Chapter 10 Urinogenital disorders
Urinary tract
Introduction
Conditions with secondary renal pathology include pruritus-pyrexia-hemorrhagica (PPH) (9.39), oak (acorn) poisoning (13.6, 13.7), renal infarction secondary to caudal vena caval thrombosis (5.33), babesiosis (redwater, 12.39–12.43), and the many causes of bacteremia and septicemia.
Pyelonephritis
Clinical features
although worldwide in distribution, cases of pyelonephritis are sporadic only and overall incidence is low. Most often seen in the first 3 months postpartum, it may result from contact with infected urine or from a genital tract infection. Most infections start in the winter housing period when cow-to-cow contact increases. Affected cows are pyrexic, lose weight, show polyuria, hematuria or pyuria, and may develop a dry, brownish discoloration of the coat, often with urine staining over the tail and perineum which resembles cystitis (10.14). Rectal palpation may reveal a thickened ureter or enlarged (left) kidney. An 18-month-old Limousin heifer (10.1), ill for several days, showed at autopsy a granular renal cortex with areas of recent hemorrhage. In addition, several small discrete renal abscesses are evident, one of which has burst.
Differential diagnosis
urolithiasis, intestinal obstruction (in acute pyelonephritis), cystitis (10.14).
Leptospirosis
Clinical features
in adults the main effects of Leptospira interrogans serovar pomona or hardjo infection are multiple abortions (see 10.86 for a fetus from a possible leptospiral abortion), stillbirths, loss of milk production, and reduced fertility. In calves L. pomona causes an acute septicemia with hemoglobinuria, jaundice, anemia, and possibly death. Dark, swollen kidneys (10.4) are usually indicative of a hemolytic crisis. Recovered cattle show little more than ill-defined, grayish, cortical spots, indicative of a focal interstitial nephritis. The spirochetes may be seen under dark field microscopy of urine, but confirmation of diagnosis otherwise depends on serology or histopathology.
Differential diagnosis
babesiosis (12.39–12.43), anaplasmosis (12.44–12.47), rape and kale poisoning (13.10), postparturient hemoglobinuria, bacillary hemoglobinuria. Note the completely different appearances of the kidney in pyelonephritis (10.2) and amyloidosis (10.13).
Urolithiasis
Clinical features
early cases are dull, anorexic, and walk stiffly. If grown sufficiently, rectal examination may reveal an enlarged and painful bladder. Diagnosis is made on the basis of changes in the preputial region. Although preputial crystals (often struvite, i.e., magnesium-ammonium-phosphate hexahydrate) appear in many calves (10.5), relatively few will develop signs of obstruction, which tends to occur in or just proximal to the sigmoid flexure, or in the distal portion of the penis. An intraoperative view (10.6) of the perineal region shows the dilated urethra proximal to the sigmoid flexure and the obstructing calculus. Continuing complete urethral obstruction results in either bladder or, more commonly, urethral rupture. The crossbred Charolais male in (10.7) has a large subcutaneous swelling containing urine as a result of urethral rupture in the sigmoid region. The swelling extends forward from the sigmoid to the preputial orifice, where dry preputial hairs are covered with crystals. A rear view (10.8) shows gross enlargement of the scrotum, especially at the neck, early bruising, and a superficial fluid ooze, all caused by accumulated urine. In occasional cases the swelling is discretely localized to the peripreputial area. In contrast, in a severe and advanced case the Friesian steer (10.9) had such severe swelling that ischemic necrosis has caused an extensive skin slough overlying the penis.
Autopsy examination of a 6-year-old Shorthorn bull that died as a result of severe uremia following bladder rupture and uroperitoneum reveals a congested and hemorrhagic bladder mucosa (10.11). Numerous calculi (2–7 mm diameter) and fibrin are seen on the mucosal surface. The peritoneum tends to be diffusely inflamed, but the changes are less severe than those following septic reticuloperitonitis (4.90, 4.91). Urolithiasis frequently accompanies cases of severe pyelonephritis (10.1–10.3).
Differential diagnosis
in a mature bull this includes penile hematoma (10.23) or abscess formation, or, in a younger animal, urethral rupture due to faulty application of a bloodless castrator (Burdizzo) some days previously (see 10.36). Differentials for cases with ventral abdominal swelling not localized to the penis and prepuce include ascites (4.92), intestinal obstruction (4.88), and generalized peritonitis with massive exudation (4.91). Other differential diagnoses include cystitis (10.14), severe balanoposthitis, and severe preputial frostbite.
Amyloidosis
Differential diagnosis
diagnosis is difficult, especially in the presence of coexisting disease, including pyelonephritis.
Male genital tract
Congenital male abnormalities
Pseudohermaphrodite (freemartin)
Definition
an individual with gonads of one sex but with contradictions in the morphological criteria of sex.
Persistent penile preputial frenulum
Clinical features
in 10.15 the penile body remains attached to the prepuce by a fine, longitudinal band of connective tissue (A). Persistent penile frenulum causing penile deviation is a congenital anomaly, but signs, such as ventral penile deviation or a failure of complete protrusion, are usually first seen at attempted intromission. In some breeds it is inherited, and surgically corrected bulls should not be used to sire replacement breeding stock. A 2-year-old Angus bull (10.16) presented for a fertility check following recent purchase, had a long-standing penile-preputial adhesion (contrast 10.15). The bull was returned to the seller. Surgical correction was considered unethical.
Penile conditions
Fibropapilloma (“wart”)
Definition
a benign tumor of epithelial and connective tissue caused by a species-specific papovavirus.
Management
small tumors slowly regress, and like teat warts have resolved by 2–3 years of age. Large masses may cause persistent penile protrusion and require removal (e.g., by ligation) or retention within the prepuce by a purse-string suture, which was the option chosen for 10.19. 10.20 shows the same bull 4 months later and soon afterwards he was used for service. In some cases healing is accompanied by scarring and distortion of the penile tunic, resulting in penile deviation and failure of intromission.
Spiral deviation of penis (“corkscrew penis”)
Clinical features
a spiral or corkscrew penile conformation is a normal occurrence at ejaculation in the vagina, but premature corkscrewing may be severe enough to prevent intromission. The first case (10.21), a 2-year-old Charolais, shows a 90° ventral curvature. The second case (10.22) clearly illustrates the spiraling effect, and the difficulty of intromission. In some bulls, an ulcer on the glans penis indicates abrasion from repeated perineal contact. Rarely is the condition traumatic in origin.
Differential diagnosis
persistent penile frenulum in young bulls, scarring following fibropapillomata.
Penile and parapenile hematoma (“fracture of penis”, “broken penis”)
Clinical features
a discrete swelling is seen in the Hereford bull in 10.23, which also had a secondary prolapse of the penis. He cannot serve. The extent of the ruptured CCP is evident in the autopsy specimen of an affected penis (10.24) in which the sigmoid flexure (A) is just proximal to the mass. The black wire has been inserted into the urethra.