Transurethral cystoscopy in dogs with recurrent urinary tract infections: Retrospective study (2011-2018)

ACVIM consensus statement on diagnosis and management of urinary incontinence in dogs

Urinary incontinence (UI) is a disorder of micturition that can occur in dogs of any age, sex, and breed depending on the underlying cause and time of onset. Diagnosis and treatment for various causes of UI in dogs have been described by multiple comprehensive single author review articles, but large prospective clinical trials comparing treatment outcomes in veterinary medicine are lacking. The objectives of this consensus statement therefore are to provide guidelines on both recommended diagnostic testing and treatment for various causes of UI in dogs. Specifically, pathophysiology directly related to the canine urinary system will be reviewed and diagnostic and therapeutic challenges will be addressed. A panel of 12 experts in the field (8 small animal internists [L. Adams, J. Bartges, A. Berent, J. Byron, J. Foster, A. Kendall, S. Vaden, J. Westropp], 2 neurologists [J. Coates, N. Olby], 1 radiologist [G. Oetelaar], and 1 surgeon [C. Adin]) was formed to assess and summarize evidence in the peer-reviewed literature and to complement it with consensus recommendations using the Delphi method. Some statements were not voted on by all panelists. This consensus statement aims to provide guidance for management of both male and female dogs with underlying storage or voiding disorders resulting in UI.

Escherichia coli-associated follicular cystitis in dogs: Clinical and pathologic characterization

BACKGROUND

Follicular cystitis is an uncommon inflammatory change in the urinary bladder wall characterized by the formation of tertiary lymphoid structures (TLSs) in the submucosa.

OBJECTIVES

To characterize clinical and pathologic features of follicular cystitis in dogs and to explore in situ distribution and possible role of Escherichia coli as an associated cause.

ANIMALS

Eight dogs diagnosed with follicular cystitis and 2 control dogs.

METHODS

Retrospective descriptive study. Dogs diagnosed with follicular cystitis (macroscopic follicular lesions in the urinary bladder mucosa and histopathologic detection of TLSs in bladder wall biopsies) were identified from medical records. Paraffin embedded bladder wall biopsies were subject to in situ hybridization for E. coli 16SrRNA identification.

RESULTS

Follicular cystitis was diagnosed in large breed (median weight 24.9 kg, interquartile range [IQR] 18.8-35.4 kg) female dogs with a history of chronic recurrent urinary tract infections (UTIs; median duration of clinical signs 7 months, IQR 3-17 months; median number of previous UTIs 5, IQR 4-6). Positive E. coli 16SrRNA signal was detected within developing, immature and mature TLSs in 7/8 dogs, through submucosal stroma in 8/8 dogs and within the urothelium in 3/8 dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

Chronic inflammation associated with an intramural E. coli infection in the urinary bladder wall represents a possible triggering factor for the development of follicular cystitis.

Evaluation of a rapid immunoassay for bacteriuria in dogs

BACKGROUND

The ability to detect bacteriuria in dogs with a point-of-care test might improve medical care and antimicrobial stewardship.

HYPOTHESIS AND OBJECTIVE

A rapid immunoassay (RIA; RapidBac) will provide acceptable sensitivity and specificity for diagnosis of bacteriuria.

ANIMALS

Forty-four client-owned dogs with a clinical indication for urinalysis and aerobic bacterial urine culture.

METHODS

Prospective study. Urine, collected by cystocentesis, was submitted for urinalysis and culture at a diagnostic laboratory. Owners completed an enrollment questionnaire regarding their dogs' clinical signs. The RIA was performed according to the manufacturer's guidelines. Results were compared to culture.

RESULTS

Forty-four urine specimens were evaluated from 44 dogs. The sensitivity and specificity of the RIA test to detect bacteriuria compared to urine culture were 81.8% (95% CI, 65.7%-97.9%) and 95.5% (95% CI, 86.8%-99.9%), respectively. For cultures yielding ≥10³  CFU/mL, sensitivity increased to 90.0% (95% CI, 76.9%-100%) and specificity was similar at 95.2% (95% CI, 86.1%-99.9%). Malodorous urine, bacteriuria, and pyuria were more likely to be present in dogs with positive RIA or urine culture results compared to dogs with negative results.

