Investigation of lower urinary tract disease

Question 1

Which elements of the patient’s history are suggestive of FLUTD or important for the diagnosis of FLUTD

Answer 1

Age
- young to middle-aged cats are over-represented with FIC
- old cats are unlikely to present with a first episode of FIC but may suffer other diseases resulting in a predisposition to UTI (e.g., CKD)

As the most common cause of LUTD is FIC, it is important to include questions about potential stress in the cat’s life (e.g., how many cats, lifestyle)

Dietary history (e.g. dry vs wet)

Pattern of clinical signs
- cats with FIC tend to suffer multiple short episodes of dysuria, rather than continuous or progressive signs that may indicate UTI or neoplasia

Presence of concurrent signs that may suggest an underlying systemic disease
- e.g., PU/PD and polyphagia with diabetes

Question 2

Which clinical signs is suggestive of urethral obstruction

Answer 2

palpation of a large, painful bladder in a cat presenting with dysuria/pollakiuria

Question 3

How is the bladder in cats with non-obstructive FIC

Answer 3

Cats with non-obstructive FIC tend to have small, empty bladders due to the pollakiuria

They may have generalized bladder wall thickening

Rarely a urolith or mass may be palpated within the bladder

Question 4

Explain how renal palpation could help differentiating UTI from FIC

Answer 4

Cats with CKD may present with dysuria due to UTI and have small firm irregular kidneys

Question 5

Which body condition is a risk factor for FLUTD

Answer 5

Overweight or obese cats are predisposed to FLUTD

Question 6

What is a risk factor for UTI

Answer 6

Cats with conditions resulting in reduced urine concentrating ability may suffer UTI (e.g. diabetes mellitus)

Question 7

Which examination is vital in the investigation of cats with urinary signs

Answer 7

Urinalysis is vital in the investigation od cats with urinary signs
- A cystocentesis sampleis desirable to avoid bacterial contamination but it may be difficult in case of pollakiuria due to small bladder size

Question 8

Explain why examination of urine sediment should be routine in the investigation of dysuria/pollakiuria or inappropriate urination

Answer 8

Because pyuria and hematuria are commonly found

Ideally bacterial culture is performed to exclude UTI

Question 9

Which precaution is important to take with the urine sample for sediment evaluation

Answer 9

All samples should be examined as soons as possible to avoid artifactual crystalluria

Question 10

What are the most common causes of FLUTD

Answer 10

Urolithiasis and urethral obstruction accounting for up to 40 % of clinical cases

Urerthal obstuction can be caused by:
- a single urolith
- an accumulation of small uroliths
- a urethral plug (this is the most common cause)
- urethral stricture
- functional spasm of the urethral sphincter