Table Of ContentBSAVA Manual of Canine and Feline
BSAVA Manual of
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Nephrology and Urology B s.i
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S o Canine and Feline
Third edition A B
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Edited by Jonathan Elliott, Gregory F. Grauer and Jodi L. Westropp
M Nephrology
This third edition of the BSAVA Manual of Canine and Feline Nephrology and Urology a
covers common presenting clinical and laboratory problems, therapeutic techniques, n
and the clinical management of important disease syndromes in this area. A new suite of u
chapters considers the effects of systemic diseases that complicate the diagnosis and/or a
management of kidney disease, including cardiovascular–renal syndrome, hypertension l and Urology
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and hyperthyroidism.
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New chapters include early detection of chronic kidney disease, assessment of calcium C
and phosphate homeostasis in chronic kidney disease, and the genetic basis for urinary a
tract diseases. Chapters from the previous edition have been updated to reflect current n
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consensus. Case examples, comprehensive reference tables and flowcharts are included n
third edition
for ease of reference. e
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CONTENTS: Stranguria and haematuria; Polyuria and polydipsia; Urinary incontinence and urine
retention; Abnormal renal palpation; Proteinuria; Complete urinalysis; Diagnostic imaging of the urinary F
tract; Cystoscopy; Diagnostic approach to the incontinent patient; Early detection of chronic kidney e
l
disease; Assessment of calcium and phosphate homeostasis in chronic kidney disease; Diagnostic i
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algorithms for grading acute kidney injury and staging the chronic kidney disease patient; Renal
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biopsy; Genetic basis for urinary tract diseases; Measurement of blood pressure; Cardiovascular–
renal disorders; Hyperthyroidism and the feline kidney; Hypertension and the kidney; Effects of other N
endocrine diseases on kidney function; Effects of non-steroidal anti-inflammatory drug treatment on e
the kidney; Acute kidney injury; Haemodialysis and peritoneal dialysis; Management of chronic kidney p
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disease; Management of glomerulopathies; Management of prostatic disease; Medical management
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of urolithiasis; Non-medical management of urolithiasis; Management of non-obstructive idiopathic/
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interstitial cystitis in cats; Urinary tract infections; Medical and surgical management of urinary l
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incontinence; Index
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Jonathan Elliott MA VetMB PhD CertSAC DipECVPT FHEA MRCVS n
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Jonathan is Professor in Veterinary Clinical Pharmacology and Vice
Principal for Research and Innovation at the Royal Veterinary College. A U
Cambridge University graduate, he completed an internship at the University r
of Pennsylvania and a PhD in vascular biology before joining the RVC in o
1990 where he developed research interests in feline kidney disease and lo
hypertension. Jonathan is a board member of the International Renal Interest g
Society, has served as a member of the Veterinary Products Committee y
(2001–2009) and is Junior Vice President of the European College of ,
Veterinary Pharmacology and Toxicology. t
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Gregory F. Grauer DVM MS DipACVIM (Small Animal Internal Medicine) d
Greg received his DVM degree from Iowa State University in 1978, going on
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to complete his postgraduate training at Colorado State University. Greg
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obtained his specialty board certification in Internal Medicine in 1983. Greg
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worked at the University of Wisconsin for 7 years and then returned to t
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Colorado State University, where he served as Professor and Section Chief of o
Small Animal Medicine until 2000. Currently, Greg is a Professor and the Jarvis n
Chair of Small Animal Internal Medicine at Kansas State University. His areas
of clinical and research interest involve the small animal urinary system.
Jodi L. Westropp DVM PhD DipACVIM
Jodi Westropp is the director of the G.V. Ling Urinary Stone Analysis
Laboratory. She graduated from Ohio State University in 1997 before
moving to New York City for an internship at the Animal Medical
Center, later returning to Ohio for her internal medicine residency Edited by
and PhD. She is currently an Associate Professor in the Department
Jonathan Elliott, Gregory F. Grauer
of Medicine and Epidemio logy at the University of California, Davis.
