Monday, January 30, 2023

Feline Lower Urinary Tract Disease

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Urinary Health Questions To Ask Your Veterinarian

Feline Lower Urinary Tract Disease (FLUTD) – VetVid Episode 008
  • What may be causing my cats accidents? What are the short-term and long-term treatment options?
  • Be sure to ask if infrequent or non-patterned accidents may be a sign of a more serious problem.
  • Ask if the problem is behavioral, environmental or medical.
  • Ask how nutrition and water consumption may be affecting your cats health.
  • Should nutrition be a part of my cats treatment regimen? Would you recommend a Hills® Prescription Diet® cat food for my cats bladder health?
  • What if I have multiple cats? Can I feed them all the same cat food?
  • How can nutrition help? What is the benefit of feeding therapeutic nutrition versus administering pills?
  • What are the pros and cons of using nutrition to help manage my cats urinary health?
  • Which form of cat food is better for urinary issues, kibble or wet? Why?
  • If you feed your cat a mixture of kibble and wet food, ask which therapeutic formulas can be mixed.
  • How long will I need to feed the recommended food to my cat?
  • Ask how feeding a therapeutic cat food can help promote long-term urinary health for my cat?
  • What is the best way to reach you or your hospital if I have questions?
  • Ask if you need a follow-up appointment.
  • Ask if a reminder email or notice will be sent.
  • What Are The Signs

    Most cats with FLUTD will have blood in the urine and discomfort while urinating. The discomfort is usually mild, but can become much worse if it is not treated. Other signs include:

    • Frequent urination or straining, often only passing a small amount
    • Meowing or howling during urination
    • Foul-smelling or cloudy urine
    • Frequent licking of the genital area
    • Inappropriate elimination

    Cfeline Lower Urinary Tract Disease

    When clinical signs of FLUTD are present, a complete diagnostic evaluation including urinalysis should be performed to aid in selection of treatment and dietary management. Diet has been shown to be important in the management of FLUTD, especially when struvite urolithiasis is involved. Because FLUTD tends to be a recurrent problem in affected cats, practical recommendations for long-term dietary management usually include feeding diets that acidify the urine and avoiding diets containing excessive dietary magnesium . Because precipitation of struvite crystals is intensified by a low volume of urine, use of canned foods is also recommended, because canned foods contain 7080% water and promote higher urine volume.

    J.F. Ladlow, in, 2014

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    What Is The Treatment For Flutd

    This depends on the underlying cause. For example:

    • Bacterial infections of the lower urinary tract usually respond well to antibiotic therapy. See handout “Urinary Tract Infections in Cats” for further information.
    • If a cat develops a blocked urethra, emergency treatment is required to remove the blockage. Usually the cat will be given a short-acting general anesthetic and the urethra will be flushed or catheterized. Urethral obstruction occurs almost exclusively in male cats. Other treatment options may be recommended based on your cats specific blockage.
    • If bladder stones or uroliths are present, they will have to be removed. Depending on their type, they may be able to be dissolved by using a special diet or dietary additive, or they may require surgical removal. In some cases, this can be determined by the results of a urinalysis. See handout “Bladder Stones in Cats” for further information.

    “Treatment has to be tailored to the individual cat.”

    There is no universal treatment for FLUTD. Each case has to be investigated to determine the underlying cause, and then the treatment has to be tailored to the individual cat. Sometimes despite appropriate tests and treatment, clinical signs may still recur, requiring further therapy and diagnostic testing.

    Recovery And Management Of Flutd

    Drovers Vet Hospital

    Though improvement of symptoms can occur within days, it is common for FLUTD to come back, so active management will be a lifelong commitment. Medications may only be used long-term in severe cases. Cats that respond well to prescription diets should stay on them indefinitely. You will work with your veterinarian to adjust treatment accordingly.

    Sudden changes in your cats environment make it much more likely for symptoms to return. You will need to try to anticipate stressful situations for your cat, such as moving or adding new pets or family members to the household.

    While many cats with FLUTD can live a long and happy life, it is not uncommon for treatment to fail. Unfortunately, euthanasia may be considered for cats with pain and anxiety that cannot be controlled.

