43. Disease of urinary bladder & urethra (except urolithiasis)

What are examples of diseases of the urinary bladder and urethra?

1. Urinary tract infection

2. Feline lower urinary tract disease (FLUTD)

3. Feline idiopathic cystitis

4. Urinary tract obstruction

What is a urinary tract infection (UTI)?

Microbial infection of the urinary tract

What are some aetiologies of UTI?

Secondary microbial infection due to anatomical defects or systemic immunosuppression. Common causative agents include E. coli, Staphylococcus, Proteus, and Klebsiella

What are the clinical signs of cystitis?

Pollakiuria, dysuria, haematuria, incontinence, and stranguria

What are the clinical signs of pyelonephritis?

Fever, lumbar pain, anorexia, and PU/PD

How is a UTI diagnosed?

Urinalysis (sediment test, culture), haematology, and biochemistry

How is a UTI treated?

Antibiotics based on culture results (e.g., amoxicillin)

What is feline lower urinary tract disease (FLUTD)?

A term used for a group of symptoms affecting the urinary bladder, urethra, or both. It can be obstructive or non-obstructive

What are some causes of non-obstructive FLUTD?

Idiopathic cystitis, crystalluria, uroliths, neurological issues (urethral spasm, reflex dyssynergia), neoplasia, and infections

What is a cause of obstructive FLUTD?

Urethral plugs (mineral – struvite, calcium oxalate) – an emergency!

What are some clinical signs of FLUTD?

Stranguria, pollakiuria, haematuria, frequent licking of the urogenital area, vomiting, anorexia, apathy, and dehydration

How is FLUTD diagnosed?

1. History and anamnesis (including behavioural abnormalities)

2. Physical examination (bladder palpation, assessment of wall thickness)

3. Laboratory examination (urinalysis, biochemistry, haematology, urine culture, biopsy)

4. Imaging (X-ray, ultrasound, cystoscopy)

How is FLUTD treated?

Depends on the primary cause. Treatment may include correcting dehydration, antibiotics, corticosteroids, acidifying diets, pain relief, and urinary catheterisation and bladder flushing if there is an obstruction

What is feline idiopathic cystitis (FIC), also known as stress cystitis?

Inflammation of the urinary bladder due to a psychosomatic problem stemming from an inability to handle stress

Which cats are affected by FIC?

Both male and female cats

What are some aetiologies of FIC?

Stress from the environment, hormones, viral infections, diet, or discomfort of the urinary bladder

What are some clinical signs of FIC?

Frequent urination, blood in the urine, straining or distress while urinating, and urination in inappropriate locations

How is FIC diagnosed?

By exclusion of all other causes

How is FIC treated?

1. Modification of the environment (providing a safe retreat), elimination of stress

2. Analgesia (NSAIDs)

3. Sedatives, pheromones (Feliway)

4. Access to plenty of fresh, clean water

5. Urinary stress diet (e.g., Hill's c/d Urinary Stress) may also be recommended

How can urinary tract obstructions be classified?

1. Intraluminal

2. Intramural

3. Other

What are some intraluminal causes of urinary tract obstruction?

Uroliths, plugs, and blood clots (of the ureters or urethra)

What are some intramural causes of urinary tract obstruction?

Neoplasia, fibrosis, oedema, and haemorrhages (of the ureters or urethra)

What are some other causes of urinary tract obstruction?

Displacement of the bladder and neurological issues

What can urinary tract obstruction lead to?

1. Hydronephrosis (dilation of the renal pelvis), hydroureter

2. Accumulation of metabolic wastes and post-renal azotaemia/uraemia

What are some clinical signs of urinary tract obstruction?

Pollakiuria, stranguria, decreased urine output, haematuria, and signs of uraemia (lethargy, anorexia, vomiting). Bladder distension, dehydration, weakness, and bradycardia (due to hyperkalaemia) may also be present

How is urinary tract obstruction diagnosed?

1. Acute uraemia, a distended bladder

2. Haematology (usually normal)

3. Biochemistry (acidosis, increased urea)

4. Cystocentesis & urinalysis (protein, crystals)

5. Imaging (X-ray with/without contrast, ultrasound)

What types of contrast studies can be used to examine the bladder?

Retrograde: Positive contrast, negative contrast (air), and double contrast (air then positive contrast medium)

How is urinary tract obstruction treated?

1. Emptying the bladder

2. Fluid therapy (to improve renal function and correct electrolyte and acid-base abnormalities)

3. Bicarbonate (in animals with severe hyperkalaemia and cardiac arrhythmias)

4. Surgery (often necessary for complete ureteral obstruction)

Which diagnostic method is best for urinary tract infections?

Cystocentesis