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3700 Nephrology 3e Cover SPREAD.indd 1 Covers Placed.indd 1 0212//0088//22001177 1009::2397
BSAVA Manual of
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Nephrology and Urology
third edition
Editors:
Jonathan Elliott
MA VetMB PhD CertSAC DipECVPT FHEA MRCVS
Comparative Biomedical Sciences,
The Royal Veterinary College,
Royal College Street, London NW1 0TU, UK
Gregory F. Grauer
DVM MS DipACVIM (Small Animal Internal Medicine)
College of Veterinary Medicine,
Kansas State University,
Manhattan, KS 66506, USA
Jodi L. Westropp
DVM PhD DipACVIM
UC Davis School of Veterinary Medicine,
One Shields Avenue, Davis, CA 95616, USA
Published by:
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way,
Waterwells Business Park, Quedgeley,
Gloucester GL2 2AB
A Company Limited by Guarantee in England
Registered Company No. 2837793
Registered as a Charity
Copyright © 2017 BSAVA
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in form or by any means, electronic, mechanical, photocopying, recording or
otherwise without prior written permission of the copyright holder.
Figures 2.1, 5.1, 11.1, 11.3, 13.12a, 25.1, 25.2, 25.9 and 25.11 were drawn by
S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
A catalogue record for this book is available from the British Library.
ISBN 978 1 905319 94 7
e-ISBN 978 1 910443 35 4
The publishers, editors and contributors cannot take responsibility for information provided on
dosages and methods of application of drugs mentioned or referred to in this publication.
Details of this kind must be verified in each case by individual users from up to date literature
published by the manufacturers or suppliers of those drugs. Veterinary surgeons are reminded
that in each case they must follow all appropriate national legislation and regulations (for
example, in the United Kingdom, the prescribing cascade) from time to time in force.
Printed by Cambrian Printers, Aberystwyth, UK
Printed on ECF paper made from sustainable forests 3700PUBS17
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Titles in the BSAVA Manuals series
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Manual of Avian Practice: A Foundation Manual
Manual of Canine & Feline Abdominal Imaging
Manual of Canine & Feline Abdominal Surgery
Manual of Canine & Feline Advanced Veterinary Nursing
Manual of Canine & Feline Anaesthesia and Analgesia
Manual of Canine & Feline Behavioural Medicine
Manual of Canine & Feline Cardiorespiratory Medicine
Manual of Canine & Feline Clinical Pathology
Manual of Canine & Feline Dentistry
Manual of Canine & Feline Dermatology
Manual of Canine & Feline Emergency and Critical Care
Manual of Canine & Feline Endocrinology
Manual of Canine & Feline Endoscopy and Endosurgery
Manual of Canine & Feline Fracture Repair and Management
Manual of Canine & Feline Gastroenterology
Manual of Canine & Feline Haematology and Transfusion Medicine
Manual of Canine & Feline Head, Neck and Thoracic Surgery
Manual of Canine & Feline Musculoskeletal Disorders
Manual of Canine & Feline Musculoskeletal Imaging
Manual of Canine & Feline Nephrology and Urology
Manual of Canine & Feline Neurology
Manual of Canine & Feline Oncology
Manual of Canine & Feline Ophthalmology
Manual of Canine & Feline Radiography and Radiology: A Foundation Manual
Manual of Canine & Feline Rehabilitation, Supportive and Palliative Care:
Case Studies in Patient Management
Manual of Canine & Feline Reproduction and Neonatology
Manual of Canine & Feline Surgical Principles: A Foundation Manual
Manual of Canine & Feline Thoracic Imaging
Manual of Canine & Feline Ultrasonography
Manual of Canine & Feline Wound Management and Reconstruction
Manual of Canine Practice: A Foundation Manual
Manual of Exotic Pet and Wildlife Nursing
