Feline Lower Urinary Tract Disease (FLUTD) refers to a constellation of clinical signs that can indicate one (or more) disease processes. The clinical signs often include, periuria (urination in areas other than the litter box), dysuria (painful urination), hematuria (bloody urine), stranguria (straining to urinate), and pollakiuria (small, usually frequent, amounts of urine). These clinical signs can be the result of a urethral obstruction, which is a life threatening condition that requires immediate medical care, but can also be caused by a urinary tract infection and a newly recognized condition, Feline Idiopathic Cystitis (FIC), or a combination of these. An underlying condition, such as an anatomical defect (e.g. diverticulum, hernia or urethral stricture), or a mass/neoplasia/cancer may be exacerbating or causing these processes. There may also be a behavioral, or neurogenic/neuropathic component to any of these conditions.
Urethral obstruction may result from a urolith (‘bladder stone’ that has passed into the urethra and gotten lodged), urethral plug (protein and cellular (e.g. white blood cells) material), inflammation/swelling, spasms of the urethra, trauma, congenital defects, masses, or foreign bodies. Typically, males become obstructed more frequently than females as their urethras are long and narrow. As a urethral obstruction is a life threatening emergency, due to hyperkalemia (elevated blood potassium), which causes a fatal heart arrhythmia.
If you notice that your cat is urinating in places other than their litter box, is crying/vocalizing while attempting to urinate, has blood in their urine, is attempting to urinate and little or no urine is being produced, or is urinating only small amounts (typically very frequently), CONTACT YOUR PRIMARY CARE VETERINARIAN, OR THE AERC IF YOUR DOCTOR IS NOT IMMEDIATELY AVAILABLE. The veterinarian will want to perform complete blood work to determine the health of your pet, an underlying cause of the obstruction, potentially, and the level of potassium in their blood, which, if too high, may be fatal. Imaging (radiographs/’x-rays’, and or an ultrasound) will also be required to understand why the urethra is obstructed – some uroliths (‘bladder stones’) can be seen with imaging techniques. Imaging will also help the veterinarian to understand the health of the bladder and entire urinary tract. The urine should also be assessed to understand the health of the urinary tract, and to microscopically assess the potential cause of the obstruction, be it crystals, or proteinaceous/cellular debris. Understanding the underlying cause of the urethral obstruction will help determine the best treatment to prevent another occurrence, which, unfortunately, is common for cats that are predisposed to this process.
While understanding the underlying cause is of utmost importance, caring for the pet and helping them to return to health is the goal of any veterinarian. To do so, it will be required that your pet is hospitalized for initiating treatments and supportively caring for them. Your cat may most likely need to have an indwelling urinary catheter placed to ensure the voidance of urine while the underlying cause of the obstruction is diagnosed and treated. In addition, any electrolyte abnormalities (e.g. hyperkalemia) will need to be resolved, usually with intravenous fluids, to return your cat to health. Antibiotic therapy and pain management are also typically employed while treating urethral obstruction, but there may be additional treatments, including medications for behavioral modification, and a recently developed therapy with glycosaminoglycan, which helps to return the bladder’s mucosal layer to health and significantly reduces the reoccurrence of urethral obstruction.