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Feline Lower Urinary Tract Signs 1417

Feline Lower Urinary Tract Signs
VetBooks.ir Cat with lower urinary

tract (LUT) signs

Obstructed?
No Yes

Proceed with
Polyuria/polydipsia (PU/PD)?
emergency therapy and
No Yes radiographs (p. 1009).
Culture urine after
catheter is removed.
If all tests are negative,
First presentation? Proceed with appropriate proceed with treatment
diagnostics such as regimen to include client
Yes No urinalysis, specific gravity, education, resources,
serum biochemical and environmental
profile T4 enrichment
Periuria only? Second presentation?
Yes No Yes No

A B Periuria only? Third presentation?
Yes No

Periuria only?
C D
Yes No

Periuria: urination in inappropriate locations. E F
A Diagnostic: None is usually necessary.
Treatment: Address litter box management and cleaning of soiled areas. (see Inappropriate Elimination, Cat p. 533)
Medications: No medications are recommended.
B Diagnostic: A radiograph should be considered, especially if hematuria is present.
Treatment: If the radiograph is negative, therapy should include analgesia for 2 to 3 days during the acute episode. Litter box management and cleaning of
soiled areas should be addressed.
Medications: No medications are recommended.
C Diagnostic: A urinalysis is recommended. If submaximal urine specific gravity is present, then appropriate diagnostics are needed.
Treatment: If diagnostic tests are negative, then the resource checklist* should be reviewed and additional areas that were not previously addressed should
be incorporated.
Medications: Pheromone therapy is recommended.
D Diagnostic: A radiograph, urinalysis, and urine culture are recommended.
Treatment: If all tests are negative, analgesia should be provided for 2 to 3 days during acute episode. Canned food is encouraged for the cat in addition to
litter box management and cleaning of soiled areas. The cat’s urine specity gravity is monitored for 3 to 4 weeks to assess the cat’s water intake.
Medications: Pheromone therapy is recommended.
E Diagnostic: A urinalysis should be performed if it has not already been done. Radiographs, urine culture, and biochemical profile are also recommended. Clinical Algorithms
Treatment: If all tests are negative, then the resource checklist* is formally reviewed and those areas that have not already been addressed should be
incorporated. Further information for cleaning soiled areas should be provided. Additional resources (websites, books) on how to provide an enhanced
indoor environment for cats should be provided to clients. Intercat conflict issues should also be addressed.
Medications: Pheromone therapy should be used in conjunction with behavior-altering medications such as tricyclic antidepressants (TCAs) or buspirone.
The medication should be taken for 4 weeks; if no improvement is seen, a referral for further diagnostics and consultation should be considered.
F Diagnostic: A radiograph, a urinalysis, and a urine culture should be performed. A complete blood count (CBC) and biochemical profile should also be
submitted. If all tests are negative, a contrast study or abdominal ultrasound of the bladder and urethra should be considered to rule out radiolucent
calculi and other mass lesions.
Treatment: If all diagnostics are negative, analgesia should be provided for 2 to 3 days during acute episode. In addition to canned food, ensure that water
consumption is sufficient. Water should be viewed as a “drug,” and the cat’s urine specific gravity should be monitored (goal: submaximal concentration, e.g.,
urine specific gravity < 1.040) to evaluate water intake. The resource checklist* should be formally reviewed, and those areas that have not already been
addressed should be incorporated. Additional resources (websites, books) on how to provide an enhanced indoor environment for cats and information on
litterbox hygiene should be provided (see client handout How to Reduce Inappropriate Elimination by Litterbox Hygiene)
to clients. Intercat conflict issues should also be addressed. Follow-up and support for clients are essential.
Medications: Pheromone therapy should be used in conjunction with behavior-altering medications such as TCAs or anxiolytics. Medication should be
taken for 4 weeks; if no improvement is seen, a referral for further diagnostics such as a cystoscopy should be considered.
*Additional materials available at http://indoorpet.osu.edu/index.cfm.
(Modified from Ettinger SJ, Feldman EC: Textbook of veterinary internal medicine, ed 6, St. Louis, 2005, Saunders.)
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