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    What Can I Do At Home To Prevent Future Occurrences

    A few unfortunate cats who have suffered from FLUTD will experience frequent recurrences of bladder inflammation, re-obstruction, or formation of uroliths. Fortunately, most others rarely experience the problem again or will have only occasional recurrences.

    Home care of cats who have suffered from lower urinary tract disease is determined by the cause, and varies depending on the cats condition and history. Some steps can be taken, however, to help reduce the frequency of attacks and both the severity and duration of signs when the problem occurs.

    Steps to Reduce Occurrences and Signs of FLUTD

  • Feed small meals on a frequent basis.
  • For cats with a history of struvite formation, owners should feed diets that promote the formation of urine that is acidic. Most commercial diets meet this criterion. Avoid supplementing such diets with additional urinary acidifiers, because over-acidification can cause metabolic acidosis, impaired kidney function, and mineral imbalance.
  • Provide clean, fresh water at all times.
  • Provide an adequate number of litter boxes .
  • Keep litter boxes in quiet, safe areas of the house.
  • Keep litter boxes clean.
  • Minimize major changes in routine.
  • Cats with a urethral obstruction will show the above signs but will pass little or no urine and will become increasingly distressed. A urethral obstruction is an absolute emergency, requiring immediate veterinary treatment.

    Which Cats Are The Most At Risk Of Flutd

    FLUTD is thought to affect around 1-3% of cats each year, so is among the more common diseases seen. Because of the diverse nature of the underlying causes, cats of any age, breed and gender can be affected by FLUTD, but in general, the disease is more common in:

    • Middle-aged cats
    • Cats which take little exercise
    • Cats with little or no access outside
    • Cats that eat a dry diet

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    Immediate Stabilization Of A Cat With Feline Urinary Obstruction

    Immediate stabilization with an IV fluid bolus and analgesics are recommended. If hyperkalemia is present, or suspected based on bradycardia, treatment to reduce the potassium is essential.

    There are three approaches to treatment of hyperkalemia shifting potassium into cells, increasing renal excretion of potassium, and prevention of cardiac conductance abnormalities.

    • Intracellular shifting of potassium can be accomplished with dextrose by causing endogenous release of insulin. Exogenous insulin can also be administered but must be accompanied by dextrose administration to prevent hypoglycemia. Beta agonists and sodium bicarbonate can also be utilized, but their use is restricted to critical patients due to the risks associated with administration.
    • Renal excretion of potassium is primarily accomplished by relieving the obstruction, but fluid administration can also increase excretion.
    • Calcium gluconate alters membrane action potentials within the heart thus preventing the negative sequelae of hyperkalemia in the heart. Calcium gluconate is recommended for patients that have arrhythmias or bradycardia as a result of hyperkalemia but given that it does not affect potassium concentrations it must be used in conjunction with other therapies to normalize potassium.

    Lower Urinary Tract Disease Treatment In Cats

    Feline Lower Urinary Tract Disease (FLUTD)

    FLUTD treatment will depend on what condition is causing the signs. Potential treatments include:

    • Antibiotics If bacteria are found through urinalysis, a culture will be taken to determine an appropriate antibiotic for treatment.
    • Diet change Changing to a wet food is recommended for many cats, and certain diets can help dissolve struvite stones.
    • Catheterization When an urethral obstruction occurs, the blockage is usually resolved using a urethral catheter. The procedure typically is performed under heavy sedation or general anesthesia, and intravenous fluids may be required to help prevent damage to the kidneys.
    • Surgery Calcium oxalate stones must be removed via surgery.
    • Pain medication Medications may be prescribed to help alleviate pain in affected cats.
    • Environmental management For cats affected by FIC, environmental changes to encourage hydration and decrease stress are recommended.

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    Why Is It Important To Understand Flutd

    Inappropriate urination is the number one behavior problem in cats. Many cats are given up to shelters for urinating outside of the litter box. If not properly treated, inappropriate urination can affect the cleanliness/safety of your home and the bond you share with your cat. The good news is that often, this problem is caused by a feline lower urinary tract disease and it is a treatable medical condition.

