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Basics ⬇

Basics

Definition

  • Dysuria-difficult or painful urination.
  • Pollakiuria-voiding small quantities of urine with increased frequency of micturition.

Pathophysiology

The urinary bladder and urethra normally serve as a reservoir for storage and periodic release of urine. Inflammatory and non-inflammatory disorders of the lower urinary tract may decrease bladder compliance and storage capacity by damaging structural components of the bladder wall or by stimulating sensory nerve endings located in the bladder or urethra. Sensations of bladder fullness, urgency, and pain stimulate premature micturition and reduce functional bladder capacity. Dysuria and pollakiuria are caused by lesions of the urinary bladder and/or urethra and provide unequivocal evidence of lower urinary tract disease; these clinical signs do not exclude concurrent involvement of the upper urinary tract or disorders of other body systems.

Systems Affected

Renal/Urologic-bladder, urethra, and prostate gland

Signalment

Dog and cat

Signs

N/A

Causes

Urinary Bladder

  • Urinary tract infection-bacterial, viral, fungal, parasitic, or mycoplasmal.
  • Urocystolithiasis.
  • Neoplasia-e.g., transitional cell carcinoma.
  • Trauma.
  • Anatomic abnormalities-e.g., ureterocele, persistent uterus masculinus, perineal hernias containing the urinary bladder, and spay granulomas.
  • Detrusor atony-e.g., chronic partial obstruction and dysautonomia.
  • Chemicals/drugs-e.g., cyclophosphamide.
  • Iatrogenic-e.g., catheterization, palpation, reverse flushing, overdistension of the bladder during contrast radiography, urohydropropulsion, urethrocystoscopy, and surgery.
  • Idiopathic-e.g., idiopathic feline lower urinary tract disease.

Urethra

  • Urinary tract infection-see previous section.
  • Urethrolithiasis-see previous section.
  • Urethral plugs-e.g., matrix and matrix-crystalline.
  • Neoplasia-see previous section; local invasion by malignant neoplasms of adjacent structures.
  • Trauma.
  • Anatomic anomalies-e.g., congenital or acquired strictures, urethrorectal fistulas, and pseudohermaphrodites.
  • Urethral sphincter hypertonicity-e.g., upper motor neuron spinal cord lesions, reflex dyssynergia, and urethral spasm.
  • Iatrogenic-see previous section.
  • Idiopathic-see previous section.

Prostate Gland

  • Prostatitis or prostatic abscess
  • Neoplasia-adenocarcinoma and transitional cell carcinoma
  • Cystic hyperplasia
  • Paraprostatic cysts

Risk Factors

  • Diseases, diagnostic procedures, or treatments that (1) alter normal host urinary tract defenses and predispose to infection, (2) predispose to formation of uroliths, or (3) damage the urothelium or other tissues of the lower urinary tract.
  • Mural or extramural diseases that compress the bladder or urethral lumen.

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

Differentiating from Other Abnormal Patterns of Micturition

  • Rule out polyuria-increased frequency and volume of urine >50 mL/kg/day.
  • Rule out urethral obstruction-stranguria, anuria, overdistended urinary bladder, signs of post-renal uremia.
  • Rule out urinary incontinence-involuntary urination, urine dribbling, enuresis, incomplete bladder emptying.
  • Rule out urine spraying or marking-voiding small amounts of urine on vertical surfaces or other socially significant places.

Differentiate Causes of Dysuria and Pollakiuria

  • Rule out urinary tract infection-hematuria; malodorous or cloudy urine; small, painful, thickened bladder.
  • Rule out urolithiasis-hematuria; palpable uroliths in urethra or bladder.
  • Rule out neoplasia-hematuria; palpable masses in urethra or bladder.
  • Rule out neurogenic disorders-flaccid bladder wall; residual urine in bladder lumen after micturition; other neurologic deficits to hind legs, tail, perineum, and anal sphincter.
  • Rule out prostatic diseases-urethral discharge, prostatomegaly, pyrexia, depression, tenesmus, caudal abdominal pain, stiff gait.
  • Rule out cyclophosphamide cystitis-history.
  • Rule out iatrogenic disorders-history of catheterization, reverse flushing, contrast radiography, urohydropropulsion, urethrocystoscopy, or surgery.

CBC/Biochemistry/Urinalysis

  • Results of CBC and biochemistries are often normal. Lower urinary tract disease complicated by urethral obstruction may be associated with azotemia, hyperphosphatemia, acidosis, and hyperkalemia. Patients with concurrent pyelonephritis may have impaired urine-concentrating capacity, leukocytosis, and azotemia. Patients with acute prostatitis or prostatic abscesses may have leukocytosis. Dehydrated patients may have elevated total plasma protein.
  • Disorders of the urinary bladder are best evaluated with a urine specimen collected by cystocentesis. Urethral disorders are best evaluated with a voided urine sample or by comparison of results of analysis of voided and cystocentesis samples. (Caution: cystocentesis may induce hematuria.)
  • Pyuria, hematuria, and proteinuria indicate urinary tract inflammation, but these are non-specific findings that may result from infectious and non-infectious causes of lower urinary tract disease.
  • Identification of bacteria, fungi, or parasite ova in urine sediment suggests, but does not prove, that urinary tract infection is causing or complicating lower urinary tract disease. Consider contamination of urine during collection and storage when interpreting urinalysis results.
  • Identification of neoplastic cells in urine sediment indicates urinary tract neoplasia. Use caution in establishing a diagnosis of neoplasia based on urine sediment examination. Urinary tract inflammation or extremes in urine pH or osmolality can cause epithelial cell atypia that is difficult to differentiate from neoplasia.
  • Crystalluria occurs in normal patients, patients with urolithiasis, or patients with lower urinary tract disease unassociated with uroliths. Interpret the significance of crystalluria cautiously.
  • Hematuria, proteinuria, and variable crystalluria occur in cats with non-obstructive idiopathic lower urinary tract disease. Significant pyuria is rare in these patients.