CONCLUSIONS AND CLINICAL IMPORTANCE

The RIA was easy to perform and had good sensitivity and excellent specificity in this group of dogs. The RIA might be a useful screening test for decision-making regarding antimicrobial therapy in dogs with a clinical indication for urine culture. Consideration could be given to amending the International Society for Companion Animal Infectious Disease definition of bacterial cystitis as the presence of signs of lower urinary tract disease together with positive culture or a positive RIA.

Diagnostic yield of uroendoscopy compared to ultrasonography for evaluating lower urinary tract disorders in dogs

Background

Cystourethroscopy and vaginoscopy (uroendoscopy) is often used in the diagnostic evaluation of dogs with lower urinary tract disorders (LUTD).

Objective/Hypothesis

To evaluate if uroendoscopy is warranted in dogs with various LUTD, the agreement between uroendoscopic and ultrasonographic diagnoses were compared. Dogs with recurrent urinary tract infections (rUTI) will have the highest diagnostic agreement between uroendoscopy and ultrasonography (US) compared to dogs presenting for other LUTD.

Animals

Two hundred thirty‐seven dogs presenting between 2014 and 2019 with lower urinary tract signs (LUTS) that had US within 60 days preceding uroendoscopy.

Methods

Retrospective study. Dogs were categorized by primary indication for ultrasound. Pertinent uroendoscopic findings were recorded and agreements (κ analysis) between the final uroendoscopic diagnosis were compared with the final ultrasonographic diagnosis.

Results

Pertinent uroendoscopic findings were recorded for 69/237 (29%) cases. For dogs presenting primarily for urinary incontinence (UI), agreement between uroendoscopy and US was 71% (46/65; κ = 0.47, 95% CI 0.28‐0.66), for dogs with stranguria, 58% (29/50; κ = 0.47, 95% CI 0.31‐0.62) and for dogs with rUTI the agreement was substantial at 87% (26/30; κ = 0.70, 95% CI 0.43‐0.98). Urethral strictures were the majority (14/21; 67%) of pertinent uroendoscopic findings for dogs with stranguria, of which 12 were male dogs.

Conclusions and Clinical Importance

Agreement between uroendoscopy and US was moderate for all dogs. Based on these data, recommendation for uroendoscopy should be tailored to individual clinical presentation and signalment; transabdominal US is not the preferred modality for urethral lesions.

Cystoscopic Abnormalities in Dogs Presented for Episioplasty

A recessed vulva is a conformational abnormality that predisposes affected dogs to urinary tract infections. An episioplasty can be recommended for correction of this abnormality when medical management of recurrent urinary tract infection fails. The objective of this study was to investigate the type and incidence of urogenital abnormalities visualized by cystoscopy in dogs presenting for episioplasty. Medical records of 29 dogs that presented for an episioplasty and had a concurrent or prior cystoscopy were reviewed. Eleven of the 29 dogs had urogenital abnormalities diagnosed on cystoscopic evaluation, and 1 dog was diagnosed with a urogenital abnormality during vaginal examination while under general anesthesia. Ten of the dogs with urogenital abnormalities had a corrective procedure performed, 8 of which were cystoscopically assisted. Cystoscopy provides the ability to directly visualize the urinary tract and obtain samples for biopsy and culture and facilitates correction of some anatomic abnormalities that may predispose the patient to developing recurrent urinary tract infections. Cystoscopy should be considered as a routine part of a thorough evaluation of the urinary tract in cases presenting for episioplasty.

Clinical features, outcome, and illness severity scoring in 32 dogs with urosepsis (2017-2018)

OBJECTIVE

To describe the clinical features, outcome, and utility of illness severity scoring in dogs diagnosed with urosepsis.

DESIGN

Retrospective study (2017-2018).

SETTING

University teaching hospital.

ANIMALS

Thirty-two dogs diagnosed with urosepsis secondary to pyometra, prostatitis, or pyelonephritis.

INTERVENTIONS

 None.

