Page 227 - Problem-Based Feline Medicine

14 – THE CAT WITH INAPPROPRIATE URINATION 219

IATROGENIC
● Catheterization of the urinary bladder or urethra* (p 224)
History of catheterization for relief of urethral obstruction, bladder disease or for diagnostics.
TRAUMATIC
● Trauma to urethra and/or urinary bladder*** (p 223)
History of trauma or physical examination findings of trauma (fractures, skin abrasions, uroab-
domen, etc.). Cats may be able to urinate even when the urinary bladder is compromised.

● In young cats, idiopathic lower urinary tract dis-
INTRODUCTION
ease is the most common cause of lower urinary
tract disease occurring in 50–70% of cases.
MECHANISM? – Urolithiasis is the second most common cause
occurring in 15–25% of cases.
Inappropriate urination is defined as cats urinating in
– Bacterial urinary tract infection, trauma, neoplasia
inappropriate places (typically outside of a litter box)
and incontinence are uncommon in young cats.
or at inappropriate times.
● In cats older than 10 years, bacterial urinary
Lower urinary tract disease is the most common cause tract infection is the most common cause of lower
of inappropriate urination, and signs such as pollaki- urinary tract disease, occurring in 35–50% of cases.
uria, stranguria and/or hematuria, are usually present. – Urolithiasis occurs in 10–15% of cases.
– Idiopathic disease, trauma, neoplasia and
Inappropriate urination may also occur with inconti-
incontinence are uncommon causes.
nence, polyuric states and an inability to retain urine
appropriately, or as a behavioral problem. Inappropriate urination, however, may occur without
– Inappropriate urination may be a behavioral prob- signs of lower urinary tract disease.
lem that is learned while the cat is suffering from ● It may occur with incontinence.
another lower urinary tract disease, such as idio- ● It may occur with polyuric states.
pathic lower urinary tract disease or urolithiasis. ● It may be behavioral.
● Cats are inherently fastidious creatures and do not
Diagnosis is based on historical information, physical
normally soil where they live.
examination findings and results of laboratory and radi-
● Male cats may urinate outside of the litter box to
ological evaluation.
mark their territory.
● Female cats usually do not mark territory; how-
DISEASES CAUSING INAPPROPRIATE
ever, they may do so if they are, or become, the
URINATION
dominant cat in the household.
BEHAVIORAL***
WHERE?
Classical signs
Brain, bladder and urethral sphincter (mucosa, muscle,
● Behavioral elimination problems are the most
nerves).
common behavior complaints of owners.
● If pollakiuria, stranguria and hematuria are present,
● Cats may urinate outside of the box.
it localizes the disease to the lower urinary tract.
● Behavioral urination problems may include
inappropriate urination or urine marking.
WHAT? ● Underlying medical problems may result in
a behavioral component causing
Most commonly, inappropriate urination occurs with inappropriate urination.
lower urinary tract disease.