Manual of Exotic Pets: A Foundation Manual
Manual of Feline Practice: A Foundation Manual
Manual of Ornamental Fish
Manual of Practical Animal Care
Manual of Practical Veterinary Nursing
Manual of Psittacine Birds
Manual of Rabbit Medicine
Manual of Rabbit Surgery, Dentistry and Imaging
Manual of Raptors, Pigeons and Passerine Birds
Manual of Reptiles
Manual of Rodents and Ferrets
Manual of Small Animal Practice Management and Development
Manual of Wildlife Casualties
For further information on these and all BSAVA publications, please visit our website: www.bsava.com
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Contents
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List of contributors v
Foreword vii
Preface viii
Stranguria and haematuria 1
1
Mary Thompson and A. David J. Watson
Polyuria and polydipsia 8
2
Rosanne Jepson
Urinary incontinence and urine retention 24
3
Julie R. Fischer and India F. Lane
Abnormal renal palpation 37
4
Alexander J. German
Proteinuria 50
5
Xavier Roura, Jonathan Elliott and Gregory F. Grauer
Complete urinalysis 60
6
Rick Alleman and Heather Wamsley
Diagnostic imaging of the urinary tract 84
7
Rachel E. Pollard and Kathryn L. Phillips
Cystoscopy 116
8
Larry Adams
Diagnostic approach to the incontinent patient 122
9
Julie Byron
Early detection of chronic kidney disease 130
10
Natalie Finch and Reidun Heiene
Assessment of calcium and phosphate homeostasis in chronic kidney disease 143
11
Rebecca Geddes and Jonathan Elliott
Diagnostic algorithms for grading acute kidney injury and staging 151
12
the chronic kidney disease patient
Jonathan Elliott and Larry D. Cowgill
Renal biopsy 161
13
Shelly L. Vaden and Cathy Brown
Genetic basis for urinary tract diseases 172
14
Meryl P. Littman
Measurement of blood pressure 185
15
Gilad Segev
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Cardiovascular–renal disorders 196
16
Shelly L. Vaden, Clarke Atkins and Mark A. Oyama
Hyperthyroidism and the feline kidney 205
17
Tim Williams
Hypertension and the kidney 216
18
Amanda E. Coleman and Scott A. Brown
Effects of other endocrine diseases on kidney function 224
19
David J. Polzin
Effects of non-steroidal anti-inflammatory drug treatment on the kidney 232
20
Ludovic Pelligand and Jonathan Elliott
Acute kidney injury 246
21
Sarah Crilly Guess and Gregory F. Grauer
Haemodialysis and peritoneal dialysis 254
22
Sheri Ross and Cathy Langston
Management of chronic kidney disease 263
23
Rosanne Jepson and Harriet Syme
Management of glomerulopathies 278
24
David J. Polzin and Larry D. Cowgill
Management of prostatic disease 291
25
Autumn P. Davidson
Medical management of urolithiasis 304
26
Jodi L. Westropp and Jody Lulich
Non-medical management of urolithiasis 311
27
William T. N. Culp and Carrie A. Palm
Management of non-obstructive idiopathic/interstitial cystitis in cats 317
28
Tony Buffington and Dennis J. Chew
Urinary tract infections 328
29
Joe Bartges and Shelly Olin
Medical and surgical management of urinary incontinence 338
30
Allyson Berent and Philipp Mayhew
Appendix 1
1 Conversion tables 353
Index 354
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Contributors
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Larry Adams Amanda E. Coleman
DVM PhD DVM DipACVIM (Cardiology)
Department of Veterinary Clinical Sciences, Department of Small Animal Medicine and Surgery,
Purdue University, 625 Harrison Street, College of Veterinary Medicine, The University of
West Lafayette, IN 47907, USA Georgia, Athens, GA 30602, USA
Rick Alleman Larry D. Cowgill
DVM PhD DipACBVP DipACVP DVM PhD DipACVIM
Lighthouse Veterinary Consultants, UC Davis School of Veterinary Medicine,
13337 NW 172nd Avenue, Alachua, FL 32615, USA One Shields Avenue, Davis, CA 95616, USA
Clarke Atkins William T. N. Culp
DVM DipACVIM VMD DipACVS
