Ultrasound-guided Cystocentesis Research Articles

CYSTOCENTESIS AND URINALYSIS IN ZOOMEDICINE: AN UNDERESTIMATED TOOL FOR LARGE FELID STANDARD HEALTH CHECKS.

Chronic kidney disease (CKD) is a prevalent disease among felids; yet its origin is still poorly understood, and the disease often remains asymptomatic for years, underscoring the need for early diagnosis. This study aimed to investigate the diagnostic value of urinalysis in accurately staging CKD, particularly as routine health checks in large felids often overlook its significance. In this research, ultrasound-guided cystocentesis (UGC) was performed on 50 captive nondomestic felids during routine veterinary health checks under general anesthesia. Urinalysis included microscopic examination of the sediment, measurement of urine specific gravity (USG) and protein to creatinine ratio (UPC). Additional serum kidney markers, such as creatinine and symmetric dimethylarginine, were compared with USG and UPC to assess their diagnostic value as urinary biomarkers. The results demonstrated proteinuria (UPC > 0.4) or borderline proteinuria (UPC 0.2-0.4) in 49% of the animals. Among these cases, 62% were of renal origin, and 38% were postrenal causes. USG was significantly higher in felids with borderline proteinuria compared to those with proteinuria. A moderate, but significant negative correlation between serum parameters and USG was observed, emphasizing the importance of assessing both diagnostic parameters during kidney evaluations. Additionally, felids with CKD have an increased risk of urinary tract infections, necessitating microscopic urinalysis and bacterial culture analysis. Abnormalities, including hematuria, pyuria, crystalluria, and bacteriuria, were found in approximately 38% of cases through microscopical examination of urine. No complications associated with UGC were observed and abnormal findings were detected in 60% of the cases. Based on these results, the authors recommend the inclusion of UGC and urinalysis as standard diagnostic tools in general health checks for nondomestic felids. This approach provides valuable insights into the early detection and staging of CKD, supporting early intervention and supportive medical care to prolong renal health in these animals.

No viable bacterial communities reside in the urinary bladder of cats with feline idiopathic cystitis

Urinary microbial diversities have been reported in humans according to sex, age and clinical status, including painful bladder syndrome/interstitial cystitis (PBS/IC). To date, the role of the urinary microbiome in the pathogenesis of PBS/IC is debated. Feline idiopathic cystitis (FIC) is a chronic lower urinary tract disorder affecting cats with similarities to PBS/IC in women and represents an important problem in veterinary medicine as its aetiology is currently unknown. In this study, the presence of a bacterial community residing in the urinary bladder of cats with a diagnosis of FIC was investigated. Nineteen cats with clinical signs and history of FIC and without growing bacteria in standard urine culture were included and urine collected with ultrasound-guided cystocentesis. Bacterial community was investigated using a culture-dependent approach consisted of expanded quantitative urine culture techniques and a culture-independent approach consisted of 16S rRNA NGS. Several methodological practices were adopted to both avoid and detect any contamination or bias introduced by means of urine collection and processing which could be relevant due to the low microbial biomass environment of the bladder and urinary tract, including negative controls analysis. All the cats included showed no growing bacteria in the urine analysed. Although few reads were originated using 16S rRNA NGS, a comparable pattern was observed between urine samples and negative controls, and no taxa were confidently classified as non-contaminant. The results obtained suggest the absence of viable bacteria and of bacterial DNA of urinary origin in the urinary bladder of cats with FIC.

Cystitis in a Bitch with Chronic Kidney Disease Caused by Multidrug-Resistant Escherichia coli

