Page 230 - Problem-Based Feline Medicine

222 PART 4 CAT WITH URINARY TRACT SIGNS

– Tricyclic antidepressants are used commonly
NON-OBSTRUCTIVE IDIOPATHIC LOWER
to treat behavioral disorders.
URINARY TRACT DISEASE*** (IDIOPATHIC
– Amitriptyline is used most commonly although
CYSTITIS, FELINE UROLOGIC SYNDROME,
clomipramine has been used.
INTERSTITIAL CYSTITIS, IDIOPATHIC
– Dosage for amitriptyline is 2.5–10 mg PO q 24
FLUTD)
h or 0.5–1 mg/kg PO q 24 h, and for
clomipramine, it is 1–5 mg PO q 12–24 h.
Classical signs
– Side effects include sedation and possible anti-
cholinergic effects. ● Inappropriate urination, hematuria,
– Selective serotonin reuptake inhibitors act selec- stranguria and pollakiuria.
tively on the serotonin neurotransmitter system. ● Signs are usually transient lasting between
– Fluoxetine and paroxetine have been used to 3 and 7 days.
treat urine marking.
– Dosage for fluoxetine is 0.5 mg/kg PO q 12 h or See main reference on page 176 for details (The Cat
1–2.5 mg PO q 24 h, and for paroxetine, 0.5 Straining to Urinate) on idiopathic lower urinary tract
mg/kg PO q 24 h or 1.25–2.5 mg PO q 24 h. disease.
– Fluoxetine may take 3–4 weeks before an effect
is observed; paroxetine has a shorter half-life Clinical signs
and is quicker acting.
– Side effects include vomiting, diarrhea, nausea, Inappropriate urination, pollakiuria, stranguria and
inappetence, sleep disturbances and irritability. hematuria commonly occur.
– Historically, progestational compounds have been
Idiopathic disease is more common in cats younger
used to treat urine marking; however, because
than 10 years of age.
severe side effects such as diabetes mellitus may
occur, other pharmacotherapy should be used. Clinical signs typically last between 3 and 7 days.
● Surgical treatment can affect the incidence of
urine marking. Diagnosis
– Castrate intact males.
The diagnosis of idiopathic lower urinary tract disease
– Olfactory transaction has been used rarely and is
is based on clinical signs and exclusion of other causes
reserved for cats that are refractory to all other
of lower urinary tract disease.
forms of therapy.
● Urinalysis reveals hematuria (> 5 RBC/hbf).
● Pyuria and bacteruria are not present (i.e. < 5
Prognosis WBC/hbf).
● Abdominal radiography and ultrasonography, and
Prognosis for behavioral inappropriate urination is
contrast urethrocystography are normal or only
good; however, owner compliance is necessary.
show mild thickening of the bladder wall.
Prognosis for urine marking is good; however, cats that
Complete blood cell counts and serum biochemical
are refractory to treatment often become unacceptable
analysis are normal, and FeLV and FIV are negative.
as indoor pets and are put outdoors or are euthanized.
Prevention
UROLITHIASIS**
Inappropriate urination may be prevented by treating
underlying medical problems and by appropriate care Classical signs
of the litter box.
● Inappropriate urination is usually
Urine marking may be prevented by castrating cats associated with stranguria and hematuria.
when kittens, by minimizing stress in the environ-
ment, and by early treatment of the problem. See main reference on page 184 for details on urolithiasis.