Department of Clinical Sciences, UC Davis School of Veterinary Medicine,
College of Veterinary Medicine, North Carolina One Shields Avenue, Davis, CA 95616, USA
State University, 1060 William Moore Drive,
Autumn P. Davidson
Raleigh, NC 27607, USA
DVM MS DipACVIM
Joe Bartges UC Davis School of Veterinary Medicine,
One Shields Avenue, Davis, CA 95616, USA
DVM PhD DipACVIM DipACVN
Department of Small Animal Medicine and Surgery,
Jonathan Elliott
College of Veterinary Medicine, The University of
MA VetMB PhD CertSAC DipECVPT FHEA MRCVS
Georgia, Athens, GA 30602, USA
Comparative Biomedical Sciences,
The Royal Veterinary College, Royal College Street,
Allyson Berent
London NW1 0TU, UK
DVM DipACVIM
Animal Medical Center,
Natalie Finch
510 East 62nd Street, New York, NY 10065, USA
BVSc PhD DipECVIM-CA MRCVS
School of Clinical Sciences and School of Veterinary
Cathy Brown
Sciences, University of Bristol, Whitson Street,
VMD PhD DipACVP
Bristol BS1 3NY, UK
Department of Pathology,
College of Veterinary Medicine, The University of
Julie R. Fischer
Georgia, Athens, GA 30602, USA
DVM DipACVIM (Small Animal Internal Medicine)
Veterinary Specialty Hospital,
Scott A. Brown
10435 Sorrento Valley Road, San Diego, CA 92121, USA
VMD PhD DipACVIM (Small Animal Internal Medicine)
Departments of Physiology & Pharmacology and Rebecca Geddes
Small Animal Medicine & Surgery, College of
MA VetMB GPCert(FelP) PhD MRCVS
Veterinary Medicine, The University of Georgia, Queen Mother Hospital for Animals,
Athens, GA 30602, USA The Royal Veterinary College, Hawkshead Lane,
North Mymms, Hatfield (cid:40)(cid:51)9 7(cid:59)(cid:40), U(cid:50)
Tony Buffington
DVM PhD DipACVN Alexander J. German
California, USA
BVSc(Hons) PhD CertSAM DipECVIM-CA MRCVS
Institute of Veterinary Science,
Julie Byron
University of Liverpool, Leahurst Campus,
DVM MS DipACVIM
Chester High Road, Neston CH64 7TE, UK
Department of Veterinary Clinical Sciences,
College of Veterinary Medicine, The Ohio State Gregory F. Grauer
University, 601 Vernon L. Tharp Street, Columbus, DVM MS DipACVIM (Small Animal Internal Medicine)
OH 43210, USA College of Veterinary Medicine,
Kansas State University, Manhattan, KS 66506, USA
Dennis J. Chew
DVM DipACVIM Sarah Crilly Guess
Department of Veterinary Clinical Sciences, DVM MS
College of Veterinary Medicine, The Ohio State Columbia River Veterinary Specialists,
University, 601 Vernon L. Tharp Street, 6607 NE 84th Street, Suite 109, Vancouver,
Columbus, OH 43210, USA WA 98665, Canada
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Reidun Heiene Rachel E. Pollard
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s.i DVM PhD MRCVS DVM PhD DipACVR
ok Oslo, Norway UC Davis School of Veterinary Medicine,
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B One Shields Avenue, Davis, CA 95616, USA
et Rosanne Jepson
V BVSc MVetMed PhD DipACVIM DipECVIM MRCVS David J. Polzin
Queen Mother Hospital for Animals, DVM PhD DipACVIM (Small Animal Internal Medicine)
The Royal Veterinary College, Hawkshead Lane, Department of Veterinary Clinical Sciences,
North Mymms, Hatfield (cid:40)(cid:51)9 7(cid:59)(cid:40), U(cid:50) College of Veterinary Medicine, University of Minnesota,
1352 Boyd Avenue, St Paul, MN 55108, USA
India F. Lane
DVM MS EdD DipACVIM (Small Animal Internal Medicine) Sheri Ross
(cid:40)cademic (cid:40)ffairs and Student Success, DVM PhD DipACVIM
The University of Tennessee, 823 Andy Holt Tower, UC Veterinary Medical Center - San Diego,
Knoxville, TN 37996, USA 10435 Sorrento Valley Road, Suite 101,
San Diego, CA 92121, USA
Cathy Langston
DVM DipACVIM Xavier Roura
Department of Veterinary Clinical Sciences, DVM PhD DipECVIM-CA
College of Veterinary Medicine, The Ohio State Hospital Clinic Veterinari,
University, 601 Vernon L. Tharp Street, Columbus, Universitat Autònoma de Barcelona,
