Functional anatomy and neural regulation of the lower urinary tract in female dogs: A review

Summary

A review of the literature of the functional anatomy and neural regulation of the lower urinary tract is presented. The two main functions of the lower urinary tract are the storage and the periodic elimination of urine. The smooth muscle of the bladder exhibits intermittent contractions as the bladder adapts its capacity to increasing volumes and it exhibits sustained contractions associated with relaxation of the external sphincter to effect micturition. During storage, tension receptors in the bladder wall initiate external sphincter contraction (somatic), internal sphincter contraction (sympathetic), detrusor inhibition, and parasympathetic ganglion inhibition (sympathetic). The storage phase can be switched to the micturition phase either voluntarily or involuntarily. Neuroanatomical and electrophysiological studies reveal that medial and lateral cell groups in the dorsolateral pons may be regarded as micturition and storage control centres, respectively.     

Functional anatomy and neural regulation of the lower urinary tract in female dogs: a review.

A review of the literature of the functional anatomy and neural regulation of the lower urinary tract is presented. The two main functions of the lower urinary tract are the storage and the periodic elimination of urine. The smooth muscle of the bladder exhibits intermittent contractions as the bladder adapts its capacity to increasing volumes and it exhibits sustained contractions associated with relaxation of the external sphincter to effect micturition. During storage, tension receptors in the bladder wall initiate external sphincter contraction (somatic), internal sphincter contraction (sympathetic), detrusor inhibition, and parasympathetic ganglion inhibition (sympathetic). The storage phase can be switched to the micturition phase either voluntarily or involuntarily. Neuroanatomical and electrophysiological studies reveal that medial and lateral cell groups in the dorsolateral pons may be regarded as micturition and storage control centres, respectively.     

Medical management of male and female cats with nonobstructive lower urinary tract disease

This case is typical of recurrent urolithiasis managed by repeated surgery. Retrospective assessment of the disorder indicates the need for quantitative analyses of uroliths removed by cystotomy. Compliance of the owners with recommendations to minimize recurrent urolithiasis might have been beneficial. Results of medical therapy designed to induce dissolution of uroliths in this case are representative of preliminary findings of medical dissolution of naturally occurring struvite uroliths in ten other cats. It is of interest that the uroliths dissolved even though no effort was made to induce diuresis. The underlying cause of UTI in this patient may have been damage to the lower urinary tract induced by previous diagnostic and therapeutic procedures and/or sterile struvite uroliths that compromised local host defense mechanisms. Lack of urease production by the uropathogens suggests that they did not play a causative role in formation of uroliths. The need for preventative therapy of recurrent formation of uroliths after their medical dissolution is worthy of further comment. In this patient, specific measures to prevent urolith recurrence were not initiated because it is a part of a prospective clinical study. In the event uroliths recur, medical therapy designed to induce dissolution of uroliths would be repeated. Need for long-term preventative therapy would be dependent on the time interval between recurrent episodes (weeks, months, or years), and the effectiveness of medical therapy for urolith dissolution. Long-term prophylactic therapy would include urine acidifiers and diets low in magnesium.     

Uroendoscopy. Evaluation of the lower urinary tract.

Recent advances in uroendoscopy have allowed diagnostic evaluation of the lower urinary tract in most of our canine and feline patients. By providing a magnified view of the luminal surfaces of the lower urinary tract, uroendoscopy provides useful diagnostic information that is not readily available even by more invasive techniques.     

Nutrition and aspects of feline lower urinary tract disease

Important causes of feline lower urinary tract disease (LUTD) that have been identified include urolithiasis and the formation of urethral plugs. In many cases, however, no specific cause of disease may be evident. Clinical studies in cats with apparently ‘idiopathic’ feline LUTD have suggested that some cases may respond to dietary modification, with diets designed to acidify urine, provide a good urine volume and relatively restricted magnesium intake. Nutritional research has predominantly focused on factors that may contribute to the formation of struvite uroliths, and has resulted in the development of specific recommendations for the management and subsequent prevention of recurrence of this condition. Urethral plugs have been less well studied, although recent clinical observations provide evidence that dietary modification may be of value in preventing their recurrence.     