Background: In dogs with bacterial cystitis that is resistant to multiple antibiotics, resulting from repeated infections and antimicrobial administration, especially if the dog has impaired renal function and the induction of systemic side effects by intravenous or oral administration is a concern, intravesical instillation of antibiotics might represent an alternative treatment option. In human and veterinary medicine, a number of studies showed intravesical instillation of antibiotics is effective for the therapy multidrug-resistant bacterial urinary tract infection (UTI). This report firstly illustrates successful intravesical meropenem treatment of a UTI caused by multidrug-resistant Escherichia coli with no systemic side effects in dog with chronic kidney disease (CKD).Case: A 15-year-old spayed female Maltese was presented with recurrent bacterial cystitis. The risk factors for the recurrent UTI were spinal cord injury and CKD which had been managed for 1 year. Ultrasound-guided cystocentesis was performed to obtain a urine sample for urinalysis, bacteriologic culture, and antibiotic susceptibility testing. Bacterial cystitis caused by multidrug-resistant Escherichia coli was diagnosed on the basis of bacterial culture, and antimicrobial susceptibility testing. Because the dog had CKD, reducing the clearance of meropenem, intravesical instillation of antibiotics was initiated. The intravesical instillation process consisted of the emptying of the urinary bladder, infusion of a diluted meropenem solution (8.5 mg/kg diluted in 20 mL of saline solution) into the bladder through a urethral catheter, and retention of the meropenem solution in the bladder for 1 h, and its removal. The procedure was repeated every 8 h. On day 8 of the intravesical instillation therapy, Bactereologic culture yielded a growth of E. coli (50,000 CFUs/mL), which was less than previously obtained. the concentration of the meropenem solution being administered was increased to 17 mg/kg diluted in 20 mL of saline solution, to improve the effectiveness of the therapy. After 21 days of the intravesical meropenem instillation, the bacterial cystitis was resolved. One year after completion of the treatment, the dog is still alive without any recurrence of bacterial cystitis. Discussion: Because resistant uropathogens can cause zoonotic infections, effective therapy is important with increasing incidence not only for patients, but also for public health. Intravesical instillation of antibiotics can be an effective treatment method for dogs with urinary tract infection in which oral antibiotics are likely to be ineffective and injectable antibiotics cannot be a treatment option. The antibiotics can be administered directly to the affected location, and systemic side effects can be minimized by the impermeabtility of the bladder wall via intravesical instillation procedure. Meropenem is likely to accumulate in dogs with impaired renal function, leading to systemic side effects and the aggravation of CKD in old dogs. This report describes the successful treatment of multidrug-resistant E. coli infection by intravesical instillation of meropenem without any side effects in dogs with CKD. Therefore, clinician should consider the use of intravesical instillation of antibiotics which predominately excreted in the urine for the control of urinary tract infection caused by multidrug-resistant bacteria in dogs showing reduced renal function. Keywords: canine, intravesical instillation, meropenem, multidrug-resistant organism, urinary tract infection.

Formula for the estimation of urine osmolality in healthy cats

A simple and intuitive formula for the estimation of urine osmolality (Uosm) using the measured concentrations of major active urine osmolytes over a wide range of urine dilutions was proposed in healthy cats. Sixty-three urine samples were retrieved using ultrasound-guided cystocentesis from sixteen healthy cats under 5 years of age receiving intravenous infusion over a period of 24 h. Samples were collected at baseline (T0), T2, T6, T12, and T24. Urine osmolality was measured using a freezing-point osmometer, and the concentrations of osmolytes (urea, sodium, glucose, and potassium) were evaluated. A simple linear regression model for a clinical use was selected, and the agreement between the calculated and actual urine osmolalities was assessed. Urinary concentrations of urea, sodium and glucose were the three variables included in the model with the lowest AICC. Urine osmolality can be predicted accurately and precisely using urine urea, sodium and glucose with the following equation: Uosm = 1.25 × urea (mmol/l) or 20.87 × urea (g/l) + 1.1 × sodium (mmol/l) + 67 × glucose (mmol/l) or 3.72 × glucose (mg/dl). The concordance correlation coefficient for repeated measures between the actual and the calculated urine osmolality was extremely close to 1, which supported a high agreement: 0.996 (CI 95%: [0.993; 0.998]). In a population of healthy cats, urine osmolality can be predicted accurately and precisely using urinary urea, sodium and glucose concentrations. Similar formulae could potentially be established to help the clinician in pathological situations.

