Feline Lower Urinary Tract Disease

Question 1

Define feline lower urinary tract disease/feline urological syndrome

Answer 1

Collective terms for signs of lower urinary tract disease and abnormal voiding behaviour
FLUTD is a collective term for a variety of conditions affecting the bladder and/or urethra of cats that result in similar clinical signs

Question 2

Name some non-obstructive feline lower urinary tract diseases

Answer 2

• Idiopathic cystitis
• Uroliths
• Anatomical defects, cancer, etc
• Behavioural problems
• Bacterial infection

Question 3

Name some obstructive feline lower urinary tract diseases

Answer 3

Idiopathic cystitis
Uroliths
Urethral plug
Bacterial infection

Question 4

What is feline idiopathic cystitis?

Answer 4

• Abnormal voiding behaviour after exclusion of other disorders
• No obvious cause
• Chronic, persistent or recurrent

Question 5

Which animals are predisposed to lower urinary tract infections?

Answer 5

Any age or sex - young to middle-aged neutered cats, 2-6 years old
Males more prone to obstruction
Persians appear predisposed

Question 6

List the 4 predisposing factors for lower urinary tract disease in cats

Answer 6

Obesity
Indoor / sedentary cats
Dry diet
Multi-cat household

Question 7

How will a cat with lower urinary tract disease present?

Answer 7

Dysuria (difficulty urinating)
Pollakiuria (increased frequency)
Haematuria
Inability to urinate (urethral obstruction)
Behavioural changes
Appear to lose litterbox training

Question 8

What is the term used to describe urinating in inappropriate places?

Answer 8

Periuria

Question 9

How do cats with non-obstructed lower urinary tract disease most commonly present?

Answer 9

• Generally well
• Usually self limiting and resolves in 5-10 days
• Bladder small, firm and may be painful

Question 10

How do cats with obstructed lower urinary tract disease most commonly present?

Answer 10

Emergency situation!
Large, painful bladder
Check penis for signs of trauma/crystals
Dehydration, uraemic breath, bradycardia
Bladder may rupture = non-palpable, abdominal pain

Question 11

Describe the pathophysiology of feline idiopathic cystitis

Answer 11

• Alterations in neurotransmission to and from the bladder lead to inflammation
• Reduced glycosaminoglycan layer, which protects the bladder lining
• Get petechial haemorrhages on the bladder wall

Question 12

How is ‘pandoras syndrome’ linked to FIC?

Answer 12

Cats with chronic LUT signs in the presence of comorbid disorders (e.g. behavioural, cardiovascular, dermatological, GI problems)

Question 13

Describe the main features of urethral plugs

Answer 13

• More common in males (longer, narrower urethra)
• Most common cause of obstruction
• Plug consists of mucus / glycoprotein matrix, often with other substances trapped in the matrix

Question 14

Name the 3 urolith types seen in cats

Answer 14

Struvite
Calcium oxalate
Urates

Question 15

How are struvite uroliths different in dogs and cats?

Answer 15

Struvite uroliths in cats are most commonly sterile (different to dogs where they are usually associated with UTIs)

Question 16

Describe UTIs in cats

Answer 16

Rare!

Question 17

Name 4 inherited anatomical defects of the urinary tract in cats

Answer 17

Vesico-urachal diverticulae
Bladder hypoplasia
Urethral strictures
Phimosis

Question 18

Name 2 acquired anatomical defects of the urinary tract in cats

Answer 18

Strictures due to trauma
Iatrogenic damage

Question 19

Describe blood sampling as a diagnostic tool in FLUTD

Answer 19

Very important in blocked cats
- Hyperkalaemia
- Hyperphosphataemia
- Metabolic acidosis
- Azotaemia

Question 20

Describe urinalysis as a diagnostic tool in FLUTD

Answer 20

Dipstick
Sediment analysis
USG
Culture

Question 21

What are the considerations of the sediment analysis in cats?

