Reimagining the Office Visit for Every Urinary Tract Disorder through POCUS: A Case Study

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Abnormalities involving the urinary tract are a common presenting complaint in dogs and cats. Clients may notice a change in a pet’s urine color or odor or typical urinary habits. Changes in frequency or urine volume, straining to urinate or appearing uncomfortable when urinating, and inappropriate location of urination are also common presenting complaints that can lead to a visit to the clinic.¹ Adding a focused ultrasound scan to the diagnostic investigation may help improve patient outcomes and client satisfaction while practicing progressive medicine.

Traditionally, a complete history and physical examination findings direct the diagnostic investigation and treatment plan for a patient exhibiting signs of urinary disease. Urinalysis is commonly recommended, along with a CBC and serum chemistry, depending on the patient’s age and signalment. Radiography or ultrasonography is also frequently recommended²; however, imaging may be postponed for a variety of reasons.² For example, radiography can be expensive and time-consuming, possibly requiring sedation and the attention of multiple technicians. Radiation safety is also a consideration for veterinary staff.³ Ultrasonography may be postponed due to limitations in access to ultrasound equipment. For example, even for clinics that have an ultrasound machine, larger, clinic-based ultrasound machines can be challenging to maneuver into the examination room for a simple, brief bladder evaluation; therefore, this simple diagnostic tool is often reserved only for cystocentesis in the treatment area of the clinic to collect a sterile urine sample for culture and susceptibility testing. Point-of-care ultrasound (POCUS) evaluation of the bladder can overcome these barriers and can be beneficial for any patient presenting with signs of urinary disease. POCUS enables the clinician to gather valuable information in a noninvasive way and can even take place in the presence of the client in the examination room.

Although urinary tract infections are often a top differential diagnosis for patients displaying signs of urinary tract disease, there are many conditions that may present with the same set of clinical signs (eg, bladder stones, crystals in the urine, chronic cystitis, neoplasia).⁴ The gold standard diagnostic investigation for a suspected urinary tract infection involves urine culture and susceptibility testing⁵; however, a trial of empiric antibiotics can sometimes be implemented as a first-line therapy. Although there may be transient improvement of clinical signs with this approach, if infection is secondary to an underlying disorder, the clinical improvement will be short-lived and the patient and the owner will have endured the unnecessary stress of medication administration, a delay in the diagnosis of the primary disease, and increased cost associated with repeat office visits. The addition of a POCUS evaluation of the bladder can potentially avoid a scenario such as this.

A scan of the bladder with POCUS enables the veterinarian to assess the bladder for volume, bladder wall thickness or abnormalities (as can be seen with neoplasia), bladder stones, and diseases of associated structures. If desired, the clinician can also evaluate the ureters and kidneys, the prostate in the male dog, and the uterus or uterine stump in the spayed female patient. Identifying abnormalities in the aforementioned areas can lead to an earlier, more accurate diagnosis; an appropriate treatment plan; and a more positive clinical outcome. An additional benefit of POCUS in cases of urinary disorders is ruling out neoplasia before the traditional “blind stick” cystocentesis technique is used. Ultrasound identification of a possible cancerous lesion may prevent seeding of the needle tract and abdominal wall with cancerous cells.⁶ Although transitional cell carcinoma is relatively rare, this is a potential complication that can occur in cases of transitional cell carcinoma.

Available at a low cost, durable, portable, and easy to use, POCUS equipment gives veterinarians the opportunity to rule out a myriad of underlying, noninfectious disorders of the urinary tract, allowing more accurate and confident diagnoses and treatments for patients. This simple addition to the diagnostic investigation of any patient presented with urinary tract signs can help guide the way to a better clinical outcome for the pet, the owner, and the veterinarian.

For trained veterinary professionals only.

980-23834-00 Rev A

This content is provided by Butterfly. Clinician's Brief does not inherently endorse any product or organization advertised across its properties. The appearance of an advertisement on Clinician's Brief properties is neither a guarantee nor an endorsement of the product or advertising claims. Clinician's Brief is not responsible for the content promoted in an advertisement.