Cystitis and Urinary Bladder Paralysis in Horses

Cystitis and Urinary Bladder Paralysis in Horses

Introduction to Cystitis and Urinary Bladder Paralysis in Horses

Knowledge of urinary tract anatomy and the numerous functions of the kidney in regulating fluids, electrolytes, acid-base balance, and waste products improve the ability of the clinician to diagnose, treat, and make appropriate recommendations for the management of the horse with renal disease. Several conditions can directly or indirectly affect renal function on a temporary or permanent basis. Endogenous and exogenous compounds (e.g. drugs, toxins, hemoglobin) alone or in combination with inappropriate renal blood flow can promote or exacerbate renal disease.
Human used equine from thousands years. Recently it is important in race, and riding.
So they are interesting in the good health of equine to get the best performance.
Urinary system is one of the most important systems in equine and it affect all other systems.
Cystitis is one of the most important common disease in horse .
Cystitis is inflammation and disorders in urinary bladder.
Clinical disease resulting from bacterial colonization of the equine urinary tract remains an uncommon occurrence.

Equine urinary tract infection (UTI) is rarely a primary event, most often occurring subsequent to mechanical obstructions or functional impairments that impede normal urine flow. In contrast to the less prominent role of UTIs in equine patients, bacterial infections of the urinary tract represent one of the most common reasons prompting human patients to seek medical attention.

The urinary system or tract includes the kidneys, the ureters (tubes that connect the kidneys to the bladder), the bladder, and the urethra (the tube through which urine exits the body).

The urinary system has several important functions. It gets rid of the waste products that are created when food is transformed into energy. It also maintains the correct balance of water and electrolytes (salts) within the body. Another key function is the production of hormones called erythropoietin and renin, which are important in maintaining healthy blood pressure, producing blood cells, and absorbing salt correctly. Finally, the urinary system processes vitamin D to its active form.
Veterinarian can diagnose most urinary system problems by taking a history of how your horse has acted in the days prior to becoming sick, performing a physical examination, and performing tests on the horse’s blood and urine. The history that the veterinarian takes might include information regarding changes in how much water your horse drinks, how often it urinates, how much urine it produces, how the urine looks, and how your horse behaves. Your veterinarian will also need information about what medications your horse has taken or is currently taking, your horse’s appetite, diet, changes in body weight, and previous illnesses or injuries.

There are many tests the veterinarian might perform in the case of a urinary disorder. These include blood tests, blood pressure measurement, urinalysis, x-rays, contrast x-rays (tests in which a special dye is given to outline the urinary tract on the x-ray), ultrasonography, biopsies, and endoscopic evaluation of the urethra and bladder.

Urinalysis is a laboratory test that evaluates urine. It is one of the most important tools a veterinarian can use to diagnose urinary tract problems. Many tests are performed as part of a urinalysis. Physical examination of the urine includes noting the color and cloudiness, if any, and measuring the pH (to determine how acidic or alkaline the urine is) and urine specific gravity (which indicates of how concentrated the urine sample is). Chemical evaluation of the urine follows with tests for the presence of substances in the urine, such as sugar (glucose), ketones (a byproduct of the fat metabolism), bilirubin (a pigment produced by the liver), blood, and protein. Finally, urine sediment (prepared by centrifuging urine) is examined under a microscope to look for red blood cells, white blood cells, other cells, bacteria, and crystals.

Endoscopic evaluation is another valuable source of diagnostic information for a veterinarian. A small flexible tube with a camera located at its tip is inserted through the horse’s urethra and can be used to visualize the urethra and sometimes the bladder. This provides a good way to identify problems such as obstructions of the urethra, tumors, or malformations.
Causes:
Cystitis is caused by infection resulting in inflammation of the bladder. Often it is not an isolated infection, but is a result of other physical conditions such as tumors, neurological diseases, development of calculi, or sub mucosal cysts, diet, water intake and loss, excessive sweating or diarrhea can precipitate the development of calculi.

Pasturing horses on Sudan grass, sorghum or sorghum-sudan hybrid grass causes some horses to develop cystitis. Since there is no way to predict which horses will be susceptible to development of this infection as a result of grazing, horses should not be allowed access to these kinds of pastures.

  • Primary causes is rare.
    • Secondary – also rare; secondary to urinary stasis with subsequent bacterial proliferation caused by:
    1. Cystic calculi.
    2. Neurological disease of the urinary tract such as sorghum cystitis, herpes virus, myeloencephalitis, etc.
    Bacterial cystitis is infection and inflammation of the urinary bladder. Clinical signs are pollakiuria, hematuria, dysuria, and urinating in inappropriate places.