Answer 21

RBC are a common finding, +/- WBC, epithelial cells.
Note that crystals are a normal finding – but if large numbers, may play a role - Don’t overinterpret

Question 22

Why is USG important in FLUTD

Answer 22

Highly concentrated urine predisposes to urolith formation

Question 23

How is radiography used as a diagnostic tool for FLUTD

Answer 23

Include ALL of the urinary tract, including penile urethra
Plain: may see radio-opaque calculi / plugs
Contrast studies

Question 24

How is ultrasound used as a diagnostic tool for FLUTD

Answer 24

May see hyperechoic sediment / uroliths and acoustic shadowing, bladder masses, thickened bladder walls

Question 25

A 6 year old MN cat has been urinating more often, vocalising when urinating, and urinating outside his litter box. What is the best term for this?

Answer 25

FLUTD If you investigated further and found nothing you would probably diagnose as FIC

Question 26

Which urolith of cats is associated with UTI?

Answer 26

None

Question 27

Which urolith of cats does not dissolve and must be managed surgically?

Answer 27

Oxalate

Question 28

Describe treatment of urethral plugs

Answer 28

- Blocked urethra is emergency situation - Develop post-renal azotaemia within 24h - Bladder may rupture - Relieve pressure in bladder by emergency cystocentesis – this will relieve back pressure and allow glomerular filtration to recommence - Start fluid therapy: very important (0.9% NaCl initially to rehydrate – correct dehydration over 1-4h) - Treat electrolyte and acid-base disturbances

Question 29

How are uroliths treated?

Answer 29

- Struvite may be dissolved with medical dissolution diet - Calcium oxalate will need surgical removal - Encourage water intake - Use diet to prevent recurrence

Question 30

How is feline idiopathic cystitis treated?

Answer 30

- Most cases resolve spontaneously in 5-10 days - Most treatments have not been well investigated by double-blinded placebo controlled studies - Corticosteroids and antibiotics have been critically assessed and have no positive effect

Question 31

What questions may you ask to find out about stress in a cats life?

Answer 31

Changes in environment - Household - Pets - Neighbours Is the cat more anxious?

Question 32

List the factors that can cause stress for cats

Answer 32

Other cats Overcrowding Changes in diet Weather Environment Owner stress Introduction of new pets or people

Question 33

How can you reduce stress in cats?

Answer 33

- Reduce overcrowding and bullying; provide safe places - Provide multiple and separated key environmental resources - Reassure cat with physical contact - Pheromone sprays (Feliway, Ceva) to reduce anxiety - Optimal litter box management

Question 34

How can you create dilute urine in cats with FLUTD?

Answer 34

Change to a wet diet Free access to water at all times Water fountain Fish or chicken stock

Question 35

What is the role of GAG supplements in management of FLUTD?

Answer 35

Exogenous GAG attaches to bladder lining and decreases bladder permeability Some success in people with interstitial cystitis Studies in cats no significant differences

Question 36

What is the role of analgesic and Antinflammatories in management of FLUTD?

Answer 36

- Buprenorphine - NSAIDs may help in some cases (check kidney function) e.g. Meloxicam - Stop if vomiting develops or introduce at a low dose and slowly increase to effect - Don’t use steroids

Question 37

What is the role of Tricyclic anti-depressants in management of FLUTD?

Answer 37

Amitriptyline Usually require long term treatment Reserve for chronic cases

Question 38

What are the side effects of TCAs?

Answer 38

May cause somnolence May cause urinary retention Raised liver enzymes, neutropenia and thrombocytopenia

Question 39

A cat presents with LUT signs. What is the MOST IMPORTANT thing to check on physical examination?

Answer 39

Bladder size – is it blocked or not

Question 40

You prescribe amoxycillin to a cat with signs of FIC. Will it improve?

Answer 40

Yes – because it is self limiting, not because of the antibiotic

Question 41

If 2 cats live in a house, how many litter trays should there be?

Answer 41

3