Page 755 - Small Animal Internal Medicine, 6th Edition

CHAPTER 44 Obstructive and Nonobstructive Feline Idiopathic Cystitis 727

Indwelling urinary catheters are not mandatory for every q12h), with variable success. Because hypotension could
urethral obstruction. An indwelling catheter might be irri- develop with the administration of these drugs, they should
VetBooks.ir tating to the urethra and potentiate urethral irritation and not be given until the cat is stable and alert; blood pressure
should be monitored if clinically indicated. In one study,
subsequent reobstructions once the catheter is removed.
However, an indwelling catheter should be placed in cats
struction in cats with naturally occurring obstructive FIC;
with severe azotemia, an abundance of debris and hemor- prazosin had no effect on the incidence of urethral reob-
rhage noted in the urine, or the presence of detrusor atony, however the authors were concerned their study was under-
or in cats with urethral obstructions caused by calculi (until powered. No other medications, including oral meloxicam
surgery can be performed). A soft 3.5F or 5F catheter (e.g., administered for 5 days, intravesical lidocaine infusion, or
red rubber or Slippery Sam catheter) can be left in place; intravesical glycosaminoglycans, have been reported to have
strict aseptic technique should be followed. A closed collec- a beneficial effect in preventing urethral reobstruction in FIC
tion system should be used to aid in sterility as well as to cats. If bladder atony is suspected, the parasympathomimetic
monitor urine output (Fig. 44.5). Azotemic cats can have a bethanechol can also be administered (2.5 mg/cat PO q12h).
pronounced postobstructive diuresis, and it is imperative to Adverse effects with this class of drugs are primarily GI
provide adequate IV fluid therapy for these patients. Urine (vomiting and diarrhea). Once the diuresis is complete, the
output should be recorded every 4 hours initially, and the IV fluids can be tapered and the catheter removed. Once the
amount recorded. The rate of IV fluids administered can catheter is removed, chronic management is the same as for
then be adjusted based on the recorded urine output. Renal nonobstructive FIC.
parameters and potassium concentration should be moni-
tored; hypokalemia can develop during the diuresis phase. A Nonobstructive Feline Idiopathic Cystitis
urine culture can be considered after the urinary catheter is FIC has a variable outcome; clinical signs resolve in as many
removed; there is no indication to culture the catheter tip. as 85% of cats within 2 to 3 days, with or without treatment.
In addition to analgesics, α 1 -antagonists such as phenoxy- When a cat is diagnosed with FIC, analgesic therapy for
benzamine (2.5 mg/cat orally [PO] q12h) or prazosin acute management of the disease should be provided. Pro-
(0.5 mg/cat PO q12h) is often administered to cats with ure- viding analgesia for cats with FIC seems prudent given the
thral obstruction to decrease urethral “spasms” and hope- clinical manifestation. Nonsteroidal antiinflammatory drugs
fully prevent reobstruction. Anecdotally, veterinarians have (NSAIDs) have been described for this disease, with variable
also used the more selective α 1 -antagonist, tamsulosin results. Because of the risk for dehydration-associated reduc-
(Flomax; anecdotal doses are 0.004-0.006 mg/kg PO q24h or tions in blood flow to the kidneys and the potential for acute
kidney injury, these medications might increase the risk for
adverse outcomes. It is important the cat is eating and drink-
ing well when NSAIDs are administered.

CHRONIC MANAGEMENT
Environmental Alterations
No cure is currently available for FIC; treatment options are
aimed at clinical recovery, keeping the cat’s clinical signs to
a minimum, and increasing the disease-free interval. After
the diagnosis of FIC is made, a thorough environmental
history, as well as notation of all other comorbidities present,
needs to be obtained so the clinician can establish that all the
environmental needs of the cat have been met. A technician-
based program, in which a staff member works with these
patients as often as necessary to be sure the cat’s problems
are thoroughly explained to the owners so they can under-
stand the disease process enough to feel comfortable with
managing their cat’s disease, can also be of great benefit.
Following a staged approach to therapy that begins with
client education and multimodal environmental modifica-
tions (MEMO) seems beneficial in many cats with FIC.
MEMO therapy involves obtaining a thorough environmen-
tal history, including but not limited to the topics presented
FIG 44.5
Closed collection system used for a cat with significant in Box 44.1. The client should answer these questions for all
hematuria postobstruction. By doing this, the clinician can cats in the household, and the clinician can then review the
also record the amount of urine produced by the cat to list and identify issues that may be contributing to the cat’s
guide intravenous fluid therapy. clinical signs. After the questionnaire is completed, it should