Idiopathic cystitis in domestic cats--beyond the lower urinary tract

Signs of lower urinary tract (LUT) disease in domestic cats can be acute or chronic, and can result from variable combinations of abnormalities within the lumen of the LUT, the parenchyma of the LUT itself, or other organ system(s) that then lead to LUT dysfunction. In the majority of cats with chronic signs of LUT dysfunction, no specific underlying cause can be confirmed after standard clinical evaluation of the LUT, so these cats typically are classified as having idiopathic cystitis. A syndrome in human beings commonly known as interstitial cystitis (IC) shares many features in common with these cats, permitting comparisons between the two species. A wide range of similarities in abnormalities has been identified between these syndromes outside as well as inside the LUT. A variety of potential familial and developmental risk factors also have been identified. These results have permitted generation of the hypothesis that some of these people have a disorder affecting the LUT rather than a disorder of the LUT. This perspective has suggested alternative diagnostic strategies and novel approaches to treatment, at least in cats. The purpose of this review is to summarize research investigations into the various abnormalities present in cats, to compare some of these findings with those identified in human beings, and to discuss how they might modify perceptions about the etiopathogenesis, diagnosis, and treatment of cats with this disease. Dedication: I dedicate this contribution to Professor Dennis J. Chew, whose collaboration, patience, and support made it all possible.     

Elucidating the risk factors of feline lower urinary tract disease

A questionnaire-based case-control study investigating the association of a range of host-related, owner-related and environmental risk factors with feline lower urinary tract disease was conducted in New Zealand over a 2-year period from 1991 to 1993. The study was subsequently extended in two ways, to examine the influence of the use of litter trays and to correlate weather records with the appearance of the disease in one particular region of the country. A range of statistical techniques was employed to analyse the data, including univariate odds ratio and chi-squared calculations, time series analysis, Poisson regression and conditional and unconditional logistic regression. Variables that were positively associated with lower urinary tract disease included low activity levels, the use of a litter tray coupled with restriction indoors, a high number of rainfall days in the month preceding the appearance of clinical signs, stress factors such as moving house within the last 3 months or the presence of more than one cat in the household, and a diet high in dry cat food. There was some indication that high levels of fluid consumption reduced the effect of a diet high in dry cat food. Other variables that appeared to have some protective effects included a routine visit to the veterinarian in the last 12 months and the use of alternative food sources such as rodents and birds.     

Nutrition and lower urinary tract disease in cats.

Lower urinary tract disease occurs commonly in cats and is often associated with crystal-related disease. Dietary modification is beneficial in managing some of these diseases, including idiopathic cystitis, urolithiasis, and urethral matrix-crystalline plugs. Altering dietary formulation may result in decreasing urinary concentrations of crystallogenic compounds, increasing urinary concentrations fo crystallogenic inhibitors, and diluting urine composition.     

Evidence-based management of feline lower urinary tract disease.

Many treatments have been recommended for managing cats with feline urinary tract disease (FLUTD). Veterinarians making therapeutic decisions should consider the quality of evidence supporting a recommendation to use (or not use) a particular treatment for cats with FLUTD. Whenever possible, recommendations should be based on results of randomized and well-controlled scientific studies performed in clinical patients with the spontaneously occurring disease of interest. In the absence of such studies, one is left to make the best recommendation possible with consideration of all information, including the quality of the evidence. At this time, additional studies are needed to evaluate evidence for many currently recommended treatments for cats with FLUTD.     

Litter impaction of the lower intestinal tract in male broiler breeders

Increased mortality occurred among males in a house of 26-wk-old broiler breeders. A severe impaction of the lower intestinal tract, because of litter, was found on necropsy in two of three recently dead cockerels. Litter could be seen in the markedly distended vent of the most affected bird. This bird also had feces and litter in the body cavity because of a ruptured small intestine. Both birds had extensive urate and fecal soiling of feathers around the vent. Other visceral organs were normal except for lack of fat around the base of the heart and decreased myocardial tone. Impaction of the lower intestinal tract in these birds most likely resulted from eating litter because of a change in feeding regimen, which caused confusion and feed competition among male birds.     

Microscopic anatomy of the ringed seal (Phoca hispida) lower respiratory tract

The microscopic anatomy of the ringed seal lung exhibits unique features and many features similar to those described in other seal species. Unique features include: Trachealis muscle predominately oriented longitudinally; Large veins within the tracheal wall supported by elastic fibers; Goblet cells and pseudostratified epithelium lining the duct system of bronchial glands of the segmental bronchi; Lamina propria of the segmental bronchus heavily invested with elastic fibers clustered into dense longitudinal bundles; and Capillaries and venules covered with squamous epithelium protruding into bronchiolar lumina. Common features include: Cartilage support of the bronchial tree extending distally into respiratory bronchioles; Smooth muscle enhancements in the distal airways producing sphincter like formations; and Lungs extensively supported with interstitial tissue, which divide lungs into lobules.     