Hematuria may be more noticeable at the end of the urine stream. An animal may exhibit pain on palpation of the caudal abdomen, and the bladder may feel thickened or irregular. Bacterial cystitis is occasionally diagnosed in an asymptomatic animal when a routine urinalysis is performed.

Chronic glucocorticoid administration, hyperadrenocorticism, chronic kidney disease, and diabetes mellitus may be associated with asymptomatic urinary tract infections. Occasionally, animals with no concurrent disease will have bacteria in the urine without evidence of a true infection (i.e., bladder mucosal invasion and inflammation); this condition is termed asymptomatic bacteriuria.

Urinalysis often shows increased protein and hemoglobin on the urine dipstick analysis. The WBC part of the dipstick (i.e., nitrate) is inaccurate in dogs and cats and should not be used. The urine pH may be alkaline (7.5–9) if the bacteria are urease positive (e.g., Staphylococcus or Proteus). However, an alkaline urine pH by itself is not abnormal, because diet and other factors can affect urine pH. Urine sediment should be examined microscopically. Increased numbers of WBCs, RBCs, and/or bacteria are consistent with cystitis. Bacteria can be confused with stain precipitate; filtering the stain or evaluating the sediment without staining is advised. Lack of visible bacteria in the sediment does not exclude urinary tract infection.

If clinical signs and/or urinalysis are suggestive of infection, a urine culture and antimicrobial susceptibility test should be performed. Cystocentesis is the preferred method for sample collection, followed by sterile urethral catheterization or a midstream free catch into a sterile collection cup. A quantitative culture is necessary to interpret the result, unless the sample was collected by cystocentesis. Ideally, the culture should be set up within 2 hours of collection. If the laboratory is off-site, the sample should be refrigerated and processed by the laboratory within 24 hr. If the specimen cannot be refrigerated, commercial collection kits that contain preservatives can be used to maintain a stable bacterial population at room temperature for 24 hr. Laboratories that can provide both quantitative culturing and a minimum inhibitory concentration–based method for antimicrobial susceptibility testing are preferred.

Antibiotic regimens for infections involving soft tissues, such as bacterial cystitis with prostatic involvement, should be similar to pyelonephritis. Simple bacterial cystitis is treated for 2 weeks with a broad-spectrum antibiotic that achieves a high concentration in the urine. Appropriate initial choices include amoxicillin(10–20 mg/kg, PO, bid-tid), cefadroxil (22–30 mg/kg, PO, bid), cefpodoxime (5–10 mg/kg/day, FDA approved for dogs only), ormetoprim-sulfadimethoxine (27 mg/kg, PO, day one, then 13.5 mg/kg/day, PO), or cefovecin (8 mg/kg, SC, day one, which may be repeated once 7 days later). A repeat urine culture 3–7 days after oral therapy or on day 21 if cefovecin is used is recommended. If positive, another antibiotic based on the new susceptibility test results is given for a longer treatment period (eg, 3–4 wk). Very resistant or recurrent infections should be treated for 4–6 weeks. Every course of treatment should be followed by a urine culture, even if the signs have resolved. In animals that have a history of chronic or recurrent infections, a urine culture should be done 3–7 days and 3 months after successful therapy. If both of these cultures are negative, then a urine culture should be repeated at 6 and 12 months after therapy. Because resistance to antibiotics can develop during therapy, antimicrobial susceptibility testing should be performed on every positive urine culture.

Animals with recurrent bacterial cystitis should be evaluated for an underlying cause. A recurrent infection caused by the same bacterial organism is termed a relapse and is essentially a treatment failure. This is typically caused by inappropriate antibiotic therapy (i.e., wrong drug, dosage, or treatment duration) and often occurs because of an unrecognized complicating factor (e.g., deep-seated bladder wall infection, bladder polyps, renal or prostatic involvement, concurrent disease). A recurrent infection in which different organisms are causative is termed a reinfection and is usually caused by host defense problems such as disorders of micturition (e.g., urethral incompetence), anatomic abnormalities (e.g., hooded vulva, patent urachus, ectopic ureters, uroliths), and/or concurrent disease (e.g., chronic kidney disease, hyperadrenocorticism, chronic glucocorticoid administration). antibiotic that achieves a high concentration in the urine. Appropriate initial choices include amoxicillin(10–20 mg/kg, PO, bid-tid), cefadroxil (22–30 mg/kg, PO, bid), cefpodoxime (5–10 mg/kg/day, FDA approved for dogs only), ormetoprim-sulfadimethoxine (27 mg/kg, PO, day one, then 13.5 mg/kg/day, PO), or cefovecin (8 mg/kg, SC, day one, which may be repeated once 7 days later). A repeat urine culture 3–7 days after oral therapy or on day 21 if cefovecin is used is recommended. If positive, another antibiotic based on the new susceptibility test results is given for a longer treatment period (eg, 3–4 wk). Very resistant or recurrent infections should be treated for 4–6 weeks. Every course of treatment should be followed by a urine culture, even if the signs have resolved. In animals that have a history of chronic or recurrent infections, a urine culture should be done 3–7 days and 3 months after successful therapy. If both of these cultures are negative, then a urine culture should be repeated at 6 and 12 months after therapy. Because resistance to antibiotics can develop during therapy, antimicrobial susceptibility testing should be performed on every positive urine culture.

