Page 897 - Small Animal Clinical Nutrition 5th Edition

Feline Lower Urinary Tract Diseases 929

whether table food, supplements or treats are offered. Access to
VetBooks.ir other food should also be determined (e.g., other pets in the
household that eat different foods, access to food at other
households or in the outdoor environment). Trends in water
consumption (i.e., increased, decreased, unchanged) should also
be noted.
Pet owners should be questioned carefully about: 1) dura-
tion and progression of clinical signs (same, better, worse), 2)
whether the episode was the patient’s first or a recurrence, 3)
interval between episodes, 4) previous treatments (medical,
surgical, nutritional) and response to therapy, 5) presence of
other illnesses, injuries or trauma (current or previous) and 6)
presence of systemic signs (e.g., inappetence, vomiting, diar-
rhea, weight loss). Questions should be asked to determine
presence or absence of dysuria, pollakiuria, urinary inconti- Figure 46-4. Occurrence of calcium oxalate and struvite uroliths
nence, periuria, discolored urine and uroliths or urethral plugs analyzed at the Minnesota Urolith Center from 2001-2006. During
voided during urination. Approximate urine volume and any this six-year period, the number of calcium oxalate uroliths gradually
declined with a concomitant increase in struvite uroliths. (Adapted
changes in volume should be determined to distinguish be-
from Osborne CA, Lulich JP. Unpublished data. Minnesota Urolith
tween pollakiuria and polyuria. Owners should be asked Center, University of Minnesota, St Paul, 2007.)
about pharmaceutical agents that may be risk factors for
urolithiasis (e.g., allopurinol may predispose to xanthine
uroliths, excessive use of urinary acidifiers may predispose cats
to calcium-containing uroliths).

Physical Examination
The urinary bladder should be palpated carefully to evaluate
its size, shape, surface contours and thickness of the bladder
wall. The presence of pain or masses within the urinary blad-
der lumen should also be assessed. Most feline urocystoliths
cannot be detected by abdominal palpation; however, hearing
a “grating” sound during palpation of the urinary bladder
strongly suggests their presence. In male cats, the penis and
prepuce should be examined for urethral abnormalities. The
kidneys should be evaluated for size, shape, surface contour Figure 46-5. The frequency of feline perineal urethrostomies per-
and symmetry. If possible, the patient should be observed dur- formed at veterinary teaching hospitals in Canada and the United
States declined during a 20-year period and paralleled a similar
ing urination to evaluate the size of its urine stream and detect
decline in frequency of urethral obstructions and urethral plugs or
abnormalities such as discolored urine, pollakiuria, dysuria urethroliths. (Adapted from Lekcharoensuk C, Osborne CA, Lulich
and stranguria. JP. Evaluation of trends in frequency of urethrostomy for treatment
of urethral obstruction in cats. Journal of the American Veterinary
Diagnostic Evaluation Medical Association 2002; 221: 502-505.)
Initial diagnostic evaluation of all cats with lower urinary tract
signs should include urinalysis and some form of diagnostic
imaging (i.e., plain abdominal radiographs, abdominal ultra- Urinalysis
sound). Additional tests may be indicated in some patients. Complete urinalysis including determination of specific grav-
Because urine sediment examination is an unreliable means of ity, dipstick analysis and sediment examination is indicated in
detecting UTI, quantitative urine culture should be performed all cats with lower urinary tract signs. Because many cats with
in all cats with lower urinary tract signs. (See Urine Culture lower urinary tract diseases have pollakiuria, obtaining an ad-
below.) Contrast urethrocystography should be performed to equate sample for urinalysis may be challenging. Whenever
exclude small or radiolucent uroliths, urethral plugs and ana- possible, urine should be collected before treatment and eval-
tomic defects. If available, cystoscopy can also be used to detect uated as soon as possible. This is especially important for
and evaluate disorders of the lower urinary tract (e.g., uroliths, patients with crystalluria because crystals may begin to form
neoplasia). In cats with systemic signs of illness (e.g., inappe- immediately in urine as its temperature decreases. Micro-
tence, vomiting, weight loss), a complete blood count and scopic examination of urine sediment is essential to confirm
serum biochemistry analysis are indicated; however, these tests the presence of hematuria, pyuria and crystalluria.
are unlikely to be helpful in cats with signs limited to the lower Examination of unstained urine sediment, however, is an
urinary tract. unreliable method of detecting bacteriuria. When compared