Background 

·         Have previous studies been done on this topic? If so, what were the results and how do they lay the
groundwork for the article being presented? 
- SB identified in 8-30# of dogs with inflammatory skin disease treated with cyclosporine, glucocorticoids
- 2x retrospective studies ID treatment with corticosteroids or antineoplastic chemotherapy as common risk
factor in dogs with PUC
- Prevelence of PUC in dogs is reported for dogs with urogenital neoplasia, none nonurogenital neoplasia
o Both due to immunosuppression by cancer and chemo

·         What is the aim +/-hypothesis of this article? 

Report on the long term clinical outcome of the use of this modified proportional margin approach with respect to
obtaining complete surgical margins of MCTs of different sizes and grades, along with reporting on rates of local
recurrence, de novo MCT and post op mets.

Methods 
Prospective observational longitudinal clinical study
46 client-owned dogs with various neoplastic disease presented for antineoplasic chemotherapy to the Clinic of
Small Animal Internal Medicine, Ludwig-Maximillan-University, Munich (July 2018 – October 2020)

Inclusion criteria: Treated with at least 1 of the following antineoplasic agents

 See paper

Exclusion:
- Received chemo previous 6 months before enrolment
- Cancer of urogenital tract

Evaluations:
- Initial > performed before first chemo administered (day of – 41 dogs, up to 1 month prior – 5 dogs)
- Different protocols: re-evaluations at different timeframes but at least once
- History (specific questions about LUTD, if dog had been on abs), physical exam (+ rectal if male dog),
complete UA and culture +.- CBC/serum biochemistry
- First PUC > U/S of urogenital tract performed and serum-creatinine concentration – signs of rtenal and
prostatic involvement

Classification:
SB vs UTI (further classified into pyelonephritis, prostatitis, cystitis)

Results 

OF 46 dogs, collected 185 urine cultures – mostly by cysto, 1x catheterisation, 5x voiding (mid-stream). Bacterial
growth quantified in colony-forming units, cut off is different and higher in samples collected via catheterisation &
voiding.

21/185 specimens of 8 dogs were positive, total of 10 episodes of PUC. 5 postiive before chemo, 3 during chemo.
Mixed breed. One dog had 5 PUCs, 3 had 4, 4 had only 1 PUC.
** see table > nice summary in table 1
Risk factors = hyperA, incontinence 1, urolithiasis in 1, other known risk factors eg (DM, anatomic defect of urinary
tract, transurethral catheterisation were not presented > excluded
- Urine retention increase PUC by 40x fold
- HyperA in line with other literature. However they think it’s the chronic and long lasting exposure to
endogenous cortisol rather than short exogenous cortisol administration

Prevelence of PUC was 11% before start of antineoplastic chemo and 13% during chemo.
7/10 classified as SB, 3x classified as UTI

  
Conclusions 
Concluded that chemotherapy had no influence on the prevalence of PUC. Incidence rate is 135 cases per 1000 dogs
per year.
Main mechanism dogs receiving chemotherapy leads to immunosuppression and predispose to infectin is
neutropaenia, however all dogs, if any only had grade 1 neutropaenia (not clinically relevant). They found no
association between neutropaenia and PUC.

Ecoli = most common pathogen (9/10).

Of the 8 dogs that had PUC, 2 euthanised because of progressive disease, PM performed. One dog consistent with SB
and other dog had bacterial prostatitis and pyelonephritis.

Strengths:
- Prospective studies

Limitations
- Selection bias > dogs excluded if no follow up urine culture during chemo obtained
o Prevalence in excluded dogs was similar
- Different cancers and chemo protocols and different comorbidities
- Small sample size
- Dogs without PUC, urine cultures performed during or after antibiotic treatment > false-negative

In conclusion
- Regularly screening dogs by urine culture before start of chemo, not showing signs of UTI and culture is
negative, no further culture necessary.
- If positive, ddx SB vs UTI, particularly male intact dogs, abs case-by-case decision