MEASUREMENTS AND MAIN RESULTS

Urosepsis was identified in 32 dogs, consisting of 9 of 32 (28.1%) with pyometra, 7 of 32 (21.8%) with prostatitis, and 16 of 32 (50%) with pyelonephritis. In total, 28 (87.5%) dogs survived to discharge, with the following group-specific survival rates: pyometra, 9 of 9 (100%); prostatitis, 5 of 7 (71.4%); and pyelonephritis, 14 of 16 (87.5%). Positive bacterial cultures were obtained in 27 of 32 (84.1%) dogs. The most commonly implicated pathogens were Escherichia coli (14/37 [37.8%]), Klebsiella pneumoniae (8/37 [21.6%]), and Staphylococcus pseudintermedius (6/37 [16.2%]). Multiple organ dysfunction syndrome (MODS) was identified in 21 of 32 dogs (65.6%). Although the presence of MODS was not different between survivors and nonsurvivors (P = 0.6), nonsurvivors had more dysfunctional organs (P = 0.04). Nonsurvivors also had higher Acute Patient Physiology and Laboratory Evaluation (APPLE_FAST ) scores compared to survivors (P = 0.01).

CONCLUSIONS

Survival of dogs with urosepsis was good and may be higher than for other sources of sepsis. Compared to survivors, nonsurvivors had more dysfunctional organs and higher illness severity scores, which may be helpful in the assessment and management of dogs with urosepsis.

Characterization of recessed vulvas in dogs

OBJECTIVE

To determine the prevalence of vulvar recession in a large population of dogs and to compare the reproductive and physical differences between dogs with and without recessed vulvas.

ANIMALS

250 female dogs presenting to a tertiary referral institution.

PROCEDURES

Female dogs > 6 months of age presenting to a tertiary referral institution were enrolled. At enrollment, a full medical history was obtained with particular emphasis on the presence of lower urinary tract (LUT) disease in the 3 months prior to presentation. All dogs underwent a full physical examination including perivulvar cytologic examination and scoring of the degree of perivulvar skin coverage on the basis of an 8-point scale. Dogs with scores of ≥ 7 were classified as having recessed vulvas. When available, urinalysis data were also included.

RESULTS

Recessed vulvas were identified in 36 of 250 (14%) dogs. Dogs with recessed vulvas had significantly higher body condition scores and body weights than unaffected dogs. In addition, recessed vulvas were more common in spayed than sexually intact dogs. Dogs spayed at ≤ 1 year of age were almost 3 times as likely to have vulvar recession, compared with dogs spayed at > 1 year of age. No significant difference was identified between affected and unaffected dogs with respect to the prevalence of LUT signs, urinary tract infections, or perivulvar dermatitis.

CONCLUSIONS AND CLINICAL RELEVANCE

Although recessed vulvas were relatively common in dogs, they did not appear to be associated with an increased risk of LUT disease or perivulvar dermatitis.

Comparison of urine fibrinogen and interleukin-6 concentrations between healthy dogs and dogs with risk factors for enterococcal bacteriuria

OBJECTIVE

To compare urine concentrations of fibrinogen (uFIB) and interleukin-6 (uIL-6) between dogs with risk factors for enterococcal bacteriuria and healthy dogs.

SAMPLE

Banked urine samples with negative aerobic culture results from 8 dogs with urolithiasis, 9 dogs with anatomic abnormalities of the lower portion of the urinary tract (LUT), 10 dogs with LUT neoplasia, and 21 healthy control dogs.

PROCEDURES

Urine creatinine concentration (uCrea) was determined by an automated biochemical analyzer, and uFIB and uIL-6 were determined by dog-specific ELISAs. The uFIB:uCrea and uIL-6:uCrea ratios were calculated for each sample to normalize intersample differences in urine concentration and were compared among the 4 experimental groups.

RESULTS

Median uFIB:uCrea ratios for dogs with urolithiasis (0.72; interquartile [25th to 75 percentile] range [IQR], 0.46 to 3.48) and LUT neoplasia (6.16; IQR, 3.89 to 12.75), but not for dogs with LUT anatomic abnormalities (0.48; IQR, 0.27 to 0.69), were significantly greater than that for control dogs (0.17; IQR, 0.07 to 0.39). Median uIL-6: uCrea ratios for dogs with urolithiasis (0.48; IQR, 0.18 to 1.61), LUT anatomic abnormalities (0.25; IQR, 0.17 to 0.33), and LUT neoplasia (0.25; IQR, 0.12 to 1.01) were significantly greater than that for control dogs (0.08; IQR, 0.06 to 0.11).

