Urogenital Disease

• Structure of Bladder

  • Thinned-walled sac like organ situated in pelvic canal
  • Connected to kidneys by ureters
  • Expels urine through urethra
• Structure of Bladder

  • Contains transitional cells on mucosa layer
  • Specialized cells that can stretch to accommodate changes in volume
• Structure of Bladder

  • Apex, body, and trigone regions
  • Urethra- tube connecting bladder to exterior of body
  • Females- opening within vaginal canal
  • Males- opening through penis
• Structure of Uterus

  • Parts○ Uterine body○ Uterine horns ○ Ovaries ○ Broad Ligament
• Structure of Uterus

  • Other parts of genitals
  • ○ Vulva
  • ○ Vaginal canal
  • ○ Cervix
• Structure of Male Genitals

  • Testes
  • ○ Head, body, and tail of epididymis
  • ○ Ductus deferens
  • ○ Parietal and visceral vaginal tunic
  • ○ Cremaster muscle
• Structure of Male Genitals

  • Prostate
  • At base of bladder- goes around urethra
• Structure of Male Genitals

  • Bulbus glandis
  • On dogs, helps males and females “tie"
• Structure of Male Genitals

  • Penis
  • Prepuce
  • +/- os penis
• Bladder Diseases

  • Cystitis- inflammation of the urinary bladder
  • Most common in cats is idiopathic
  • Feline Lower Urinary Tract Disease (FLUTD)
  • Most common in dogs is bacterial
• Bladder Diseases

  • Crystalluria- crystals in the urine
  • Uroliths- stones in the urinary bladder
• FLUTD Cystitis

  • Unknown definitive cause but stress canmake it worse
  • Can be obstructive (ulcerative) or unobstructive (non-ulcerative)
• FLUTD Cystitis

  • Generally self-limiting within 1-10 days○ But can have frequent recurrence
• Risk factors - FLUTD Cystitis

  • More common in middle-aged,overweight cats
• Risk factors - FLUTD Cystitis

  • Use of indoor litterbox, minimal outdoor access, and eat dry food also risk factors
• Risk factors - FLUTD Cystitis

  • Stressful environments, multi-cat households, and abrupt changes increase episodes
• Clinical signs - FLUTD Cystitis

  • Stranguria (straining)
  • Pollakiuria (frequent urination)
  • Crying while urinating
  • Excessive licking of genital area
• Clinical signs - FLUTD Cystitis

  • Inappropriate urination
  • Hematuria
  • +/- lethargy
• Bacterial Cystitis

  • Happens in ~14% of dogs sometime in their lifetime
• Bacterial Cystitis

  • Infection most commonly of Gram negative bacteria
  • E. coli*- Gram negative rod bacteria (1)
  • Staphylococcus sp.- Gram positive cocci bacteria that forms grape clusters (2)
• Bacterial Cystitis

  • Infection most commonly of Gram negative bacteria
  • Streptococcus sp.- Gram positive cocci bacteria that formschains (3)
  • Proteus- Gram negative bacilli bacteria with flagellae (4)
• Bacterial Cystitis

  • Infection most commonly of Gram negative bacteria
  • Klebsiella- Gram negative short, fat rod bacteria (5)
  • Pseudomonas- Gram negative rod bacteria (smells like Fritos chips) (6)
• Risk factors - Bacterial cystitis

  • Recessed vulva
  • Diseases like diabetes mellitus, Cushing’s disease, CKD, neoplasia, back injuries (IVDD)
• Risk factors - Bacterial cystitis

  • More likely in females than males
  • Age is NOT a risk factor
• Clinical Signs - Bacterial cystitis

  • Stranguria
  • Foul smelling urine
  • Hematuria
  • Cloudy appearance to urine
• Clinical Signs - Bacterial cystitis

  • Pollakuria
  • Accidents in house
  • Excessive licking of vulva/penis
  • +/- lethargy
  • +/- inappetence
• Crystalluria/Uroliths

  • Concentrates of minerals in urine
• Types of crystals/uroliths

  • Struvite- magnesium ammonium phosphates
  • Crystals common finding naturally in dog urine
  • Significant crystalluria or urolith formation due to UTI due to urease-producing bacteria
• Types of crystals/uroliths

  • Ca2+ oxalates
  • 2nd most common type
  • Due to high Ca2+, citrates, or oxalates in diet AND acidic urine
  • Risk factors: higher carbohydrate diets and obesity
  • Genetic predisposition- miniature schnauzers, yorkshire terriers, lhasa apso, bichon frise, havanese
• Types of crystals/uroliths

  • Ammonium biurate
  • Genetic predisposition- dalmatians, English bulldogs, Spanish water dogs
  • Animals with liver disease like portosystemic shunts
• Types of crystals/uroliths

  • Cystine
  • Rare and genetic predisposition Newfoundland, Labrador retrievers
  • Heavy excretion of amino acid cystine
• Clinical Signs - Crystalluria/Uroliths

  • Stranguria
  • Hematuria
  • Accidents in house
  • +/- foul odor
• Clinical Signs - Crystalluria/Uroliths

  • Crying while urinating
  • +/- lethargy
  • +/- inappetence
  • Polyuria
• Physical exam- Bacterial Cystitis, FLUTD, Crystalluria / Uroliths

  • BAR-QAR
  • +/- painful on abdominal palpation
  • If uroliths, sometimes palpable in bladder
  • Urinating in room
  • NSF otherwise
• Diagnostics - Bacterial Cystitis, FLUTD, Crystalluria / Uroliths

  • Urinalysis
  • Proteinuria, hematuria, +/- elevated leukocytes, alkaline urine, +/- bacteria and/or crystals on sediment
  • Acidic urine may be present for specific crystal types
• Diagnostics - Bacterial Cystitis, FLUTD, Crystalluria / Uroliths

  • Urine culture (if bacteria)
  • Helps identify most appropriate antibiotic to use
• Diagnostics - Bacterial Cystitis, FLUTD, Crystalluria / Uroliths

  • CBC/chem- use as rule outs for other PU/PD conditions, especially in older animals
• Diagnostics - Bacterial Cystitis, FLUTD, Crystalluria / Uroliths

  • Radiographs
  • Radiopaque circular object visible in urinary bladder
  • Cannot see bacteria or crystals
• Treatment- Bacterial Cystitis

  • Bacterial cystitis- antibiotics○ Clavamox- 13.75mg/kg BID○ Enrofloxacin- 5-7mg/kg SID○ Cefpodoxime- 5-10mg/kg SID
• Treatment- FLUTD

  • Diet change- prescription diet made for stress can help
  • Avoid major changes to environment, remove from multi-cat household if too stressed, can use pheromone collars