Page 198 - Problem-Based Feline Medicine

190 PART 4 CAT WITH URINARY TRACT SIGNS

Urethral rupture may result in subcutaneous accumu- Clinical signs
lation of urine in the perineal region leading to
Small amounts of urine are frequently voided while the
swelling, discoloration and necrosis of the skin.
urinary bladder is still small.
Clinical signs Dribbling urine (incontinence) associated with a small
bladder.
Dysuria.
Pollakiuria.
Stranguria.
Palpation of the bladder often initiates the act of
Perineal swelling.
urination.
Red discoloration of the perineal skin.

Abdominal pain. *Diagnosis
Signs of post-renal renal failure. Diagnosis is based on clinical signs, especially that the
cat frequently urinates or dribbles urine when the
Diagnosis bladder is quite small.

History of trauma or catheterization. Urodynamic procedures, such as cystometrography,
demonstrate reduced threshold volumes and pressure,
Clinical signs of swelling, discoloration or necrosis in which indicate reduced bladder compliance or
the perineal region. detrussor hypercontractility.

Positive-contrast urethrography will demonstrate Urinalysis may reveal pyuria or neoplasia.
extravasation of contrast into the periurethral soft tis-
sue. If the rupture is at the proximal end of the urethra, Radiography may help to determine the underlining
contrast agent may enter the abdomen. cause, for example neoplasia and cystitis (thickened
bladder wall).
FeLV test.
HYPERCONTRACTILE BLADDER*

Classical signs Differential diagnosis
● Small urinary bladder. Infectious cystitis/urethritis – hematuria, pyuria and
● Dribbling urine. bacteriuria are usually present.
● Pollakiuria.
Non-obstructed LUTD – hematuria is usually present.

Pathogenesis
Treatment
Hypercontractility of the urinary bladder occurs when
detrusor muscle contractions are triggered at low Management of storage dysfunction of the urinary
volumes and pressure, resulting in dysfunction of uri- bladder may include elimination of urinary tract
nary bladder storage. inflammation, correction of neurologic disorders or
pharmacologic manipulation to reduce detrusor muscle
It may be due to reduced bladder capacity (hypoplas-
excitability.
tic bladder, neoplasia), excessive sensory input
● Always treat urinary tract infections first before
(inflammation) or neurologic disorders (upper motor
attempting pharmacologic manipulation.
neuron lesions).
● Parasympathetic inhibitors (anticholinergic
Bladder hypercontractibility (idiopathic detrusor insta- agents), such as propantheline (5–7.5 mg /cat
bility), not associated with any known cause, has been orally every 72 hours or more frequently as
reported in one cat with FeLV that responded to anti- required) and oxybutynin (0.5–1.25 mg/cat orally
cholinergic therapy. every 8–12 hours) may be used.