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Background Urinary disorders in cats often require subjective caregiver quantification of clinical signs to establish a diagnosis and monitor therapeutic outcomes. Objective To investigate use of a video recording system (VRS) to better assess and quantify urination behaviors in cats. Animals Eleven healthy cats and 8 cats with disorders potentially associated with abnormal urination patterns. Methods Prospective study design. Litter box urination behaviors were quantified with a VRS for 14 days and compared to daily caregiver observations. Video recordings were analyzed by a behavior analysis software program. Results The mean number of urinations per day detected by VRS (2.5 ± 0.7) was significantly higher compared with caregiver observations (0.6 ± 0.6; P < .0001). Five cats were never observed in the litter box by their caregivers. The mean number of urinations per day detected by VRS was significantly higher for abnormal cats (2.9 ± 0.7) compared with healthy cats (2.1 ± 0.7; P = .02); there were no apparent differences in frequency between these groups reported by caregivers (0.7 ± 1.0 and 0.5 ± 1.0, respectively). There were no differences in mean urination time between healthy and abnormal cats as determined by VRS or caregivers. Mean cover-up time determined by VRS was significantly longer in healthy cats (22.7 ± 12.9 seconds/urination) compared with abnormal cats (8.7 ± 12.9 seconds/urination; P = .03); differences in cover-up time were not detected by caregivers. Conclusions and Clinical Importance Caregivers commonly underestimate urination frequency in cats when compared to video-based observations. Video recording appears to facilitate objective assessment of urination behaviors and could be of value in future clinical studies of urinary disorders in cats.

The overall evidence of an association between fluid intake and bladder cancer is not entirely consistent. We examined the fluid intake-bladder cancer relationship in the Los Angeles bladder cancer case-control study. A total of 1,586 cases and their age-, sex-, and race-matched neighborhood controls were interviewed in-person from 1987 to 1999. Information on total fluid intake was derived from the consumption of specific fluids including water, coffee, tea, alcohol, milk, juice, hot chocolate and soda. Total fluid intake was not associated with bladder cancer. Daily water intake was associated with a slight decrease in bladder cancer risk, with the protection more pronounced among women (p for trend = 0.039) than among men (p for trend = 0.62). Compared to drinking

Dehydration has been related to several health aspects, and children are especially vulnerable. Since children spend a large time at school, we aim to examine children’s hydration status at school-start and its change during the school-day by objective measures. To identify subpopulations at risk, determinants of hydration were tested. In 371 Belgian 7–13-year-old children, hydration was measured by (1) urinary osmolality at school-start and by a pooled school-day sample; (2) body water% by impedance; (3) parental reported beverage consumption; (4) urination frequency. Linear regression analyses were used to test putative predictors of hydration status: age, sex, parental education, region (Dutch-speaking versus French-speaking part of Belgium), diet quality and adiposity. A mean osmolality of 888 mosmol/kg was found in the school-start sample and 767 mosmol/kg in the school-day sample. This resulted in, respectively, 76 and 54 % of the children being dehydrated (>800 mosmol/kg). In 45 % of the children, the hydration level decreased over the school-day. Also the body water% as derived from bio-impedance (57 % ±4), the reported average daily beverage intake (911 ml) and the lower urination frequency during weekdays versus weekend days confirmed the low hydration status in our school population. Boys, Walloon children and those with higher adiposity were at increased risk of low hydration level. Diet quality was not the predictor of hydration status. Hydration status at school appeared problematic in this population. This emphasizes the need for more resources and attention by school management and governmental organizations. Herein, especially Walloon schools and boys should be reached.

