1. “No pressure, no diamonds.” -Mary Case
ADVERSITY
“No pressure, no diamonds.”
-Mary Case

2. DISEASES OF THE URINARY SYSTEM Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

3. 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

4. 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

5. RECOGNIZING URINARY SYSTEM DISORDERS
About 4 million cats a year are destroyed for
“elimination problems”.

6. DIAGNOSING URINARY SYSTEM DISORDERS
DIAGNOSTIC TESTS THAT MAY BE DONE IN PATIENTS WITH URINARY DISEASE: ________________________

7. Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

8. 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

9. 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 _________________

10. 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

11. 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

12. Canine Bacterial Cystitis
Cause: ______________up the urethra
Signs
↑ frequency of urination
Hematuria
Dysuria
Cloudy urine, abnormal color
Frequent licking of vaginal/urethral area

13. Canine Bacterial Cystitis
Diagnostics
Urinalysis:
____________, bacteria
Common bacteria: E.coli, Proteus spp.
Urine culture/sensitivity
Collect by _________________
Or mid-stream collection

14. Canine Bacterial Cystitis
Treatment
Antibiotics according to sensitivity
Treat acute infections x d
Subsequent infections x 4-6 w
Avoid trauma to urinary tract during surgery
Patients needing indwelling catheters should have a __________________

15. Closed Urinary Catheter System

16. 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

17. Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

18. Feline Uroliths and Urethral Plugs

19. 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 _________________

20. 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.

21. 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

22. 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

23. 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)

24. Feline Uroliths and Urethral plugs

25. Feline Uroliths and Urethral PlugsDx
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

26. Feline Uroliths and Urethral Plugs
Double-contrast cystogram
with stones
Normal double-contrast cystogram
pneumocystogram

27. Ultrasound of bladder stone

28. 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

29. Feline Uroliths and Urethral Plugs

30. 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

31. Feline Uroliths and Urethral Plugs

32. Closed Urinary Catheter System

33. 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*

34. Feline Uroliths and Urethral Plugs: Perineal Urethrostomy

35. Feline Uroliths and Urethral Plugs: Perineal Urethrostomy

36. Canine Urolithiasis
Os Penis

37. 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

38. Canine Urolithiasis

39. 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

40. Canine Uroliths Struvite Calcium Oxalate Urate
Type of stone cannot be determined by appearance; chemical analysis is required

41. 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

42. Cystotomy

43. Canine Urolithiasis: Cystotomy for stone removal

44. Canine Urolithiasis
What do you see? How many?

45. Canine Urolithiasis What do you see? Flush toward bladder (8 times)
Saline flush
One in bladder, 2 in urethra

46. Canine Urolithiasis
What do you see?

47. 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

48. References Alleice Summers, Common Diseases of Companion Animals