20. www.sashvets.comwww.sashvets.com
RECURRENT UTIs
• More than 3 per year
• Re-infection or relapsed infection?
– Negative culture after Rx?
– Same or different bug?
• Re-infection: predisposing cause
• Relapsed infection:
ineffective treatment
25. www.sashvets.comwww.sashvets.com
Madison - History
• 2yo – Stump pyo; left ureteral dilation
• 6 months later – hydronephrosis and hydroureter on
ultrasound/IVP
• Between ages 3-4yo: multiple recurrent UTIs with
clinical signs
– Staph and Enterococcus
• Urinary incontinence
despite negative culture
27. www.sashvets.comwww.sashvets.com
To Treat or Not
• Clinical signs? / Cytological evidence?
• Resistant bacteria cultured previously?
• Underlying cause treatable?
• Immunosuppression?
• Likely cause of disease?
– Colony count, pure growth
– Coag negative Staph, Bacillus, propionibacteria,
Corynebacterium, Mycoplasma
28. www.sashvets.comwww.sashvets.com
Empiric Therapy
• Uncomplicated UTIs (waiting culture)
• Amoxicillin 15 (-20) mg/kg PO q 8h
– Clavulanate: no evidence for need
– Prefer narrow spectrum
• TMS 15mg (-30) mg/kg PO q 12h
– Schirmer’s before & q 2 weeks
• 7-14 days (probably less)
29. www.sashvets.comwww.sashvets.com
Madison - History
• Left nephrectomy by local vet to treat incontinence:
– Histopath: severe pyelonephritis, severe hyperplastic
ureteritis
• Cultured MDR Corynebacterium
– Susceptible to chloramphenicol only
• Physical examination
– Unremarkable
47. www.sashvets.comwww.sashvets.com
Key Learning Points
• Urine culture!!
• Urinary incontinence – work up and treatment trial
• Recurrent UTI work up
– To treat or not, empiric therapy
– Enterococcus infections
• Assessing likely stone types
• Struvite – medical condition; dissolution diets
• Calcium oxalate management
• Value of well positioned radiographs
58. www.sashvets.comwww.sashvets.com
References
• Davidson & Westropp (2014) Diagnosis and Management of Urinary Ectopia in Vet Clin
Small Anim 44:343-353
• International Society for Companion Animal Infectious Diseases (2011) – Antimicrobial
Use Guidelines for the Treatment of Urinary Tract Disease in Dogs and Cats:
Antimicrobial Guidelines
• Berent, Weisse, Mayhew et al. (2012) Evaluation of cystoscopic-guided laser ablation
of intramural ectopic ureters in female dogs in JAVMA 240 (6):716-725
• Sykes (2014) Canine and Feline Infectious Diseases
• Lulich et al. (2013) Efficacy of two commercially available, low-magnesium, urine-
acidifying dry foods for the dissolution of struvite uroliths in cats in JAVMA
243(8):1147-1153
• Nelson & Couto (2014) Small Animal Internal Medicine – 5th Edition
• Berent, Weisse et al. (2014) Technical and clinical outcomes of ureteral stenting
in cats with benign ureteral obstruction: 69 cases (2006-2010) in JAVMA 244(5):559-
576
• Steinhaus, Berent et al. (2015) Clinical presentation and outcome of cats with
circumcaval ureters associated with a ureteral obstruction in JVIM 29(1):63-70
Doxycycline – bacteriostatic, only 25% eliminated through kidneys
*********DISSOLUTION: cat evidence
Image removed
What went wrong?
Why is Libby now presenting with vomiting, diarrhoea, lethargy?
Do not trust crystalluria and urinalysis. If have to choose one test, choose the urine culture – that is something you can treat!
NB. NOT density
But urates can still sometimes be seen, especially if mixed or if big stone
Image removed
LESSONS! Always radiograph entire urinary tract
Always take post-op radiographs before anaesthetic recovery