Differences in the expression of luteinizing hormone and follicle-stimulating hormone receptors in the lower urinary tract between intact and gonadectomised male and female dogs

Receptors for LH (LHR) and FSH (FSHR) are expressed in the canine lower urinary tract (LUT). As gonadectomy results in an increase in plasma LH and FSH, the objective of this study was to determine whether there are any differences in the expression of LHR and FSHR in the LUT between intact and gonadectomised dogs. Four regions of the LUT, i.e. body and neck of the bladder as well as proximal and distal urethra, were collected from 20 healthy dogs (5 intact males, 5 intact anoestrous females, 4 castrated males and 6 spayed females). The mRNA and protein expression of receptors was determined by in situ hybridization and immunohistochemistry, respectively, and assessed semi-quantitatively incorporating both the distribution and the intensity of specific staining. Expression of LHR and FSHR was present in all tissue layers (epithelium, sub-epithelial stroma and muscle) of each region with different levels of the expression. Overall mRNA and protein expression for both LHR and FSHR was significantly (P < 0.001) lower in gonadectomised dogs. Intact dogs had more (P < 0.05) LHR and FSHR mRNA and protein in all tissue layers of the four regions, except for LHR mRNA expression in the sub-epithelial stroma where no differences were observed between the two statuses. Decreases in LHR and FSHR mRNA and protein in gonadectomised dogs appeared to be more consistent in spayed bitches compared to castrated males. Lower expression of LHR and FSHR observed in gonadectomised dogs may adversely affect the normal canine LUT function.     

Ultrasound- guided catheter biopsy of the lower urinary tract: technique and results in 12 dogs

Ultrasound-guided catheter biopsy of lesions affecting the lower urinary tract was attempted in 12 dogs with mucosal lesions affecting the bladder [nine] or urethra (three). Histological biopsies were obtained by catheter biopsy in 10 dogs, enabling diagnosis of transitional cell carcinoma in five, papilloma in two, prostatic carcinoma in two and chronic cystitis in one. Cytological samples alone were obtained in two dogs, one of which enabled a diagnosis of transitional cell carcinoma; the other contained evidence of haemorrhage and inflammation, but squamous cell carcinoma was found in a subsequent exci-sional biopsy. Intravesicular haemorrhage after biopsy was observed ultrasonographically in two dogs. Ultrasound guidance enables accurate determination of biopsy catheter position. The size of biopsies obtained by this method may limit the accuracy of histological diagnosis.     

Clinical evaluation of cats with lower urinary tract disease.

In a prospective study, 141 cats with hematuria, dysuria, urethral obstruction, or combinations of these signs were evaluated by contemporary diagnostic methods and compared with 26 clinically normal cats (controls). Specific diagnosis was established in 45% (64/141) of cats affected with lower urinary tract disease (LUTD). Crystalline matrix plug-induced urethral obstruction was diagnosed in 21% (30/141) of affected cats, uroliths were identified in 21% (30/141) of affected cats, uroliths with concomitant bacterial urinary tract infection (UTI) were identified in less than 2% (2/141) of affected cats, and bacterial UTI alone was identified in less than 2% (2/141) of cats with LUTD. Viruses, mycoplasmas, and ureaplasmas were not isolated from urine samples collected from affected or control cats. Bovine herpesvirus 4 (BHV-4)-neutralizing antibodies were not detected in any serum sample obtained from cats with LUTD or from control cats. In contrast, BHV-4 antibodies were detected by an indirect immunofluorescent antibody (IFA) test in sera obtained from 31% (44/141) of cats with LUTD and 23% (6/26) of control cats. The prevalence of positive BHV-4 IFA test results in affected cats was not significantly different from that observed in control cats. Significant association was not apparent between positive BHV-4 IFA test results and clinical diagnosis, abnormal laboratory findings, or cat age. However, the number of male cats with BHV-4 IFA titer was significantly (P less than 0.02, chi 2 test) greater than that of female cats. Detection of BHV-4 antibodies in approximately 30% of affected and control cats indicates prior virus exposure. Further investigations are warranted to clarify the specific role of BHV-4 in cats with naturally acquired LUTD.