Summary Introduction A bladder diary (BD) is a simple and non-invasive method of evaluating people with lower urinary tract symptoms (LUTS). Recently, the ICCS recommended a 48-h daytime frequency and volume chart (which does not need to be recorded on 2 consecutive days) to evaluate lower urinary tract (LUT) dysfunction. However, some studies on adults have demonstrated that a minimum of 3 days is required. It is believed that, to date, there are no studies in the literature that compare a 2-day BD with a 3-day BD. The advantages of a BD over a shorter period of time are the simplicity and possible better parent compliance. Objective The aim of this study was to evaluate if a 2-day BD is statistically and clinically comparable to a 3-day BD. Study design A voiding diary was filled in over a 3-day period for 92 children (ages ranged from to 3–16 years, mean 7.9 ± 3.07) attending the present institution. By using the voiding diary, the following parameters were calculated: urination frequency, maximum and average volumes of urine (MVV and AVV) and fluid intake. The diary considered the 2 days as the first and second days of the 3-day diary. Results Out of the 92 children, eight (8.7%) did not properly complete the diary. The sample predominantly comprised females (n = 55, 59.8%). No differences were seen between 2-day and 3-day bladder diaries regarding fluid intake, maximum and average voided volume. The sensitivity, specificity, positive and negative predictive values of the 2-day bladder diary for detecting frequency were 83.4%, 91.7%, 80% and 93.2%, and for low bladder capacity they were 97.2%, 90.9%, 99% and 88%, respectively ( Table ). Discussion In a 2006 document, the ICCS recommended that a bladder diary be kept for 3 days, but in new documentation (2014) there is a reference stating that 2 days are enough. Bladder capacity is an important parameter in evaluating LUTS. Using a 2-day BD, the data showed that only a small percentage of reduced bladder capacity diagnosis would be lost. Conclusion When using the 2-day diary, a 16% false negative rate for frequency should be expected. A 2-day bladder diary is sufficient to evaluate bladder capacity and fluid intake. Table . Comparison of 2-day and 3-day voiding diaries for the number of voids and low bladder capacity. 2-day voiding diary 3-day voiding diary Higher number of voids (≥8 voids/day) Low bladder capacity ( Yes No Total Yes No Total Yes 20 (83.4%) 5 (8.3%) 25 70 (97.2%) 1 (9.1%) 71 No 4 (16.6%) 55 (91.7%) 59 2 (2.8%) 10 (90.9%) 12 Total 24 60 84 72 11 83 *Sample of 92 children. Missing value for number of voids, eight (8.7%); for bladder capacity, nine (9.7%).

— The influence of type of photosensitizer, drug and light dose, and time interval between photosensitizer and illumination on the extent of photodynamic therapy (PDT)-induced bladder damage and recovery was investigated using a mouse model. The three photosensitizers studied were Photofrin, meso-tetrahydroxyphenylchlorin (m-THPC) and bacteriochlorin a (BCA). Functional bladder damage was quantitatively assessed from increases in urination frequency index (FI) at 1-35 weeks after illumination and histological damage was qualitatively assessed at 1 day, 1, 2 and 12 weeks. Photofrin-mediated PDT caused an acute increase in FI at 1 week, with recovery within 2-8 weeks after light doses of 2.7-8.2 J/cm2. After higher light doses there was only partial recovery. Previous results indicated that the acute response and rate of recovery was the same whether Photofrin was given at 1 day or up to 7 days before illumination. The m-THPC-mediated PDT at drug doses of 0.3 mg/kg also resulted in a marked acute response with good recovery, even after 10.8 J/cm2. Lower drug doses in combination with 5.4 J/cm2 did not result in acute or late damage. There was no significant difference in acute response when m-THPC was given 1, 3 or 7 days before illumination, although recovery was faster for the longer illumination intervals (3 or 7 days). Illumination at 1 h after 20 mg/kg BCA induced an acute response within 2 days after illumination, with recovery within 4-8 weeks. Lower drug doses did not result in damage. The most prominent histological changes during the acute period with all three photosensitizers were submucosal edema and vessel dilation, with epithelial denudation (depending on drug/light dose). We conclude that BCA and m-THPC are both potent new photosensitizers. They can induce a moderate to severe acute bladder response with complete healing over a period of a few weeks. The photosensitizer m-THPC is very effective with low doses of photosensitizer and light, whereas relatively high doses of BCA and light are required to obtain equivalent functional bladder damage in our mouse model.

Functional and histological damage after intravesical administration of mitomycin C or doxorubicin were studied in mouse bladders. Dosing schedules were based on those commonly used in the clinic, and bladder function was assessed from changes in urination frequency. Repeated weekly instillations of 1 mg./ml. mitomycin C induced a transient three-fold increase in Frequency Index (FI) with recovery to control levels within 3 weeks. Weekly instillations of 6 mg./ml. doxorubicin also resulted in a three-fold increase in FI, but lower doses produced only minimal changes. There was, again, full recovery within 3 weeks. Our experiments indicate that repeated intravesical instillations of mitomycin C or doxorubicin are well tolerated, with rapid recovery from functional damage within a few weeks of cessation of therapy. There was significantly less damage after repeated instillations of clinically relevant doses of doxorubicin than mitomycin C.