OH 43210, USA 08193 Bellaterra (Cerdanyola del Vallès), Spain
Meryl P. Littman Gilad Segev
VMD DipACVIM DipECVIM-CA (Internal Medicine)
School of Veterinary Medicine, Koret School of Veterinary Medicine,
University of Pennsylvania, 3900 Delancey Street, The Hebrew University of Jerusalem,
PA 19104, USA PO Box 12, Rehovot 76100, Israel
Jody Lulich Harriet Syme
DVM PhD DipACVIM BSc BVetMed PhD FHEA DipACVIM DipECVIM MRCVS
Department of Veterinary Clinical Sciences, Small Animal Medicine and Surgery Group,
College of Veterinary Medicine, University of Minnesota, The Royal Veterinary College, Hawkshead Lane,
1352 Boyd Avenue, St Paul, MN 55108, USA North Mymms, Hatfield (cid:40)(cid:51)9 7(cid:59)(cid:40), U(cid:50)
Philipp D. Mayhew Mary Thompson
BVM&S DipACVS BVSc(Hons) PhD DipACVIM MANZCVS
UC Davis School of Veterinary Medicine, School of Veterinary and Life Sciences,
One Shields Avenue, Davis, CA 95616, USA College of Veterinary Medicine,
South Street Campus, 90 South Street,
Shelly Olin
Murdoch 6150, Western Australia, Australia
DVM, DipACVIM (Small Animal Internal Medicine)
Veterinary Medical Center, Shelly L. Vaden
The University of Tennessee, 2407 River Drive, DVM PhD DipACVIM
Knoxville, TN 37996, USA Department of Clinical Sciences,
College of Veterinary Medicine,
Mark A. Oyama
North Carolina State University, 1060 William Moore
DVM MSCE DipACVIM Drive, Raleigh, NC 27607, USA
Department of Clinical Studies, School of Veterinary
Medicine and Ryan Veterinary Hospital, University of Heather L. Wamsley
Pennsylvania, 3900 Spruce Street, PA 19104, USA BS DVM PhD DipACVP (Clinical)
ANTECH Diagnostics, Tampa, FL 32614, USA
Carrie A. Palm
DVM DipACVIM A. David J. Watson
UC Davis School of Veterinary Medicine, BVSc PhD FAAVPT MACVSc DipECVPT FRCVS
One Shields Avenue, Davis, CA 95616, USA Sydney, Australia
Ludovic Pelligand
DocMedVet CertVA DipECVAA DipECVPT PhD MRCVS Jodi L. Westropp
Queen Mother Hospital for Animals, DVM PhD DipACVIM
The Royal Veterinary College, Hawkshead Lane, UC Davis School of Veterinary Medicine,
North Mymms, Hatfield (cid:40)(cid:51)9 7(cid:59)(cid:40), U(cid:50) One Shields Avenue, Davis, CA 95616, USA
Kathryn L. Phillips Tim Williams
DVM MA VetMB PhD FRCPath DipECVCP MRCVS
Department of Molecular Biomedical Sciences, Department of Veterinary Medicine,
College of Veterinary Medicine, North Carolina State University of Cambridge, Madingley Road,
University, Raleigh, NC 27607, USA Cambridge CB3 0ES, UK
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Foreword
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This is the third edition of the BSAVA Manual of Canine and Feline Nephrology and Urology,
and it has been a full decade since the publication of the previous edition. Readers will,
therefore, soon discover that whilst the arrangement and layout of the manual are similar, this
is a radically different book to the previous edition, reflecting the enormous advances in this
field over the last 10 years.
Chapters on imaging and diagnostic techniques are interspersed between chapters
describing clinical presentations and others covering clinical syndromes. The manual has
been designed as a practical and usable guide for busy practitioners and one that, I am sure,
will find everyday use in small animal practice.
The editors, Jonathan Elliott, Gregory Grauer and Jodi Westropp, have put together a world
class team of authors, and the quality of the BSAVA Manual of Canine and Feline Nephrology
and Urology is provided by the breadth and depth of knowledge of both the authors and
editors, and their ability to effectively communicate this knowledge to the reader. I would like
to congratulate the editors and authors on producing this new edition that, I am sure, will
prove to be as useful and enduring as its predecessors. On behalf of practitioners, thank you!