    How Can I Protect My Cat From These Diseases

    To help protect your cat from getting a lower urinary tract disease, be sure to:

    • Meet your cats environmental enrichment needs, such as having a safe and secure place to retreat, opportunities for play, and positive human interaction.
    • Clean your cats litter box every day.
    • Provide more than one litter box than the number of cats in your household, if you have more than one cat.
    • Always keep water available for your cat. Some cats prefer running water such as with a fountain.
    • Keep your veterinarian informed about how things are going. Every cat has his own personality, so what works for one may not work for another. This is one of the many reasons why it is important for you to visit your veterinarian for routine examinations.

    Contributed by Dr. Susan Gogolski, DVM, DABVP Dr. Tony Buffington, DVM, PhD, DACVN and Dr. Dennis Chew, DVM, DACVIM

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    Which Cats Are Most Susceptible To Flutd

    While FLUTD can affect any cat of any age, middle-aged and overweight cats commonly develop the disease. Other factors that can increase you cats FLUTD risk include:

    • Little to no exercise
    • Pre-existing kidney disease

    FLUTD occurs equally in male and female cats however, male cats have a greater risk of developing a urethral obstruction because of their urethras shape.

    Antibiotic Use In Feline Lower Urinary Tract Disease

    Diagnosing and Managing Feline Lower Urinary Tract Disease

    Feline lower urinary tract disease may be caused by a variety of conditions. Although it can be challenging, it is important to distinguish between these conditions so that appropriate treatment is given and antimicrobial drugs are used judiciously.

    Judicious use of antimicrobial drugs involves the dual goals of eradicating infection while avoiding development of antimicrobial resistance.

    Judicious use of antimicrobial drugs encompasses:

    • Using an antibiotic only when indicated.
    • Choosing a cost-effective antibiotic agent that provides appropriate coverage for the diagnosis that is suspected.
    • Prescribing the optimal dose and duration of the antibiotic.

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    Quantitative Urine Culture And Susceptibility Testing

    Urine for culture must be collected by cystocentesis. Because UTIs are a relatively uncommon cause of FLUTD in young adult cats, the decision of whether to culture may be based on factors such as owner finances and the need to have the cat return for repeat urine collection if signs persist. A urine culture is indicated before concluding a patient has FIC, since this is a diagnosis of exclusion.

    Urine culture and susceptibility testing are indicated if pyuria and bacteriuria are present on urinalysis to confirm the diagnosis and guide therapy. Studies have identified other risk factors for feline UTIs if the patient has one of these risk factors, urine culture is warranted.

    Management Of Feline Lower Urinary Tract Disorder

    Feline Lower Urinary Tract Disorder describes a clinical syndrome which manifests as pollakiuria, stranguria, and hematuria. Cats also frequently develop a habit of inappropriate elimination, which can hamper the human-animal bond and may result in relinquishment or euthanasia, making understanding of how to treat this a disorder of crucial importance.

    It is estimated that 5% of cats develop FLUTD, with equal representation between males and females. However, due to anatomical differences, there is a greater impact on males as the condition can progress to urinary obstruction, which can be fatal without prompt treatment. Young to middle-aged cats are predominantly affected, while cats over 10 years of age are rarely affected by FLUTD. Older cats with FLUTD symptoms are significantly more likely to be affected by urinary infections, urolithiasis, and neoplasia.

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    What Are The Causes Of Flutd

    Urolithiasis

    One possible cause of FLUTD is the formation of urinary stones, also called uroliths, in the bladder and/or urethra. These are collections of minerals that form in the urinary tract of cats. X-rays or ultrasound are usually needed to diagnose urinary stones. The most commonly seen uroliths are calcium oxalate and struvite . While a special, stone-dissolving diet can be prescribed to dissolve struvite stones, calcium oxalate stones need to be removed surgically. If the diet fails, or if the stones form again, then surgery may also be necessary for struvite stones. In female cats, it may also be possible for a veterinarian to help a cat pass stones by flushing its bladder with sterile fluids or remove small stones directly from the bladder using a cystoscope when the cat is under anesthesia. A veterinarian may then recommend medication or dietary changes after surgery to help prevent recurrence.

    Urinary infection

    Infection of your cats urinary tract with bacteria, fungi, parasites or possibly even viruses can cause signs of FLUTD. Although bacterial infections are more common than fungal, parasitic or viral infections, they are still relatively uncommon in cats. If an infection is found, your veterinarian will probably look for another disease or problem that may have put your cat at risk of infection. For example, uroliths and diabetes can increase the risk of urinary tract infection.