Vaginal prolapse complicated with urinary bladder retroflexion and colonic herniation in a dog

A four-year-old, intact, female Anatolian Shepherd dog was presented with a three-day vaginal prolapse and anuria. She was lethargic, dehydrated, tachycardic, and blood analysis showed leukocytosis and azotemia. Ultrasonographic examination demonstrated that the urinary bladder was located in the prolapsed vaginal tissue. Ultrasound-guided cystocentesis was performed to empty the obstructed bladder and intravenous fluid therapy was instituted. When the dog was deemed cardiovascularly stable, a caudal midline celiotomy incision was made. Through gentle retraction of the uterus, the colon descendens and the bladder were placed back to their normal positions. After resolution of the cervical invagination, the cervix was pexied to the abdominal wall to prevent recurrence and ovariohysterectomy was performed. The dog made an uneventful recovery and had normal urination at the one month follow-up. Chronic vaginal prolapse can be complicated by a retroflexed urinary bladder with urethral obstruction leading to life-threatening azotemia. Ultrasonography of the prolapsed tissues contributes greatly to early diagnosis of complicated cases.

Report of urinary bladder rupture following obstructive urolithiasis in rams of Romanov sheep flock

A 4-year old Romanov ram with a history of anorexia, severe depression, and anuria for 4 days was referred to the Veterinary Teaching Hospital of Lorestan University. In the clinical examinations of the ram, no penile protrusion from prepuce, pain, straining; decreased body temperature; and increased heart rate and respiration rate were observed. For further evaluation, the blood sample was taken, and ultrasound of the abdominal area and ultrasound-guided cystocentesis were performed. The results indicated dehydration; leukocytosis; increased serum urea, creatinine, magnesium, and cholesterol; and decreased serum calcium concentrations. The ultra-sonographic findings demonstrated that the bladder was swollen and full of urine, however, without rupture. Despite the treatment, the ram was culled after 5 days and necropsy for investigating macroscopic changes, and tissue sampling was done. Macroscopic examination indicated a fibrinopurulent layer around the right kidney, and jagged stones with various sizes and shapes in the kidney and urinary tract were observed. Microscopic results showed atrophy and degeneration of renal tubules, destruction of tubules and glomeruli, fibrosis of the kidney, and increase in the thickness of the bladder wall.

Culture-Dependent and Sequencing Methods Revealed the Absence of a Bacterial Community Residing in the Urine of Healthy Cats.

A growing number of studies suggest that the lower urinary tract of humans and dogs can harbor a urinary microbiota. Nevertheless, a certain concern has developed that the microbiota reported could be due to unaccounted contamination, especially in low-biomass samples. The aim of this study was to investigate the bacterial community which populates the urine of healthy cats using two approaches: a culture-dependent approach which consisted of the expanded quantitative urine culture (EQUC) techniques capable of identifying live bacteria not growing in standard urine cultures, and a culture-independent approach which consisted of 16S ribosomal RNA next generation sequencing (16S rRNA NGS) capable of identifying bacterial DNA and exploring microbial diversity with high resolution. To avoid confounding factors of possible bacterial contamination, the urine was sampled using ultrasound-guided cystocentesis, and several sample controls and negative controls were analyzed. The urine sampled from the 10 cats included in the study showed no bacterial growth in the EQUC procedure. Although several reads were successfully originated using 16S rRNA NGS, a comparable pattern was observed between urine samples and the negative control, and no taxa were statistically accepted as non-contaminant. Taken together, the results obtained allowed stating that no viable bacteria were present in the urine of healthy cats without lower urinary tract disease and urinary tract infections, and that the bacterial DNA detected was of contaminant origin.

Association between ultrasonographic appearance of urine and urinalysis in dogs and cats.

To evaluate association between ultrasonographic urine echogenicity and sediment examination in dogs and cats. Dogs and cats undergoing ultrasound-guided cystocentesis at a multidisciplinary referral hospital. Ultrasonographic images were stored and reviewed by a single, blinded, board-certified radiologist. Urine appearance was described as "echoic" or "anechoic". Urine sediment was examined for bacteriuria, pyuria, haematuria, crystalluria and urine-specific gravity and then classified as "active" or "inactive." Of the 194 cases included in this study, urine was echoic in 52 and anechoic in 142. Sediment was active in 52 and inactive in 142 samples. Sensitivity and specificity of echoic urine for active sediment were 40% (95% CI: 27 to 55%) and 78% (95% CI: 70 to 85%), respectively. Positive predictive value and negative predictive value of echoic urine for active sediment were 40% (CI 30 to 52%) and 78% (CI 74 to 82%), respectively. If urine-specific gravity was <1.015 urine was always described ultrasonographically as anechoic. Association between sediment analysis and ultrasonographic appearance of urine is poor. Echoic urine had low positive predictive value for active sediment in this study, suggesting that echoic urine alone should not prompt urinary investigations in the absence of other clinical suspicion. Despite a negative predictive value of 78%, urinalysis is still indicated for anechoic urine, especially if urine specific gravity is low.