John Chitty
BVetMed CertZooMed MRCVS
BSAVA President 2017–2018
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Preface
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It is 10 years since the publication of the second edition of the BSAVA Manual of Canine and Feline
Nephrology and Urology. For this third edition, a new scientific editor has joined the editorial team, bringing
deeper insight into lower urinary tract disorders in particular. New technologies are clearly influencing our
ability to understand, diagnose and treat urinary tract disorders in dogs and cats, and are reflected in the
additions made to this new edition.
The third edition follows the successful format of the first two manuals with sections on presenting problems,
diagnostic and therapeutic techniques, and management of specific problems. A series of new chapters has
been added explaining how other systemic diseases (or drug treatments) affect the kidney, influencing
diagnostic tests or contributing to kidney damage. We hope these will aid practitioners in considering the
kidney when tackling cardiovascular and endocrine disorders and when treating osteoarthritis.
A fresh look has been taken at many of the tried and tested chapters by inviting new authors to provide their
perspectives on these familiar topics. The number of clinical experts from Europe and the United States who
are actively publishing original clinical research papers in nephrology and urology has grown in recent years,
so we have had no difficulty in identifying new truly international experts as authors.
There are some exciting new developments in urinary diseases included in this new edition. For example, rapid
advances in molecular genetics mean that the genomic basis of many more inherited diseases of the urinary
tract are now known with genetic tests available. The International Renal Interest Society’s (IRIS) grading
system for acute kidney injury (AKI) is a novel framework for veterinary medicine that should enable
practitioners to pick up cases of AKI early and so manage these more successfully, particularly if the field of
urinary biomarkers advances over the next 10 years, as it has the potential to do. Early diagnostics for chronic
kidney disease (CKD) are also under development, including symmetric dimethylarginine (SDMA) which was
launched commercially in 2015. Experience of using this marker alongside creatinine is in its infancy – time will
tell what SDMA beings, but the initial data look promising. The discovery of the role of FGF-23 in mineral and
bone disorders associated with CKD and its prognostic value in the CKD patient is an exciting advance in
knowledge, the application of which will become apparent in the next decade.
The work of the WSAVA Renal Pathology Group has made significant advances in our knowledge of canine
glomerular disease pathology and this stimulated a series of consensus papers written by groups of experts
coordinated by IRIS reviewing the evidence-base treatment of glomerular disease in dogs. These
recommendations are summarized in the manual. In future years we expect further research to provide the
evidence on which to use biopsy results to further define the most appropriate approach to treatment.
Diagnosing and managing various lower urinary tract disorders in companion animals has evolved immensely
over the past 10 years, particularly with the advances in minimally invasive procedures. For example, the use
of laser ablation for the correction of ectopic ureters in dogs has meant far fewer surgical procedures for this
anomaly. Minimally invasive stone removal was one of the highlights discussed in the ACVIM Consensus
Statement for Recommendations on the Treatment and Prevention on Uroliths in Dogs and Cats in 2016, and
many of these recommendations are discussed in the manual, including voiding urohydropropulsion,
holmium:YAG laser lithotripsy and percutaneous cystolithotomy. With the advent of ureteral stents and
subcutaneous ureteral bypass procedures, we now have alternative and often better ways to manage
obstructive kidney disease in cats and dogs, and details are provided in this new edition. The most recent
medical management strategies for urolithiasis prevention are also provided in a dedicated chapter. Finally,
this edition provides a comprehensive overview as well as various updates on other aspects of lower urinary
tract disorders, which make these sections a valuable resource for students and practitioners, as well as
various veterinary specialists.
Editing a manual of this size is a hugely enjoyable if time-consuming task as one learns so much in the
process. This task has been made as easy as it could be by the efficient editorial team at BSAVA, who have
supported us so effectively throughout the process. We hope the end result will be a useful addition to your
practice library.
Jonathan Elliott, Gregory F. Grauer and Jodi L. Westropp
June 2017
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Stranguria and haematuria
Mary Thompson and A. David J. Watson
Stranguria and haematuria can occur concurrently in dogs such as polyuria/polydipsia (PU/PD), dyschezia (difficulty
and cats but may be seen separately as signs of disease. in defecating), urinary incontinence, and behavioural causes
of inappropriate urination. It is also important to note the
• Stranguria is defined as difficulty in micturition. bladder size of the patient, because an animal that presents
• Haematuria denotes the presence of blood in the with stranguria and a large bladder may have a urethral
urine. obstruction, which may constitute a medical emergency.
