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Chronic Cystitis

Sweet Pea is a 12 year old cocker with a history of chronic cystitis. I suggested we do an ultrasound. I would appreciate some feedback on this bladder. I am not quite certain what is going on here.

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14 responses to “Chronic Cystitis”

  1.  
     
    Hi Randy nice image

     
     

    Hi Randy nice image set…”ghosts” in the bladder… those suspended echoes with a reverb tail… they can come from protein exfoliation form kidneys but also anaerobic infection. Dependent sand as well I would be worried about staph here as that sand is most likely struvite. It will likely dissolve with cleanup of the UTI. Good to get deep pelvic urethra images on these to see how the tone is (see image attached of incontinent dog with “garden hose” urethral dilation). Also examine the vaginal vault assuming “Sweat pea” is a female and look for urine pooling and recessed vulva/pyoderma and cause of primary source. The apex of the UB is thickened and mildly irregular most consistent with cystitis but should be watched for progression. This is the blanket protocol I use for these recurrent uti cases:

     

    Chronic UTI Protocol

    I recommend Enrofloxacin (5 mg/kg SID PO) in late pm after urination to maximize urinary concentrations overnight. This assumes that culture supports this use. Repeat culture at 3-4 weeks and continue treatment at least 7-10 days post negative urinary sediment and negative culture. Note: Negative culture does not necessarily mean lack of UTI. Other favorite antibiotics for chronic UTI include third generation Cefa (Ceftiafur or similar sid injectable) or Clavamox. If suspicion of occult urinary incontinence is present then phenylpropanolamine (PPA) (1-2 mg/kg BID) can be employed long term to enhance urethral tone.

     

  2.  
     
    Hi Randy nice image

     
     

    Hi Randy nice image set…”ghosts” in the bladder… those suspended echoes with a reverb tail… they can come from protein exfoliation form kidneys but also anaerobic infection. Dependent sand as well I would be worried about staph here as that sand is most likely struvite. It will likely dissolve with cleanup of the UTI. Good to get deep pelvic urethra images on these to see how the tone is (see image attached of incontinent dog with “garden hose” urethral dilation). Also examine the vaginal vault assuming “Sweat pea” is a female and look for urine pooling and recessed vulva/pyoderma and cause of primary source. The apex of the UB is thickened and mildly irregular most consistent with cystitis but should be watched for progression. This is the blanket protocol I use for these recurrent uti cases:

     

    Chronic UTI Protocol

    I recommend Enrofloxacin (5 mg/kg SID PO) in late pm after urination to maximize urinary concentrations overnight. This assumes that culture supports this use. Repeat culture at 3-4 weeks and continue treatment at least 7-10 days post negative urinary sediment and negative culture. Note: Negative culture does not necessarily mean lack of UTI. Other favorite antibiotics for chronic UTI include third generation Cefa (Ceftiafur or similar sid injectable) or Clavamox. If suspicion of occult urinary incontinence is present then phenylpropanolamine (PPA) (1-2 mg/kg BID) can be employed long term to enhance urethral tone.

     

  5. I like to rescan if possible

    I like to rescan if possible at about 4 weeks if they let me to be sure the wall is resolving and no surprize TCC is popping through as well

  6. I like to rescan if possible

    I like to rescan if possible at about 4 weeks if they let me to be sure the wall is resolving and no surprize TCC is popping through as well

  7. Hi Eric
    If the ecos with

    Hi Eric

    If the ecos with reverbation were gas shoudn’t they agregate in the non dependent part of the bladder? (maybe not if it just beggining?)

    Sorry to ask, but how do you know the ecos with reverbation are protein? from article? experience test? I assume it was microlithiasis that would give sometime this reverbation effect? 

     

    Thank you

  8. Hi Eric
    If the ecos with

    Hi Eric

    If the ecos with reverbation were gas shoudn’t they agregate in the non dependent part of the bladder? (maybe not if it just beggining?)

    Sorry to ask, but how do you know the ecos with reverbation are protein? from article? experience test? I assume it was microlithiasis that would give sometime this reverbation effect? 

     

    Thank you

  13. I just wanted to update

    I just wanted to update everyone on the status of Sweet Pea. Thank you EL for your advise. The original urine MIC on Sweet Pea did indicate a Staph infection. I treated Sweet Pea with Baytril 5 mg/kg q24h before bed. I did this for a full 4 weeks. Two weeks later I recultured the urine and it wa clear and negative for Staph. I did a follow up ultrasound at that time and I am enclosing an image.

    Sweet Pea is doing great. I plan on rechecking a urine MIC in Feb to make sure the UTI has not returned.

  14. I just wanted to update

    I just wanted to update everyone on the status of Sweet Pea. Thank you EL for your advise. The original urine MIC on Sweet Pea did indicate a Staph infection. I treated Sweet Pea with Baytril 5 mg/kg q24h before bed. I did this for a full 4 weeks. Two weeks later I recultured the urine and it wa clear and negative for Staph. I did a follow up ultrasound at that time and I am enclosing an image.

    Sweet Pea is doing great. I plan on rechecking a urine MIC in Feb to make sure the UTI has not returned.

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