Complications of ultrasound-guided cystocentesis in companion animals: 21 cases (2005–2016)

Complications of ultrasound-guided cystocentesis in companion animals: 21 cases (2005–2016)

DIAGNOSIS AND SURGICAL TREATMENT OF A TRANSITIONAL CELL CARCINOMA IN THE BLADDER APEX OF A PET RABBIT (ORYCTOLAGUS CUNICULUS)

A 6-year-old, 1.9-kg female spayed lop-eared European rabbit (Oryctolagus cuniculus) was evaluated for acute hematuria and inappropriate urination and defecation of less than 12-hours duration. Abdominal ultrasonography revealed a suspected bladder mass. Ultrasound-guided cystocentesis was performed and the results of the urinalysis were unremarkable. An abdominal exploratory surgery revealed a nodular cystic mass at the cranial ventral apex of the bladder wall which measured 0.5cm × 0.5cm. Based on histopathologic evaluation, excision of the neoplasm was complete and the mass was diagnosed as transitional cell carcinoma of the bladder. This case suggests that urinary bladder transitional cell carcinoma should be considered in pet rabbits presenting with similar clinical signs.

Feline urine metabolomic signature: characterization of low-molecular-weight substances in urine from domestic cats.

Objectives This aim of this study was to characterize the composition and content of the feline urine metabolome. Methods Eight healthy domestic cats were acclimated at least 10 days before starting the study. Urine samples (~2 ml) were collected by ultrasound-guided cystocentesis. Samples were centrifuged at 1000 × g for 8 mins, and the supernatant was analyzed by gas chromatography/time-of-flight mass spectrometery. The urine metabolome was characterized using an untargeted metabolomics approach. Results Three hundred and eighteen metabolites were detected in the urine of the eight cats. These molecules are key components of at least 100 metabolic pathways. Feline urine appears to be dominated by carbohydrates, carbohydrate conjugates, organic acid and derivatives, and amino acids and analogs. The five most abundant molecules were phenaceturic acid, hippuric acid, pseudouridine phosphate and 3-(4-hydroxyphenyl) propionic acid. Conclusions and relevance This study is the first to characterize the feline urine metabolome. The results of this study revealed the presence of multiple low-molecular-weight substances that were not known to be present in feline urine. As expected, the origin of the metabolites detected in urine was diverse, including endogenous compounds and molecules biosynthesized by microbes. Also, the diet seemed to have had a relevant role on the urine metabolome. Further exploration of the urine metabolic phenotype will open a window for discovering unknown, or poorly understood, metabolic pathways. In turn, this will advance our understanding of feline biology and lead to new insights in feline physiology, nutrition and medicine.

Urine Properties of Captive Black-Tailed Prairie Dogs (Cynomys ludovicianus)

A total of 15 healthy captive black-tailed prairie dogs (Cynomys ludovicianus) of both sexes were studied to determine urine properties of this species as part of an overall clinical health evaluation performed under general isoflurane anesthesia. Each animal underwent a complete physical examination, complete blood count, serum biochemistry panel, whole-body radiology, and cardiographic examination. Urine samples were collected via ultrasound-guided cystocentesis. Each urine sample was evaluated biochemically for the presence of glucose, bilirubin, ketones, pH, proteins, hemoglobin, specific gravity, creatinine, and gamma-glutamyl transferase (GGT); macroscopically or microscopically for color, clarity, erythrocytes, leukocytes, casts, epithelial cells, and crystals; and for pathogenic leptospires by polymerase chain reaction testing. Urinary GGT to creatinine and protein to creatinine ratios were also calculated. Cloudy urine was common but not as a result of calciuria as observed in other rodents. The primary urine properties identified in this study are presented (median: minimum to maximum) and include the specific gravity (1.25: 1.005 to 1.059), GGT (883: 12 to 5833U/L), creatinine (6064: 1485 to 15,939µmol/L or 68.6: 16.8 to 180.3mg/dL), protein (19: 6 to 124mg/dL), GGT to creatinine ratio (0.112: 0.008 to 0.606), and protein to creatinine ratio (0.3: 0.2 to 1.0), which was higher in males when compared with females. Urine pH as determined by the urine dipstick was 8 to 8.5. New data presented in this report can promote better physiological understanding and improve clinical management of this rodent species.

