Feline Lower Urinary Tract Disease (FLUTD) is a term used to describe many conditions that affect the lower urinary tract.
FLUTD affects 1-3% of cats each year.
Cats more prone to FLUTD are:
- Middle aged
- Less active
- Dry food eaters.
Some common causes of FLUTD;
- Bacterial cystitis– a bacterial infection of the bladder is the most common causes of FLUTD. It tends to be seen more in older cats.
- Urethral plugs – an obstruction in the urethra of male cats happens when proteins, cells, urinary crystals and debris come together and form a plug that cannot be passed.
- Urolithiasis- bladder stones. The two most common types of stones are struvite and calcium oxalate, these account for 80-90% of cases. Sometimes small stones can become lodged in the urethra causing an urethral plug as described above.
- Neoplasia– uncommon but can occur in the bladder or urethra. The most common neoplasia as transitional cell carcinoma.
- Anatomical abnormalities – a defect in the lower urinary tract can cause signs of disease.
- Feline idiopathic cystitis (FIC) – Inflammation of the bladder. 60 – 70% of cases of FLUTD can have no underlying cause and are classified as FIC.
The equipment used in the clinic to analyse the urine – dipsticks, microscope slides and a special dye to show up crystals and white blood cells.
These are examples of the very sharp STRUVITE crystals we often see on microscopy of urine samples
This cat has had a urinary catheter placed under anaesthetic and the urine is collected into the kidney dish for analysis
These are all bladder stones (uroliths) which were surgically removed from one patient!
Emergency treatment of urethral obstruction:
- A general anaesthetic is needed to be able to pass a urinary catheter to unblock the obstruction. This can take some time with gentle pushing and flushing to try to shift. In some extreme cases this will not be possible and referral to a specialist maybe required.
- Once catheter is fully inserted, the bladder will firstly be emptied with a syringe, and then flushed repeatedly with saline. Some of the urine first collected will be kept for analysis.
- The patient will be also be started on intravenous fluids (usually started immediately prior to anaesthetic induction. These help correct imbalances in the body created by the situation, but also help to flush the bladder out over the next few days.
- Once back in the kennel to recover the patient will be either placed on absorbent bedding or connected to a urine collection bag to prevent urine scalding.
- Medication will be started including pain control, anti-inflammatories and antibiotics.
- The urine will be analysed at the clinic to identify the cause, it may also be sent to an external laboratory for further extensive tests.
- The urinary catheter will stay in place for 2-3 days and after removal, the patient will stay in hospital until he is urinating by himself well.
- Polyuria – increased frequency of urination.
- Periuria – urinating in unusual or inappropriate places.
- Dysuria – difficulty and pain in passing urine.
- Haematuria – blood present in the urine.
- Overgrooming – usually due to pain and irritation in the bladder and urethra.
- Behavioural changes – aggression or attention seeking.
- Stranguria – inability to urinate due to blockage in the urethra. Usually occurs in male cats and they will strain to urinate but be unable to pass any urine or very small dribbles.
- This is an emergency situation and veterinary attention sought immediately, untreated can lead to irreversible kidney damage or even death.
Investigation of FLUTD;
- Urinalysis – a urine sample checked for the presence of blood, white blood cells, casts, crystals, bacteria and uroliths. Ideally the sample would be taken direct from the bladder via needle and syringe (cystocentesis) to prevent environmental bacterial contamination.
- X-rays and ultrasound – can help with identifying uroliths, tumours or abnormities. By injecting a contrast dye into the bladder via a urinary catheter, the xray can highlight areas of concern. Ultrasound can also show the thickness of the bladder wall.
- Biopsy – may be needed in the cases of suspected tumours.
- Uroliths and crystals are analysed to investigate exactly which type they are (struvite or calcium oxalate) , so that the correct treatment can be given, usually by a change in diet to a specially formulated veterinary diet for the particular type.
- A change in diet will be needed to help with the dissolution of the crystals or stones, and also to help correct the pH balance in the urine. This will be started while the cat is in hospital, but may be delayed at first as the most important thing is for the patient to eat as soon as possible to reduce the risk of hepatic lipidosis, especially in overweight pets. HILLS CD diet or ROYAL CANIN WALTHAMS URINARY DIET are the 2 most commonly used longterm diets.
- Nutriceutical/supplements – improve the protective lining of the bladder (such as CYSTEASE)
- Antibiotics- to treat infection
- Muscle relaxants – in cases of urethral spasm.
- Anti-inflammatory – to help reduce inflammation in both the bladder wall, and urethra.
- Stress reducers (such as FELIWAY or ZYLKENE) – stress is shown to be a large factor in repeat cases.
- Water fountains – encourage the uptake of water, increasing urination, reducing stale urine sitting in the bladder.