Urological disorders of the dog and cat: investigation, diagnosis, and treatment

177 Pages·2008·38.612 MB·English

by  Peter E Holt

U R O LO G I CA L
D I S O R D E R S
OF THE
D O G CAT
AND
INVESTIGATION, DIAGNOSIS AND TREATMENT
Peter E Holt
BVMS, PhD, DipECVS, CBiol, FIBiol, FHEA, FRCVS
Professor of Veterinary Surgery
School of Clinical Veterinary Science
University of Bristol
Langford, Bristol, UK
MANSON PUBLISHING/THE VETERINARY PRESS
This book is dedicted to:the memory of my father Eric R Holt whose enthusiasm
for my work was, and still is, a constant source of encouragement to me; my Mum
for allowing her first born the chance to stay on at school and go to University,
contrary to family tradition; my wife, Sylvia, my best friend, supporter and, when
required, critic; my sons, Brandon and Andrew, who would probably have liked to
have seen more of their Dad as children and of whom I am immensely proud;
Alan Case, who got me through A-level Physics but then died too young;
extraordinaire
John Lamb (drummer ), ‘Cappy’ Powell and an anonymous
newsagent who helped teach me about selflessness, values and compassion; and my
mentors Sir William Weipers, Professor Donald Lawson, Professor Jimmy
Campbell, Professor Harold Pearson and Dr Christine Gibbs.
Copyright © 2008 Manson Publishing Ltd
ISBN: 978-1-84076-095-8
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Contents
3
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Differential diagnosis and
PART 2
treatment 57
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Chapter 4 Non-prostatic dysuria . . . . . . . . . 59
Diagnosis 59
Investigation of animals
PART 1 with urological signs 7 Treatment 63
Chapter 1 Clinical assessment . . . . . . . . . . . . 9 Chapter 5 Prostatic disorders . . . . . . . . . . . . 91
Diagnosis 91
Chapter 2 Radiographic investigations . . . . . 14
Treatment 94
Plain films 14
Chapter 6 Urinary tract trauma . . . . . . . . . 106
Intravenous urography 18
Renal trauma 106
Retrograde, positive contrast vagino-
Uroperitoneum 112
urethrography 25
Treatment of urinary tract
Retrograde, positive contrast
trauma 112
urethrography 29
Cystography 32 Chapter 7 Other causes of haematuria . . . . 123
Chapter 3 Other diagnostic aids . . . . . . . . . . 36 Diagnosis 123
Treatment 128
Ultrasonography 36
Urethral catheterization 38 Chapter 8 Urinary incontinence . . . . . . . . . 134
Centesis 45 Urinary incontinence in
Cytology 46 juvenile animals 134
Biopsy techniques 48 Urinary incontinence in
adult animals 142
Blood and urine analyses 51
Urethral sphincter mechanism
Urodynamics 53
incompetence 145
Endoscopy 55
References and further reading . . . . . . . . . . 160
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . 176
Foreword
4
Be careful about reading health books. You may die of a misprint.
Mark Twain (1835–1910)
THIS BOOK IS AIMED first and foremost at being a • Mr Alasdair Hotston Moore for permission to use
practical guide for the small animal veterinary practi- figures 365–367.
tioner. For this reason, the investigative procedures and • Dr Dick White and Mr Jonathan Bray for allowing
surgical techniques described are those that the author me to use their figures as a basis for figures
considers practicable in a reasonably well-equipped vet- 313–317.
erinary practice. The book is not intended to be read • My surgical colleagues and clinical scholars at
from cover to cover. Apart from certificate or diploma Langford for keeping me on my toes, especially Mr
examination candidates, I am aware of few people who Hotston Moore, Dr Martin Owen, Dr Eithne
do this. Rather, this book is meant to be referred to for Comerford and Mr Christopher Shales.
practical information on a specific problem as and • Mr John Conibear, Mr Malcolm Parsons and Ms
when the need arises, and copious cross-referencing is Tracey Dewey who took most of the photographs
used to direct the reader to related material within the used in this book.
book. I have always investigated as well as treated my • The anaesthetists and veterinary nurses who helped
own cases and no apology is made for allocating a large in the management of the cases used to illustrate
section of this book to the investigation of animals this book.
with urological signs. An accurate diagnosis is the • The students who helped to care for many of these
foundation upon which any treatment plan is built. animals.
Detailed descriptions of advanced techniques such as • Special thanks to Professor Elizabeth Stone and Mr