Functional damage in the mouse bladder was measured sequentially from 1 to 53 weeks after irradiation with a range of X ray doses (10 to 30 Gy). Damage was assessed from the independent assays of urination frequency and cystometric measurement of bladder volume at a constant intravesical pressure. There was an early, transient wave of damage from 1 to 3 weeks after bladder irradiation. During this period the urination frequency was increased to greater than or equal to 2 times control levels in 20 to 70% of the mice (depending on dose) after 15 to 30 Gy. Bladder volume was reduced to less than or equal to 50% of control values in 20 to 40% of the mice after doses of 20 to 30 Gy. This early damage usually lasted for less than 1 week and occurred at times ranging from 5 to 21 days, independent of dose. There was no significant correlation between response as measured by the two assays on an individual animal basis during the early period. The incidence of reduced bladder volume, measured cystometrically in anesthetized mice, tended to be less than the incidence of increased urination frequency, measured in non-anesthetized animals. Late bladder damage developed from 16 to 40 weeks after doses of greater than or equal to 20 Gy, and the time of onset was inversely related to dose. Less than 20% of mice treated with 10 to 15 Gy developed late bladder damage as assessed by increased urination frequency or reduced bladder volume. Late bladder damage was irreversible and there was a good correlation between response of individual animals as measured by the two assays. We conclude that changes in both urination frequency and bladder volume can be used as quantitative measures of early and late functional damage after bladder irradiation. The early, transient damage was not associated with changes in the urothelium or muscle layers of the bladder, whereas the late, persistent damage was accompanied by epithelial denudation and focal hyperplasia, with fibrosis and ulceration after higher doses.

Mouse bladders were irradiated with 1,2,4 or 8 fractions of electrons or neutrons. Urination frequency was scored from 9 to 14 months after irradiation and this was used as a measure of the extent of bladder damage. The RBE for neutrons relative to 1.8 MeV electrons increased from 3.2 for large single doses to 5.4 for 8 fractions. Repair of sublethal injury after electron irradiation was considerable, with 63-72% of each fractionated dose repaired. Repair after neutron irradiation was less, with only 35-43% of each fractionated dose recovered. Linear-quadratic analysis of all the fractionated bladder data yielded an alpha/beta ratio for electrons of 6-7 Gy and, surprisingly, the alpha/beta ratio for neutrons was only slightly higher at about 8 Gy.

The capacity for repair of sublethal damage during fractionated irradiation of the mouse bladder has been measured. Graded doses of electrons were given as 1, 2 or 5 equal daily fractions. Two functional end points were used to assess bladder damage: a) increased urination frequency and b) decreased bladder capacity. Repair of sublethal injury within 24 hours was found to be similar using both assays for bladder damage and was greater than the repair observed in mouse skin for a given dose per fraction. The possibility of a slower repair process occurring in bladder was investigated by giving two fractions in increasing overall times (from 24 hours to one month). No increased repair was observed with the longer time intervals; hence there was no evidence for slow repair in the bladder.

Summary The response of the mouse bladder to cyclophosphamide (Cy) and radiation, used alone or in combination, has been assessed in order to investigate whether epithelial denudation is the primary step in the sequence of events leading to bladder dysfunction, as expressed by increased urination frequency. The response to the two agents when used singly is consistent with the epithelium being the target tissue. However, early Cy denudation of the epithelium accompanied by rapid epthelial turnover, does not influence the time of onset of radiation dose-related bladder damage. Thus it appears that denudation of the bladder epithelium is not necessarily the immediate precursor of radiation injury.

The response of mouse bladders to multifraction irradiation was assessed from increases in urination frequency or the reduction in bladder capacity after irradiation. A range of electron doses were given as 1, 2, 5, 10 or 20 equal fractions in overall treatment times of 1-2 weeks. Dose-related increases in urination frequency were measured from 10 to 14 months after irradiation and a dose-related reduction in bladder capacity (at inflation pressures of 20 mm Hg) was apparent at the time of sacrifice. The extent of repair of sublethal and potentially lethal damage was estimated from a comparison of the isoeffective doses in fractionated regimes and single dose treatments. After small doses per fraction (2.5-6 Gy), the extent of repair in bladder was very similar to that in mouse skin. After larger doses per fraction (greater than 8 Gy) slightly more repair was seen in bladder than skin. Linear-quadratic analysis of the data suggests quite a high value for the ratio alpha/beta, in the region of 5 to 10 Gy. This is higher than the alpha/beta ratios which have been reported for most other slowly dividing normal tissues.

The response of the mouse bladder to single doses of cyclophosphamide (CY), X-rays, or their combination was assessed from the development of functional damage (haematuria and increased frequency of urination). For the combined treatments, a single dose of CY (100 mg · kg −1 ) was given immediately before or at intervals of up to 9 months before irradiation, or at one week to 9 months after irradiation. Damage after X-rays alone was expressed late, with no functional changes earlier than 5 months. CY alone, by contrast caused a marked increase in urination frequency and haematuria within one week. There was subsequently partial recovery although some residual damage persisted for at least one year. CY given before or after X-rays caused an early, X-ray dose-related expression of damage. These results suggest that the drug precipitated some of the latent radiation injury. There was also a second wave of damage after the combined treatments and the response at 9–12 months was always more severe than after X-rays alone. This increased late damage could be explained in terms of additive drug and radiation toxicities. Since drug given up to 9 months before or after irradiation caused more severe bladder damage than X-rays alone, CY should be avoided in clinical situations where the bladder has been irradiated.