CONCLUSIONS AND CLINICAL RELEVANCE

The uFIB and uIL-6 in dogs with risk factors for enterococcal bacteriuria were generally greater than corresponding values in control dogs. Further investigation is necessary to determine the role of fibrinogen in enterococcal colonization of the urinary tract of dogs.

Long-term outcome of female dogs treated for intramural ectopic ureters with cystoscopic-guided laser ablation

OBJECTIVE

To report the complications and long-term outcome of female dogs with intramural ectopic ureter(s) (iEU) undergoing cystoscopic-guided laser ablation (CLA) and determine the effect of post-CLA neutering on urinary continence.

STUDY DESIGN

Retrospective clinical study.

ANIMALS OR SAMPLE POPULATION

Thirty-four client-owned dogs.

METHODS

Medical records of female dogs that had iEU-CLA were reviewed. A 10-point continence score was assigned before, immediately after, and at a minimum of 12 months postprocedure via owner telephone contact. Neutering status prior to and postprocedure was recorded.

RESULTS

Continence scores increased in all dogs after CLA (p < .0001, mean duration of follow-up: 63.9 ± 5.7 months) with an increase of the median score from 2 (preprocedure) to 10 (postprocedure). A urethral tear occurred in 2/34 dogs immediately after the procedure, successfully managed conservatively. Mild hematuria was present in 2/34, lasting less than 48 h. Postoperative urinary tract infections were documented in 6/34 dogs. Two dogs died of urinary-related issues at 1 and 5 months after CLA. Complete and near-complete urinary continence (scores 9 and 10/10) was achieved in 26/32 dogs including 3 dogs requiring medical (2) or surgical interventions (1). Post-CLA neutering did not affect continence scores (p = .44).

CONCLUSION

A large proportion of dogs regained and maintained full continence after CLA alone. Subsequent medical or surgical therapy allowed further improvements when needed. Post-CLA neutering did not negatively impact urinary continence score.

CLINICAL SIGNIFICANCE

The beneficial effect of iEU-CLA in female dogs is long standing and not affected by postprocedural neutering.

Transurethral cystoscopy in dogs with recurrent urinary tract infections: Retrospective study (2011-2018)

Background

Urinary tract infections (UTIs) are common in female dogs and recurrent infections often require investigation by transurethral cystoscopy.

Hypothesis/Objectives

Describe the findings of transurethral cystoscopy in dogs presented for recurrent urinary tract infections (RUTI).

Animals

Fifty‐three client‐owned dogs with RUTI were included in the study.

Methods

Retrospective study. Data collected from medical records included signalment, clinical findings, bladder wall culture, cystoscopic, and histopathologic findings. UTI was defined as: presence of compatible clinical signs and at least 2 out of 3 of the following criteria: (1) pyuria, (2) positive urine culture, (3) resolution of clinical signs with antibiotic treatment. Recurrence of UTI was defined as at least 2 episodes of UTI within 6 months or at least 3 or more in 1 year.

Results

The mean age at presentation was 3.8 years with a majority of female dogs (48/53), 40/48 of which were spayed. Main breeds were Labrador (10/53), Australian Shepherd (4/53), and Miniature Schnauzer (3/53). A hooded vulva was noted in 33/48 of females. Transurethral cystoscopy showed anomalies in 45/53 of cases: mucosal edema (19/53), vestibulovaginal septal remnant (15/48), lymphoid follicles (8/53), short urethra (6/53), and ectopic ureter (5/53). Urine culture at the time of cystoscopy was positive in 13/49. Bladder wall edema and ulceration were the most common findings on histopathology (25/39).

Conclusion and Clinical Importance

RUTI occurred more frequently in spayed female dogs. Transurethral cystoscopy is useful in the diagnosis and treatment of anomalies in dogs with RUTIs.