Animals with recurrent bacterial cystitis should be evaluated for an underlying cause. A recurrent infection caused by the same bacterial organism is termed a relapse and is essentially a treatment failure. This is typically caused by inappropriate antibiotic therapy (i.e., wrong drug, dosage, or treatment duration) and often occurs because of an unrecognized complicating factor (e.g., deep-seated bladder wall infection, bladder polyps, renal or prostatic involvement, concurrent disease). A recurrent infection in which different organisms are causative is termed a reinfection and is usually caused by host defense problems such as disorders of micturition (e.g., urethral incompetence), anatomic abnormalities (e.g., hooded vulva, patent urachus, ectopic ureters, uroliths), and/or concurrent disease (e.g., chronic kidney disease, hyperadrenocorticism, chronic glucocorticoid administration).

Abdominal radiographs are frequently diagnostic for uroliths but negative survey films should be followed by ultrasonography, cystoscopy, and/or double-contrast cystourethrography to exclude radiolucent urocystoliths, anatomic defects, polyps, and neoplasia. The history may reveal chronic glucocorticoid use. A serum biochemical profile, CBC, and complete urinalysis are important to exclude predisposing systemic diseases, such as chronic kidney disease, hyperadrenocorticism, and diabetes mellitus. Other diagnostic considerations include feline immunodeficiency virus, feline leukemia virus, and hyperthyroidism in cats or hyperadrenocorticism in dogs.

In cases that respond to therapy but continue to have frequent bouts of cystitis without an identifiable cause, low-dose prophylactic antibiotics can be used to prevent ascending bacteria from establishing an infection according to the following protocol: 1) a therapeutic course of an antibiotic for the current infection is completed, 2) no antibiotics are given for 3 days, to allow collection of urine for a culture after treatment, and 3) the prophylactic protocol is immediately started. Prophylaxis consists of using a broad-spectrum antibiotic (eg, amoxicillin, cefadroxil) at one-third of the total daily dose, given at bedtime, indefinitely. Every 6–8 weeks, the antibiotic should be stopped for 3–7 days to obtain a sample for repeat urinalysis and culture. Every new infection should be treated with a therapeutic course of an antibiotic based on culture and susceptibility results. The treatment antibiotic will likely be different than the prophylactic antibiotic. Oral cranberry extract and d-mannose may be useful adjuncts. The most valuable therapeutic antibiotics (eg, fluoroquinolones, second- or third-generation cephalosporins) should be reserved for resistant infections. If the recurrent infection is resistant to the prophylactic antibiotic, this antibiotic can still be used for future prophylaxis after the infection is eradicated. Encouraging frequent voiding during the daytime is helpful to prevent recurrent infections.

The major disadvantage of using a prophylactic antibiotic protocol is development of multidrug-resistant bacteria.

Clinical signs of Cystitis and Urinary Bladder Paralysis in Horses:

• Pollakiuria (unduly frequent urination) that may resemble signs of estrus also dysuria (difficult urination), and urine dribbling.
• Perineal scalding in the mare and soiling of hind legs in the male.
• Gross haematuria in some cases.

Clinicopathological findings of Cystitis and Urinary Bladder Paralysis in Horses:

Examination of urine sediment for:
• WBCs. More than 8 WBCs per high-power field of urine collected during urination or more than 5 when urine is collected by catheterization is evidence of inflammation.
• RBCs. More than 8 RBCs per high-power field of urine collected during urination or more than 5 when urine is collected by catheterization is evidence of haemorrhage.
• Large number of bacteria. Recovery of more than 10 000 colony-forming units per mL of urine collected by catheterization is diagnostic of urinary tract infection.

Diagnosis of Cystitis and Urinary Bladder Paralysis in Horses:

Clinicopathological findings confirm the presence or urinary tract infection, and physical examination (thickened bladder palpated per rectum) and/or cystoscopic examination (thickened, hyperaemic, or ulcerated mucosa) localize the infection to the bladder.

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