Stranguric animals usually adopt the typical urinating • Animals with PU/PD should pass large volumes when
posture but show obvious effort or difficulty while attemp- urinating, and drinking is increased (see Chapter 2).
ting to pass urine and may appear distressed. If urine is • An animal with urinary incontinence caused by urethral
passed, the flow may be weak, attenuated or intermittent. sphincter mechanism incompetence may void small
If little or no urine is passed, either because the bladder amounts of urine frequently but would not typically
is nearly empty or the excretory pathway is obstructed, appear to be in pain and, by definition, is not aware that
stranguria may continue for some time, with the animal urine is being passed.
shifting position repeatedly between attempts. • A pet urinating in inappropriate places or at unusual
Whether occurring separately or together, these signs times might be described as ‘incontinent’ by the owner
are often associated with two other abnormalities: when the problem could be attributed to stranguria and
pollakiuria.
• Dysuria suggests pain upon urination, which can be • Behavioural urination typically occurs in locations
difficult to ascertain in some animals outside of what is considered normal/acceptable.
• Pollakiuria is defined as the abnormally frequent
passage of small amounts of urine. Confirmation may require the veterinary surgeon (vet-
erinarian) or nurse/technician to observe the animal’s
When pollakiuria is present, a small volume of urine is behaviour during the process of urination and this can be
passed each time the animal urinates. This pattern must be extremely useful. The importance of spending the time in
distinguished from polyuria, which refers to an increase taking a thorough history from the owner also cannot be
in daily urine volume. With polyuria, the animal will also overemphasized in terms of confirming the true nature of
urinate more frequently than usual, but a large volume is the problem or problems (some animals will present with
passed each time, and the urine is usually dilute (low more than one of the above clinical signs) (Figure 1.1).
specific gravity). Once the clinician is comfortable that stranguria is
Stranguria generally results from disorders of the lower the problem, they can use the information gained on the
urinary tract (bladder or urethra), the genital tract (prostate frequency of urination, volume passed, and location of
or vagina) or both. Haematuria can be more difficult to urin ation to gain further insight into potential causes
localize because bleeding may occur anywhere in the of stranguria and other signs that may be present.
urinary tract, from the kidneys to the urethral meatus, as
well as from the prostate, penis or prepuce in the male,
and from the uterus, vagina or vulva in the female. When • Is the volume of urine passed small or large?
• What is the frequency of urination?
haematuria and stranguria occur together, lower urinary
• Is the animal urinating in inappropriate places?
tract disease or a genital lesion is most likely to be present.
• Is there excessive straining or apparent discomfort?
• Is the stream interrupted, attenuated or weak?
• Is the urine cloudy, discoloured or malodorous?
• Is the animal licking its penis or vulva?
Stranguria (cid:182) defining the
• Does the animal appear aware that urine is being passed?
• What is the drinking behaviour of the animal?
problem
• How long have the signs been apparent?
• Have there been any previous episodes?
If stranguria is suspected on the basis of the history pro- • Has there been any previous treatment? If so, how did the animal
vided by the owners, it is important to confirm that this respond?
is indeed the problem with key questions to distinguish Important history questions to ask about a patient with
1.1
stranguria from other problems that may confuse owners (cid:149)(cid:151)(cid:149)(cid:146)(cid:135)(cid:133)(cid:150)(cid:135)(cid:134)(cid:3)(cid:145)(cid:148)(cid:3)(cid:133)(cid:145)(cid:144)(cid:420)(cid:148)(cid:143)(cid:135)(cid:134)(cid:3)(cid:149)(cid:150)(cid:148)(cid:131)(cid:144)(cid:137)(cid:151)(cid:148)(cid:139)(cid:131)(cid:484)
BSAVA Manual of Canine and Feline Nephrology and Urology, third edition. Edited by Jonathan Elliott, Gregory F. Grauer and Jodi L. Westropp. ©BSAVA 2017 1
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