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332 Feline Lower Urinary Tract Signs, Idiopathic

Feline Lower Urinary Tract Signs, Idiopathic Client Education
Sheet
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○ Bladder may be large, painful, turgid, and
BASIC INFORMATION
inexpressible (obstructed) States but seems more common in European
studies.
Definition • For cats with a typical first-time presenta-
Lower urinary tract signs (LUTS) include stran- Etiology and Pathophysiology tion and without urinary obstruction, no
guria, hematuria, dysuria (difficult or painful • The cause is not known, although a subset additional diagnostic tests may be required.
urination), pollakiuria (frequent passage of small of patients appear to have a congenital
amounts of urine), and periuria (urination in disorder of the stress-response system that Advanced or Confirmatory Testing
inappropriate locations). These signs can occur results in persistent sensitization of the system For cats with complicated initial presentations
with lower urinary tract disease (LUTD) of and reduced adrenocortical function. The or recurrent episodes, diagnostic testing is aimed
any cause. Idiopathic feline LUTD is the most sensitivity may be unmasked by cat-perceived at ruling out the most common alternative diag-
common cause of LUTS and is a diagnosis of threats in the environment, such as conflict nosis. With idiopathic LUTS, no abnormalities
exclusion (see Differential Diagnosis below). with other animals, and impoverished are expected.
environments. • Radiography of the entire lower urinary tract
Synonyms • The enhanced sympathetic drive may reduce (including the distal urethra) to identify
Feline lower urinary tract disease (FLUTD), epithelial tight-junction integrity, resulting radiopaque stones
feline idiopathic cystitis (FIC), feline urologic in increased exposure of afferent neurons • CBC, biochemical analysis, and serologic
syndrome (FUS) to environmental stimuli. When this occurs testing for feline leukemia virus and feline
in the bladder of a cat with an activated immunodeficiency virus
Epidemiology stress-response system, LUTS may result. • Other lower urinary tract imaging (e.g., ultra-
SPECIES, AGE, SEX • The imbalance between the sympathetic sonography, double-contrast cystography) or
Cats of either sex, any age. Male cats develop nervous system and hypothalamic-pituitary cystoscopy is rarely indicated.
lower urinary tract obstruction more than adrenal axis that occurs in some affected cats • A comprehensive history and investigation
female cats (narrow penile urethra). may result in impaired blood flow and release of the cat’s environment is warranted in cats
of inflammatory mediators that cause lower with recurrent episodes to better understand
GENETICS, BREED PREDISPOSITION urinary tract edema, smooth muscle spasm, provocative events and make recommenda-
Persians and long-haired cats may be at increased and pain. tions regarding environmental enrichment
risk and Siamese at reduced risk. Familial • Neurohormonal alterations may occur alone (EE).
factors (e.g., quality of maternal care) may play or in combination with physical obstruc-
a role. tion of the urinary tract by a cystolith or TREATMENT
urethral plug that precipitates lower urinary
RISK FACTORS obstruction. Treatment Overview
Identified risk factors vary between studies but Long-term treatment focuses on stress reduction
often include stress (e.g., changes in feeding, DIAGNOSIS through owner education and EE. With lower
litter boxes, human and animal family members, urinary tract obstruction, prompt attention is
owner schedule), neutering, indoor housing, Diagnostic Overview required to manage the associated metabolic
increased weight, decreased activity, multi-cat The diagnosis is suspected based on signalment, derangements and re-establish urine flow
households, and season/geographic climatic history, and physical exam. Urinalysis with because urethral obstruction is a life-threatening
variation (spring in the Northeastern United sediment exam plus culture and susceptibil- condition. A step-by-step approach to treatment
States). ity can help rule out urinary tract infection, is provided on p. 1417.
and imaging studies can rule out urolithiasis.
ASSOCIATED DISORDERS Additional diagnostic tests are warranted in Acute General Treatment
Cats with LUTS may be at increased risk for cats with atypical presentations, persistent If the cat is obstructed, relief of the obstruction
separation anxiety disorder and other behavioral or frequent episodes of LUTS, or urethral (p. 1176), re-establishment of urine flow and
abnormalities (fear, nervousness, aggression), obstruction. correction of fluid, electrolyte, and acid-base
and obesity. Urethral obstruction may occur imbalances are of prime importance.
in male cats with LUTS. Differential Diagnosis • Establish intravenous (IV) access and provide
• Urolithiasis appropriate analgesia.
Clinical Presentation • Behavioral disorder (e.g., territorial marking • Perform serum biochemical profile, CBC, and
HISTORY, CHIEF COMPLAINT [p. 533]) urinalysis. Although all can provide useful
• Abrupt onset of LUTS in an otherwise • Urinary tract infection information, serum potassium concentration
healthy, young adult cat (usually 2-6 years • Anatomic urinary tract defect (notably is of the utmost importance for cats with
old at first occurrence) vesicourachal diverticula) urethral obstruction. Point-of-care venous
• Often, affected cats are housed entirely • Bladder neoplasia (uncommon; transitional blood gas, electrolyte, and acid-base profiles
indoors and are neutered. cell carcinoma most often identified tumor generally include potassium concentrations
• Male cats with obstructive LUTD have type) and can provide results in a timely fashion.
unproductive stranguria and may vocalize, • Resuscitate moribund cats with IV fluids,
vomit, and become progressively depressed/ Initial Database and correct serious electrolyte and acid-base
obtunded. • Urinalysis with sediment exam will often disturbances before sedation or anesthesia
reveal hematuria, hypersthenuria (urine for placement of a urinary catheter.
PHYSICAL EXAM FINDINGS specific gravity > 1.035), proteinuria, ○ Obtain an electrocardiogram (ECG) of
• Often anxious, may be aggressive or shy +/− crystalluria. all systemically ill cats with urethral
• Bladder typically small and difficult to palpate • Urine culture and susceptibility: infection obstruction. Cardiotoxic effects of severe
(unobstructed) is rare in studies of FLUTD in the United hyperkalemia may need to be addressed

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