Page 716 - Cote clinical veterinary advisor dogs and cats 4th

Feline Lower Urinary Tract Signs, Idiopathic 333

even before laboratory values for serum Locate these resources in quiet places problem, and recurrent episodes of
+
where the cat is not startled during use.
potassium (K ) return if arrhythmias are ○ Provide opportunities for the cat to hide urolithiasis and LUTS still can occur.
VetBooks.ir ○ Consider decompressing the bladder by safely and explore its environment. Placing Nutrition/Diet Diseases and Disorders
present (p. 495).
cystocentesis before attempting to pass a
perches at windows so the cat can look
• Dietary therapy may be indicated if uroliths
urinary (urethral) catheter (p. 1009).
○ Several methods are described for urethral outside and structures the cat can climb or crystals are identified and depends on the
type of urolith.
on seem to be important parts of EE.
obstruction relief. A widely used technique ○ Safe outdoor spaces (e.g., fenced enclo- • Glycosaminoglycan (GAG) supplementation
is detailed on p. 1009. sures) provide excellent EE opportunities. has been suggested, but its efficacy remains
○ Manage cats medically unless recurrent ○ Provide a regularly scheduled time for unproved in cats.
obstructions occur. For most, analgesics petting, play, and/or trick teaching, working
and appropriate fluid therapy are indicated. toward at least 10 minutes each day. Possible Complications
Evidence is lacking for alpha-blocking ○ Identify and resolve intercat conflict to • When introducing EE, offer changes to
drugs (e.g., phenoxybenzamine, prazosin). the extent possible. the cat (e.g., new food in a separate bowl
○ Monitor urine output frequently in very ○ If ineffective, proceed to step 2. rather than in place of the familiar diet)
ill cats. Postobstructive diuresis (>2 mL/ • Step 2: step 1 plus consider use of phero- to avoid precipitating a threat response.
kg/h) may occur shortly after relief of mones (Feliway). If ineffective, proceed to Make changes the client wants to make,
obstruction and rehydration. During this step 3. if possible, to secure support and adher-
period, it is essential to give sufficient IV • Step 3: steps 1 and 2 plus consider use of a ence to the EE effort. Make changes
fluids to replace the volume lost as urine. tricyclic antidepressant (TCA) agent (e.g., sequentially.
The diuresis declines by 2-5 days. clomipramine or amitriptyline) or selective • When TCA or SSRI drugs are being used and
• The role of glucocorticoids (e.g., prednisone) serotonin reuptake inhibitor (SSRI; such the decision is made to discontinue them,
and nonsteroidal antiinflammatory drugs as fluoxetine) at the lowest effective dose they should be tapered slowly over at least
(e.g., aspirin, meloxicam) remains poorly possible. These drugs should be used only 2 weeks to avoid adverse reactions.
defined, and none of these drugs has been after steps 1 and 2 have been implemented
shown to be an effective treatment for and the cat is so severely affected he/she Recommended Monitoring
acute LUTS. Nonsteroidal antiinflamma- continues to have recurrences. Conclusive Liver and kidney function should be assessed
tory drugs are absolutely contraindicated results regarding the efficacy of behavior- before use of TCAs and at least annually for
in the presence of azotemia due to the risk modifying drugs are lacking. young animals if therapy is extended.
of nephrotoxicity. • Perineal urethrostomy may be needed in
severe recurrent obstructive cases. PROGNOSIS & OUTCOME
Chronic Treatment ○ This surgery increases the risks of bacterial
• Step 1: EE/multimodal environmental urinary tract infections, and postoperative Most cases of idiopathic, nonobstructive, feline
modification (MEMO) strictures are a potential complication. LUTS are self-limited, usually resolving in 5-10
○ Provide at least one food bowl, one water ○ Clients should be made aware that this days. However, recurrent episodes, including
bowl, and one litter box per cat plus one. surgery does not correct the underlying urinary tract obstruction, occur with variable
frequency. Overall prognosis depends on the
cat, client, and environment:
Drugs Commonly Used for Cats With LUTS • Cat
○ Genetic predisposition
Drug* Dosage Potential Side Effects ○ Duration of the problem
○ Frequency of occurrences
Acute Analgesic ○ Number of areas and different types of
Butorphanol (Torbugesic) 0.2-0.4 mg/kg IV, IM, SQ q 2-8h (IV: use Sedation surfaces soiled
lower end of dose range; not an ideal • Client
choice due to short duration of analgesia) ○ Ability to identify modifiable causes
Buprenorphine (Buprenex) 0.01-0.02 mg/kg IM, IV, or SQ q ○ Strength of bond with affected cat
8-12h; 0.015 mg/kg PO or sublingual/ ○ Willingness to pay for treatment
transmucosal q 8-12h (anecdotal) ○ Amount of time to devote to solution
Methadone 0.1-0.3 mg/kg IM, IV q 4-6h Sedation ○ Willingness to accept and use medications
Fentanyl CRI or patch 1-5 mcg/kg/h CRI or 25 mcg/h patch Respiratory depression, bradycardia • Environment
(Duragesic) ○ Number of cats in the household
○ Number of affected cats
Bladder/Urethral Contractility
○ Practicality of allowing limited outdoor
Acepromazine (PromAce) 0.01-0.05 mg/kg SQ q 8h, Sedation, hypotension access
2.5 mg/CAT PO ○ Ability to rearrange the environment
Prazosin (Minipress) 0.5 mg/CAT PO q 12h Hypotension
Phenoxybenzamine 2.5 mg/CAT PO q 12h Hypotension PEARLS & CONSIDERATIONS
(Dibenzyline)
Comments
Bethanechol (Urecholine) 2.5-5 mg/CAT PO q 12h Salivation, vomiting, diarrhea EE often is sufficient to suppress clinical signs
Chronic Analgesic/Anxiolytic and should be discussed with all owners of cats
Clomipramine (Anafranil) 0.5 mg/kg PO q 24h Sedation, anticholinergic effects exclusively housed indoors.
Amitriptyline (Elavil) 5-12.5 mg/CAT PO q 12-24h Sedation, weight gain, urine
retention; urolith formation Prevention
Fluoxetine hydrochloride 0.5-1 mg/kg PO q 24h Decreased food intake EE recommendations should be provided to
all owners of indoor cats, not just those with
*These are all off-label uses. a clinical problem.

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