scintigraphy and MRI or CT scanning will not be Rob White, who reviewed the draft of this book for
described. Apart from the lack of facilities in most the publishers, for their constructive comments.
practices, these are specialized techniques requiring
specialized equipment and expertise in their use and The evidence base in many areas of veterinary urology
interpretation. is thin and, sometimes, controversial (e.g. the necessi-
Mark Twain, if he was alive, would be reassured by ty to ligate the renal artery and vein separately or not
the professional assistance I have had in the production during nephrectomy). This book is therefore based
of this book and I am grateful to the following for their almost entirely upon my own experiences, good and
help and support: bad, and I would commend to the reader the following
• Dr Frances Barr for assistance with quotation by Carolyn Coats (1988) in her book
ultrasonographic illustrations (figures 85, ‘Things Your Dad Always Told You But You Didn’t
259–262) and advice. Want To Hear’:
• Dr Kostas Papasouliotis for advice on normal
laboratory values. Learn from the mistakes of others; you may not live
• Mr A Skuse for advice on the staining of long enough to make them all yourself.
cytological specimens.
• The late, great Professor Harold Pearson for
permission to use figures 432, 433.
Abbreviations
5
CT computed tomography
DHTest dihydrotestosterone
DNA deoxyribonucleic acid
ECG electrocardiogram
FLUTD feline lower urinary tract disease
FSH follicle stimulating hormone
FUS feline urological syndrome
IVU intravenous urography
LH luteinizing hormone
LHRH luteinizing hormone releasing hormone
LMN lower motor neurone
MCH mean corpuscular haemoglobin
MCHC mean corpuscular haemoglobin concentration
MCV mean corpuscular volume
MRI magnetic resonance imaging
ND:YAG neodymium: yttrium aluminium garnet (laser)
NSAID non-steroidal anti-inflammatory drug
PCV packed cell volume
RBC red blood cell(s)
RNA ribonucleic acid
Test testosterone
UMN upper motor neurone
WBC white blood cell(s)
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7
I N V E S T I G AT I O N
Part
1
O F A N I M A L S W I T H
U R O LO G I C A L S I G N S
Clinical assessment
1
Radiographic investigations
2
Other diagnostic aids
3
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Clinical assessment
1
9
But most physical defensive reactions are of the same scarcely recognisable and, so to speak,
indirect nature, and their purposeful character also has only been recognised through deep investigation
and exact observation.
Carl Jung (1875–1961)
Tables 1–5
IN THIS CHAPTER, a brief account is given of the these signs are listed in . Some sex predis-
clinical assessment of small animals presented with positions are obvious (e.g. prostatic disease), but
signs of urological disease. symbols based on the author’s experiences appear
Most animals with urological presenting signs alongside conditions potentially responsible for the
m
can be divided into those presenting primarily urological signs; = commoner in male animals;
f n
with dysuria, haematuria, urinary incontinence or = commoner in female animals; = no apparent sex
frequency/urgency. The main conditions leading to predisposition.
Table 1 Dysuria Table 3 Congenital urinary incontinence
Urethral prolapse (m) Ureteral ectopia (f)
Prostatic disorders (m) Congenital urethral sphincter mechanism
incompetence (f)
Bladder neck neoplasia (f)
Bladder hypoplasia (n)
Urethral neoplasia (f)
Pervious urachus (n)
Urethral trauma (n)
Intersexuality (n)
Urethritis (f)
Congenital neurological abnormalities (n)
Urethral stricture (n)
Neurogenic dysuria (n) Table 4 Acquired urinary incontinence
Bladder displacement/entrapment (m) Acquired urethral sphincter mechanism incompetence (f)
Functional disorders (e.g. dyssynergia [m], Prostatic disorders (m)
bladder atony [m])
Bladder/urethral neoplasia (f)
External resistance to urine outflow (e.g. ureterocoele
[rarely] [n]) Uretero- or vesicovaginal fistula (f)
Acquired neurological conditions (n)
Table 2 Haematuria Overflow incontinence with chronic retention (m)
Detrusor overactivity/hyperactivity/instability (n)
Urinary tract infection (n)
Urolithiasis (n)
Prostatic disorders (m) Table 5 Frequency/urgency (pollakiuria)
Urinary tract neoplasia (n) Cystitis/urethritis (f)
Urinary tract trauma (n) Cystolithiasis (f)
Idiopathic renal haemorrhage (n) Bladder/urethral neoplasia (f)
Urethral prolapse (m) Prostatic disease (m)
Bladder hypoplasia/detrusor overactivity/hyperactivity/
instability (n)
Lower urinary tract trauma (n)