Page 186 - Problem-Based Feline Medicine

178 PART 4 CAT WITH URINARY TRACT SIGNS

LUTD, and the benefit of these diets may be from the
TREATMENT
reduction in urine SG.
Goals of therapy are to relieve the discomfort and
Canned food has been shown to reduce the incidence
pain associated with cystitis and to reduce the fre-
of feline lower urinary tract disease compared to dry
quency of recurrence.
food, probably because of the lower urine SG pro-
Signs are self-limiting despite therapy. Remission duced. Constancy of diet may help as dietary change
usually occurs within 7 days. can precipitate signs.
Several treatments, such as antimicrobials, glucocor- Aim for a low urine specific gravity (eg. 1.020), by
ticoids, progestagens (megestrol acetate), intravesic- adding water or a meat-flavored liquid to the food.
ular administration of DMSO (10–20 ml of 10% Urine should look like water and have no odor. If feed-
solution instilled in bladder for 10 minutes under ing dry food, add 1 cup of water to 1 cup of dry food
general anesthesia), anticholinergic agents, diuretics and allow it to soak for at least 5 minutes.
(furosemide), elimination diets, pentosan polysulfate
Amitryptyline (2.5–5 mg/cat orally at night) may be
and the surgical placement of a copper ring in to the
useful in some cats to reduce signs of irritative voiding
bladder have been advocated, but their efficacy is
but not hematuria. It is a tricyclic antidepressant which
questionable.
prevents mast cell degranulation and has anti-inflam-
Antispasmodic drugs can provide symptomatic relief matory, analgesic, anticholinergic and alpha adrenergic
from straining. Flavoxate (50 mg BID), propantheline blocking effects. A significant reduction in the frequency
bromide (7.5 mg/cat sid PO), or phenoxybenzamine of recurrence may occur with prolonged use, without
(2.5–10 mg PO q 8–12 h). improvement in urinalysis or cystoscopy findings.
Adverse reactions reported in cats include sedation,
Pain relief via opiates (including a fentyl patch, butor-
weight gain, unkempt haircoat, urine retention, throm-
phanol elixir) are indicated for cats that are frequently
bocytopenia and neutropenia.
straining to urinate.
Reduction of stress and environmental change may
Anti-inflammatory drugs such as piroxicam (0.3 mg/kg
help to prevent recurrence. In susceptible cats,
PO sid) may decrease straining and pollakiuria.
episodes can be triggered by environmental change
Megestrol acetate 5 mg sid PO for 5 days has been (e.g. changes in food, house, animals or people in the
reported by one author (Norsworthy) to be the most house).
effective drug for relieving dysuria. ● Use of the synthetic feline facial pheromone
(Feliway, Ceva Animal Health), which reduces anx-
Hydrodistension of the urinary bladder (80 cm of
iety in cats may be beneficial in some situations. In
water for 10–15 minutes) may give relief of signs in
cats with interstitial cystitis, there was a trend to
some cats and prevent reoccurence.
show fewer days with clinical signs of cystitis in
Cosequin (pentosan polysulfate (Elmiron) 8 mg/kg PO cats where the environment was treated with the
q 12 h) is a glycosaminoglycan (GAG) which is used pheromone.
in humans with interstitial cystitis to promote urothelial
Ensure that there are sufficient litter boxes and they are
GAG formation. It can be mixed in the food and given
cleaned frequently.
indefinitely to reduce recurrence. However, GAG
replacers have not been proven to be more effective If signs do not resolve within 7 days, the cat should be
than placebo in cats with interstitial cystitis. re-evaluated for other diseases causing these signs.
Feed exclusively a specially formulated non-calcino-
genic diet that is used to minimize struvite crystal
Prognosis
formation and maintain a low urine pH (<6.5) and
specific gravity (<1.030). Such diets have been shown Prognosis for recurrence is guarded because the etiol-
to be effective. However, struvite crystalluria does not ogy is unknown and treatment is largely supportive in
appear to be a significant factor in non-obstructed nature.