributing factors Rx Struvite min sch female (80%) alkaline urine acidify urine (Mg Ammonium Phos) cats bacteria→urease→↑pH antibiotics minerals (diet) Only Hill’s s/d (dissolve) ↓protein (ammonia) ↑H2O intake (flush stones) acidy urine Calcium Oxalate cats males diet high in protein Sx removal (only Rx) (30-50% of min sch hypercalcemia ↓ dietary Ca all stones) Lhasa, Yorkie Cushing’s Dis min poodle use of cortisone Hill’s u/d, w/d, k/d Shih Tzu acid urine Urates Dalmatians males ↑ uric acid from kidneys Allopurinol E bulldogs acid urine (gout in humans) min schnauzer K+ Citrate (↑ urine pH) Shih Tzu Hill’s u/d, Yorkshire terrier

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