Effect of seven-day administration of carprofen or meloxicam on renal function in clinically healthy miniature pigs

Carprofen or meloxicam are nonsteroidal anti-inflammatory drugs (NSAIDs), which may elicit a variety of renal disturbances. Prior to this study, the effects of carprofen or meloxicam on renal function in pigs were unknown. A total of 21 clinically healthy Goettingen miniature pigs (36.9 &amp;plusmn; 7.22 kg) were divided into three groups based on what they were administered &amp;ndash; carprofen, meloxicam or saline. First, blood was collected from the jugular vein and urine by ultrasound-guided cystocentesis. Serum urea (U) and creatinine (CR), fractional clearance of sodium (FCNa), urine gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) activities, urine protein/creatinine ratio (UP/UC), urine gamma-glutamyltransferase/creatinine ratio (GGT/CR) and urine alkaline phosphatase/creatinine ratio (ALP/CR) and urine analysis &amp;ndash; urine specific gravity (USG) and sediment microscopy were assessed before and seven days after daily intramuscular administration (IM) of saline (1.5 ml per animal), carprofen (2 mg/kg) or meloxicam (0.1 mg/kg). All animals had identical housing, feeding and unlimited water intake and had not undergone surgery or been administered any medication for three months prior to this. All pigs served as control groups for an experimental study of fracture healing using transplantation of mesenchymal stem cells and scaffolds. The data were analyzed using a one way ANOVA and a Mann-Whitney test (P &amp;lt; 0.05). In pigs receiving carprofen, serum urea and creatinine were significantly decreased, compared to the control (P &amp;lt; 0.01) or meloxicam (P &amp;lt; 0.05) groups. In animals receiving meloxicam FCNa was significantly increased (P &amp;lt; 0.05) and urine specific gravity significantly decrease (P &amp;lt; 0.05) compared to the pretreatment values. Two carprofen-treated pigs had a slight increase in renal tubular epithelial cells upon urine sediment examination. Intramuscular administration of carprofen or meloxicam in healthy miniature pigs for seven days causes no clinically important changes in selected renal parameters (without azotemia). However these changes indicate mild damage of renal tubules. Despite these findings, meloxicam or carprofen are recommended for analgesia in healthy pigs.

Use of Walpole's solution for treatment of goats with urolithiasis: 25 cases (2001–2006)

To determine results of ultrasound-guided cystocentesis and percutaneous infusion of Walpole's solution for treatment of male goats with urolithiasis. Retrospective case series. 25 male goats with urolithiasis treated with Walpole's solution. Information obtained from the medical records included signalment, degree of urethral obstruction (partial vs complete), pertinent examination findings, concurrent illnesses, diet, other treatments administered, duration of hospitalization, whether the obstruction resolved, and outcome (ie, discharged vs euthanized). 14 (58%) animals had complete urethral obstruction, and 10 (42%) had partial obstruction (degree of urethral patency was not recorded in 1 animal). Walpole's solution was infused once in 18 (72%) animals, twice in 6 (24%) animals, and 3 times in 1 (4%) animal. The amount of Walpole's solution required to achieve the target urine pH of 4 to 5 ranged from 50 to 250 mL. In 20 (80%) goats, the urethral obstruction resolved, and the goat was discharged. The remaining 5 (20%) goats were euthanized because of unresolved urethral obstruction. Six of the 20 (30%) goats that were discharged were reexamined because of recurrence of urethral obstruction. Results suggested that ultrasound-guided cystocentesis in combination with percutaneous infusion of Walpole's solution may be a useful treatment in male goats with obstructive urolithiasis.