    Urethral obstruction

    Feline idiopathic cystitis

    Other causes

    Diagnostic Vs Therapeutic Urine Cultures

    FLUTD – Feline Lower Urinary Tract Disease

    What are diagnostic urine cultures?

    • Quantitative urine cultures before initiating antibiotic therapy is considered to be the gold standard for diagnosis of bacterial urinary tract infections .
    • Diagnostic urine cultures provide accurate identification of specific bacterial species and aid in the selection of antibiotics. It also facilitates differentiation of recurrent UTIs caused by relapses from recurrent UTIs caused by reinfections.
    • If a patient is currently being treated with an antibiotic, it should be discontinued for three to five days before diagnostic urine culture to minimize inhibition of bacterial growth.

    What are therapeutic urine cultures?

    • Culture of urine at strategic times during antibiotic therapy is an effective method of assessing therapy. Therapeutic cultures are essential for determining why a patient may not be responding to treatment.
    • For patients with a high risk of morbidity and mortality , evaluation of urine culture and urinalysis three to five days after initiating therapy allows for verification of antibiotic effectiveness before the development of irreversible organ damage or systemic spread of disease. The same strategy should be considered when prescribing antibiotics with a high risk of toxicity.

    Benefits of therapeutic urine cultures:

  • Timely test of antibiotic efficacy
  • Verification of proper antibiotic administration
  • Early detection of bacterial resistance to antibiotics
  • Timely detection of persistent infections
  • I. Diagnostic

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    How Is Flutd Treated In Cats

    FLUTD treatment varies based on the underlying cause. If your cat has been diagnosed with FLUTD, the condition may be treated by:

    Your cats urinary issues will not resolve on their own, and earlier intervention makes a cure more likely. Left untreated, a urinary problem can become life-threatening, so contact our Just Cats Clinic team for an appointment.

    How Do You Care For Your Pet After Treatment

    When your pet returns home, he/ she will be confined indoors for 3 to 4 days. Occasionally a re-blockage occurs, so we need to ensure that your cat is able to pass urine daily by using a litter tray.

    So how can we manage or prevent these FLUTD episodes? Many therapies have been trialled to reduce the frequency of episodes but the only clinically proven therapy is to reduce the concentration of urine – as dilute urine is less likely to stimulate the sensitive bladders of affected cats. Reducing the concentration of urine in cats can be very difficult and usually involves the use of a wet/canned food only. Sometimes a special diet is prescribed by your veterinarian. Encouraging cats to drink more can involve adding tuna broth to water, using water fountains and trialling different types of water containers .

    Other therapies include behavioural modification to reduce stress in affected cats. This may include altering the environment to allow for more natural behaviours such as climbing, scratching, hiding and resting. In multi cat households reducing the competition for resources such as food, water, litter boxes and hiding spots. Many veterinarians may prescribe pain relievers during an acute episode and anti anxiety medications for more long term control. Whilst sometimes antibiotics are prescribed, they have little impact in the control and management of this condition.

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    How Is It Treated

    Treatment options depend on several different factors, including changes in the urine , the type of crystals present, clinical signs, and the presence or absence of a bladder stone or urethral obstruction.

    Due to their anatomy, male cats may develop enough crystals in the urethra to cause an obstruction. This obstruction prevents elimination of urine from the bladder, causing the cat to become very ill. This is a life-threatening emergency.

    If your cat has a urethral obstruction, a catheter is passed into the bladder while he is under a short-acting anesthetic. This allows your veterinarian to flush the bladder and remove the obstruction. Your cat will need to be hospitalized for a few days until he is urinating normally and it appears unlikely an obstruction will recur.

    Treatment of bladder stones may consist of surgical removal or dietary therapy, depending on the type of crystals present in your cats urine. Struvite crystals can be dissolved in acidic urine therefore, a prescription diet that causes urinary acidification may be recommended. For calcium oxalate stones, however, acidification may actually make recurrence more likely, so a nonacidified diet is appropriate.

    If neither bladder stones nor urethral obstruction is present, antibiotics and pain medication may be used to treat any existing infection and relieve your cats discomfort. If struvite crystals are present, diet may also be used to dissolve some of the crystals in the urine and hasten recovery.

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