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Dysuria - Coggle Diagram

- - - - Aetiology: unknown
      - SX: 2-6 yo young cats
      - Hx: multicat household, often more submissive, recent stressor in house
      - CS
        
        Pollakuria: constantly at litter box
        
        Small V distinguishes from PU/PD
        
        Haematuria +/- blood clots
        
        Periuria common
        
        HOURS to DAYS
        
        PE: painful on abdominal palpation, small firm bladder.
      - Dx
        
        EXCLUSION
        
        UA: hematuria, Pyuria (uncommon), no bacteria +/- crystalluria, concentrated (generally)
        
        Get owner to collect sample at home
        
        Culture negative
        
        Imaging= rads normal (uroliths?), US- bladder wall thickening with no uroliths/tumours
      - Tx
        
        AIM: decreasing severity of CS and increasing interval between episodes
        
        Environmental enrichment, reduce stress= Feliway diffusers
        
        Feed Urinary tract diet (Hills): works over a year
        
        SHOUDL RESOLVE in 3-7 d without any treatment (further workup needed if not)
    - - Mechanical= urethral plug or urolith
    - - 20% of LUTD
      - Struvite and Ca oxalate more common
        
        Struvite= dissolved with diets in most cases
      - Dx: RADS
        
        Crystals in urine not pathologic
      - May obstruct ureters= Acute/ Chronic Kidney dz (presents with azotaemia)
    - - uncommon in young c- if young= anatomic abnormality/ sporadic occurrence
        (more likely if >10yo)
        IF recent urinary catheter/ perineal urethrostomy
      - E.coli common
      - Tx
        
        Sporadic in F and MN d and c
        
        C AND S, Ideally 7-14d course of Abx
        
        AMoxycillin or amoxyclav
        
        CS and UA improved/normal within 24hrs
        
        No indication for further measures beyond measuring of CS
        
        Recurrent Bacterial Cystitis
        
        MUST: find and Tx underlyinf cause
        
        MUST: perform C and S (await results if possible)
        
        Treat for 4 weeks
        
        If CS recur during/after Tx= follow up cultures
        
        Refer if recommended Tx fails
    - - E.coli most common
      - CKD= most likely to be affected
      - Tx: not recommended usually (risk of ascending/ systemic infection)
- - - - Benign Prostatic Hyperplasia (BPH)
        
        Sx: 80% of intact males >5yo
        
        CS
        
        Rarely causes dysuria: more Tenesmus and stranguria
        
        Haemorrhagic fluid dribbling
        
        Rectal exam: large, non painful, symetric
        
        Dog otherwise happy
      - Prostatitis
        
        CS
        
        Dysuria possible, more systemic signs common
        
        No discharge
        
        Rectal exam: painful
        
        Fever, lethargy
        
        Sx: Intact males >8yo
        
        WHY: underlying BPH usually, infection (scending)
        
        Tx
        
        4 weeks if acute, 4-6 weeks if chronic
        
        ABx must penetrate the prostate
        
        MUST: neuter the animal
        
        ABx 5-7days
      - Prostatic cysts
        
        With BPH: cysts may contribute/ cause dysuria
        
        Tx: as for BPH except if cyst very large (Sx)
      - Prostatic abscess
        
        Path
        
        Cysts become infected= abscess (DONT FNA-spills into abdomen)
        
        Tx: rapid Sx intervention
      - Neoplasia (M + NM)
        
        CS
        
        Tenesmus, stranguria
        
        Usually no discharge
        
        Rectal: enlarged prostate in castrated dog, asymmetrical
        
        If metastacised: HL lameness, HL oedema
        
        Carcinoma MOST COMMON
        (time of castration has NO INFLUENCE)
        
        Sx: Scottish Terrier
        
        Tx: no cure
    - - Struvite
        
        Assoc. with chronic bacterial cystitis and alkaline pH
        
        Urease producing bact. (Proteus, Staph)
        
        Can be dissolved with urinary tract diets
      - Ca Oxalate
        
        Assoc with chronic kidney dz in cats
        
        Can be caused by HyperCa
        
        SOme dog breeds predisp.
      - Urate and CYstine
        
        Urate= PS shunt, Genetic (Dalmatians)
        
        Cystine: genetic (Newfoundlands, mastiff, Irish terrier
        
        Radiolucent: I Cant see u."
      - Dx
        
        Palpate in bladder or pelvic urethra on rectal
        
        Male dog= commonly in base of os penis
        
        Tx: retrohydropulsed back into bladder under GA then removed via cystotomy
        
        ALWAYS send for analysis and culture
    - - Common: Urothelial Cell Carcinoma aka Transitional cell carcinoma
      - D: typically in trigone
      - Can involve urethra and prostate
      - PROG: guarded
      - Causes a local problem but metastasise possible
    - - Path
        
        ascending migration from rectal area/ perineal/ genital bacteria= adhere and colonise urothelium
        
        What= gram -ves (E.coli, Klebsiella) or skin flora (e.g. Staph)
      - CS
        
        Dysria, pollakiuria, stranguria, inappropriate urination, pigmenturia
        
        Or reflects cause e.g. bladder neoplasia
      - Types
        
        Sporadic
        
        one to occasional episodes
        
        Likely otherwise healthy
        
        Intact male d BUT always consider prostatitis
        
        Recurrent
        
        3 clinical infections in 12 mnths
        
        Predisp. causes common
      - Risk Factors
        
        Abnormal micturition
        
        Anatomic abnormalities e.g. recessed vulva, ectopic ureters
        
        Alteration of epithelium e.g. uroliths
        
        Altered urine composition e.g. DM
        
        Impaired immunity e.g. Cushings