Dear readers,
It is my pleasure to co-welcome you to the “Urogenital Health in Your Patients” JAVMA supplement! We are pleased to present you with state-of-the-art studies focusing on the upper and lower urinary tract in multiple species.
Every day we must answer the same question, in every patient: what do I do? The answer is often uncertain. However, the reports we bring you attempt to add some clarity. What works and what does not? What are the experts doing, what would they recommend, and, most importantly, what should I do for this animal here in front of me?
Small Animals
Most veterinarians in small animal practice will be presented at some point with a cat with urethral obstruction. For those cats that are successfully unobstructed and later sent home, veterinarians have to decide whether a short course of prazosin to minimize urethrospasm is a good idea. Conway et al1 determined that this drug is contraindicated and in fact seems to be associated with an increased likelihood of recurrence.
What about those dogs in which you have diagnosed ureteral ectopia? Are we limited to surgical correction or endoscopic laser ablation? Jacobson et al2 provide another option that should be available to anyone with a cystoscope. This manuscript is also the topic for the cover illustration, which was designed in collaboration with Dr. James N. Moore, Director of Educational Resources at the University of Georgia College of Veterinary Medicine.
In 2011 and 2019, the International Society of Companion Animal Infectious Diseases published guidelines for the treatment of dogs and cats suspected to have urinary tract infections.3,4 What antimicrobial should I be starting with if I have to guess what may work? When should I opt for culture and susceptibility testing? Block et al5 report that these guidelines have made a difference in first-line prescribing practices.
Large Animals
We are very pleased to feature 2 manuscripts that provide help with decision-making when presented with a small ruminant or pig with urethral obstruction due to urolithiasis. Mejia et al6 and Simpson et al7 provide us with their personal experiences and preferred methods for approaching these patients and offer help in deciding how and when to relieve the obstruction. Both groups of authors synthesize existing literature with their own personal experiences.
Exotic Animals
Finally, as exotic animals continue to grow in popularity among pet owners, many problems are occurring with sufficient regularity that we are able to draw some conclusions.
Edell et al8 report on the prognostic features of urolithiasis in guinea pigs. Most importantly, they examine whether surgical intervention for urolithiasis is a negative prognostic indicator, and they find that no, we can now tell owners that surgery is not by itself a bad thing.
Di Girolamo9 analyzes whether calcium concentrations in chelonians are associated with each other or with values for other analytes, such as serum albumin concentration. He also reports, for chelonians with abnormalities in serum calcium concentration, which organ systems are most likely to be affected (spoiler alert: this is the uroGENITAL supplement!).
No study can definitively tell us what to do for the one patient and one owner in front of us. Nevertheless, our job as veterinarians is to help owners decide what the best possible solution might be. That decision will always be a result of combining what has been reported with our own personal knowledge of the animal and its circumstances.
Barrak M. Pressler, DVM, PhD, DACVIM (Small Animal Internal Medicine)
College of Veterinary Medicine
Western University of Health Sciences
Associate Editor, JAVMA
Guest Co-Editor, Urogenital Supplement
References
- 1.↑
Conway DS, Rozanski EA, Wayne AS. Prazosin administration increases the rate of recurrent urethral obstruction in cats: 388 cases. J Am Vet Med Assoc. 2022;260(S2):S7–S11.
- 2.↑
Jacobson E, Meler EN, Delisser PJ, Thompson AL. Cystoscopic-guided scissor transection of intramural ectopic ureters as a novel alternate minimally invasive treatment option to laser ablation in female dogs: 8 cases (2011–2020). J Am Vet Med Assoc. 2022;260(S2):S12–S20.
- 3.↑
Weese JS, Blondeau JM, Boothe D, et al. Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. Vet Med Int. 2011;2011:263768.
- 4.↑
Weese JS, Blondeau J, Boothe D, et al. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J. 2019;247:8–25.
- 5.↑
Bloch RA, Papich MG, Stürmer T. Veterinary antimicrobial prescribing practices for treatment of presumptive sporadic urinary tract infections in dogs examined at primary care practices in the United States (2010–2019). J Am Vet Med Assoc. 2022;260(S2):S21–S27.
- 6.↑
Mejia S, McOnie RC, Nelligan KL, Fubini SL. Small ruminant urinary obstruction: decision trees for treatment. J Am Vet Med Assoc. 2022;260(S2):S64–S71.
- 7.↑
Simpson KM, Oman RE, Depenborck SM. Diagnosis and management of obstructive urolithiasis in miniature pigs. J Am Vet Med Assoc .2022;260(S2):S72–S79.
- 8.↑
Edell AS, Vella DG, Sheen JC, et al. Retrospective analysis of risk factors, clinical features, and prognostic indicators for urolithiasis in guinea pigs: 158 cases (2009–2019). J Am Vet Med Assoc. 2022;260(S2):S95–S100.
- 9.↑
Di Girolamo N. Relationship, difference, and diagnostic discordance between blood ionized and total calcium concentrations in client-owned chelonians. J Am Vet Med Assoc. 2022;260(S2):S101–S110.