Other Laboratory Tests

  • Quantitative urine culture-the most definitive means of identifying and characterizing bacterial urinary tract infection; negative urine culture results suggest a non-infectious cause (e.g., uroliths and neoplasia) or inflammation associated with urinary tract infection caused by fastidious organisms (e.g., mycoplasmas or viruses).
  • Cytologic evaluation of urine sediment, prostatic fluid, urethral or vaginal discharges or biopsy specimens obtained by catheter or needle aspiration-may help in evaluating patients with localized urinary tract disease; may establish a definitive diagnosis of urinary tract neoplasia, but cannot rule it out.

Imaging

Survey abdominal radiography, contrast urethrocystography and cystography, urinary tract ultrasonography, and excretory urography are important means of identifying and localizing causes of dysuria and pollakiuria.

Diagnostic Procedures

  • Use urethrocystoscopy in patients with persistent lesions of the lower urinary tract for which no definitive diagnosis has been established by other, less-invasive, means.
  • Use light microscopic evaluation of tissue biopsy specimens from patients with persistent lesions of the urinary tract for which no definitive diagnosis has been established by other, less-invasive, means. Tissue specimens may be obtained by catheter biopsy, urethrocystoscopy and forceps biopsy, or surgery.

Treatment ⬆ ⬇

Treatment

Medications ⬆ ⬇

Medications

Drug(s) Of Choice

  • Patients with urge incontinence, severe or persistent signs, or untreatable lower urinary tract disease may benefit from symptomatic therapy with propantheline, oxybutynin, or dicyclomine anticholinergic agents that may reduce the force and frequency of uncontrolled detrusor contractions.
  • Propantheline-dogs: 0.2 mg/kg PO q6–8h; cats: 0.25–0.5 mg/kg PO q12–24h. Oxybutynin-dogs: 0.2 mg/kg PO q8–12h; cats: 0.5–1.25 mg/cat PO q8–12h. Dicyclomine-dogs: 5–10 mg/dog PO q8h.
  • Patients with transitional cell carcinoma of the urinary bladder or urethra may be symptomatically managed with the nonsteroidal anti-inflammatory drug piroxicam (0.3 mg/kg PO q24h), which reduces the severity of clinical signs, improves quality of life, and in some cases, induces tumor remission.

Contraindications

  • Glucocorticoids or other immunosuppressive agents in patients suspected of having urinary or genital tract infection.
  • Potentially nephrotoxic drugs (e.g., gentamicin) in patients that are febrile, dehydrated, or azotemic or that are suspected of having pyelonephritis, septicemia, or preexisting renal disease.

Precautions

N/A

Possible Interactions

N/A

Alternative Drug(s)

N/A

Follow-Up ⬆ ⬇

Follow-Up

Patient Monitoring

  • Monitor response to treatment by status of clinical signs, serial physical examinations, laboratory testing, and radiographic and ultrasonic evaluations appropriate for each specific cause.
  • Refer to specific chapters describing diseases listed, under “Causes.”

Possible Complications

  • Dysuria and pollakiuria may be associated with formation of macroscopic vesicourachal diverticula.
  • Refer to specific chapters describing diseases listed, under “Causes.”

Miscellaneous ⬆

Miscellaneous

Associated Conditions

  • Hematuria, pyuria, and proteinuria
  • Disorders predisposing to urinary tract infection
  • Disorders predisposing to formation of uroliths
  • Macroscopic vesicourachal diverticula

Age-Related Factors

N/A

Zoonotic Potential

None

Pregnancy/Fertility/Breeding

N/A

Synonyms

  • Feline urological syndrome
  • Lower urinary tract disease

Authors John M. Kruger and Carl A. Osborne

Consulting Editor Carl A. Osborne

Suggested Reading

Forrester SD, Kruger JM, Allen TA. Feline lower urinary tract diseases. In: Hand MS, Thatcher CD, Remillard RL, et al, eds. Small Animal Clinical Nutrition, 5th ed. Topeka, KS: Mark Morris Institute2010, pp. 925–976.

Francey T. Prostatic Diseases. In: Ettinger SJ, Feldman EC, eds. Textbook if Veterinery Internal Medicine, 7th ed. St. Louis, MO: Elsevier, 2010, pp. 2047–2058.

Lane IF. Use of anticholinergic agents in lower urinary tract disease. In: Bonagura JD, ed., Kirk's Current Veterinary Therapy XIII: Small Animal Practice. Philadelphia: Saunders, 2000, pp. 899–902.

Lulich JP, Osborne CA, Albasan H. Canine and feline urolithiasis: diagnosis, treatment, and prevention. In: Bartges J, Polzin DJ eds. Nephrology and Urology of Small Animals. Chichester, UK: Wiley-Blackwell, 2011, pp. 687–706.

Phillips J. Neoplasia of the lower urinary tract. In: Bartges J, Polzin DJ, eds. Nephrology and Urology of Small Animals. Chichester, UK: Wiley-Blackwell, 2011, pp. 797–808.

Pressler B, Bartges JW. Urinary tract infections. In: Ettinger SJ, Feldman EC, eds. Textbook if Veterinery Internal Medicine, 7th ed. St. Louis, MO: Elsevier, 2010, pp. 2036–2047.