Stranguria in a Siamese Cat
A previously healthy, 3-year-old 5-kg, castrated Siamese cat was presented for a 3-day history of stranguria.
HISTORYThis indoor-only cat, which had been adopted 2 years earlier, was visiting the litter box frequently but only producing a small amount of urine. In addition, he had been grooming and licking his perineal region excessively. His vaccinations were up-to-date. Two dogs also lived in the household.
CLINICAL PRESENTATIONThe cat appeared bright, alert, and responsive with a body condition score of 4/5. His rectal temperature was 103.7°F, heart rate 210 beats/min with strong pulses, and respiratory rate 70 breaths/min. Thoracic auscultation disclosed no abnormalities. Abdominal palpation revealed a small, painful urinary bladder. Swelling and erythema were noted on the prepuce and penis. Digital rectal examination was unremarkable.
LABORATORY DIAGNOSTICS
Urinalysis (Table and Figure 1) was conducted on a free-catch urine sample obtained from a clean litter box filled with nonabsorbent substrate. Bacterial culture of a urine sample obtained by cystocentesis was negative after 48 hours. The CBC and serum biochemical panel findings were within reference intervals.
F**_ig_ure 1. Photomicrographs show urine sediment at 40Y (A) and 60Y (B)** magnifications.
Table 1. Relevant Urine Culture Findings
hpf = high-power field, lpf = low-power field
Ask Yourself:
What diagnostic differentials would you consider for this cat’s lower urinary tract signs?
What additional questions would you ask the owner?
How significant is the presence of bacteria in the urine sediment?
DIAGNOSISFeline Idiopathic Cystitis
The typical clinical presentation for feline idiopathic cystitis (FIC) is a young, indoor-only cat with lower urinary tract signs. FIC diagnosis is one of exclusion, that is, ruling out other causes of lower urinary tract disease first (eg, uroliths, bacterial urinary tract infection, neoplasia). It typically occurs secondary to stress.
WORKUP
Urinalysis, urine culture, and imaging studies—ideally abdominal radiography (Figure 2)—will not rule out all possible causes of lower urinary tract disease. However, a cat that clinically responds to supportive therapy for the typical clinical signs of FIC may require nothing beyond first-line diagnostics.
Figure 2. Abdominal radiographs (A and B) showed a small urinary bladder with no evidence of radiopaque calculi. There was no renomegaly. (Courtesy of Laura Armbrust, DVM, Diplomate ACVR, and Abbi Granger, DVM)
Contrast radiography or ultrasonography, additional cultures to exclude the presence of Ureaplasma or Mycoplasma species, and/or cystoscopy may also be helpful when clinical signs are persistent or recurrent.1
If concurrent urethral obstruction is present, immediate intervention is required. However, placement of a urethral catheter in a patient without urethral obstruction may cause unnecessary trauma, predispose the patient to secondary bacterial infection, and stimulate additional urethral spasms that could lead to secondary obstruction after the catheter has been removed. Therefore, it is necessary for clinicians to perform a thorough examination to determine whether catheter placement is necessary. Cats with small, easily expressible urinary bladders typically do not require urethral catheterization.
TREATMENTMedical intervention is unlikely to change the course of the acute disease process; however, treatment is important for preventing recurrent episodes.
Important treatment considerations include environmental enrichment and stress reduction. Treatment plans can vary but need to involve careful evaluation of possible stress triggers. For this patient, treatment included:
A canned diet to promote increased water consumption (Note: It is important to offer a cat any new food as a choice to avoid the dietary change from becoming a potential stressor.)
Constant access to fresh, clean water
Pain management (buprenorphine)
Prescription a-adrenergic blockers (ie, prazosin or phenoxybenzamine) to relax the smooth muscle of the urethra; the stress of administering a pill should be taken into consideration.
Antimicrobial treatment was not prescribed in this case because the bacteria observed in the voided urine sediment were believed to be contamination from an outside source.
In addition, the client was encouraged to complete a questionnaire that evaluates environmental enrichment factors and prevents potential FIC triggers. The questionnaire can also provide discussion points for areas of improvement.
In this case, the questionnaire revealed that the owner had recently started a home remodeling project that may have been disruptive for the cat.
The owner was encouraged to keep the cat in an area away from construction and to offer daily enrichment activities, such as interactive play with other family members, new toys, and indoor climbing towers.
OUTCOMEThe cat was reexamined in the clinic 1 week after treatment began, with telephone follow-up 1 month later. Telephone updates can provide owners with an opportunity to voice additional concerns and for veterinarians to make further recommendations.
In this case, the owners had adhered to the initial recommendations and reported that their cat was doing well.
Did You Answer?
The differential diagnosis for this cat included obstructive or nonobstructive FIC, bacterial urinary tract infection, urocystoliths, and urinary tract neoplasia.
Because FIC is typically secondary to stress, it is vital to carefullydiscuss the history for cats with lower urinary tract signs. Pet owners should be asked about recent environmental or household changes, a change in the number of animals or people in the home, litter box changes (ie, location, number, substrate), and dietary changes. Current environmental enrichment activities should be part of the discussion as well.
Although cystocentesis is the urine collection method of choice, most cats with FIC have small, irritated bladders, making collection by any method other than voiding difficult. When using free-catch samples, remember the potential for contamination via the lower urinary tract as well as any surface that comes into contact with the urine. An aerobic urinary culture is part of a routine workup, but urine is typically sterile in young cats without other predisposing factors.
See "What Can Owners can Learn About Captivity" for more on feline enrichment activities.
STRANGURIA IN A SIAMESE CAT • Nicole Smee & Gregory F. Grauer
References
1. Bacteriuria in cats with feline lower urinary tract disease: A clinical study of 134 cases in Norway. Eggertsdottir AV, Lund HS, Krontveit R, et al.J Feline Med Surg 9:458-465, 2007.Suggested Reading
Changing paradigms of feline idiopathic cystitis. Kruger JM, Osborne CA, Lulich JP. Vet Clin North Am Small Anim Pract 39:15-40, 2009.Indoor cat initiative. The Ohio State University College of Veterinary Medicine. http://vet.osu.edu/vmc/indoor-cat-initiative (accessed May 2011).Management of non-obstructive idiopathic/interstitial cystitis in cats. Buffington CAT, Chew DJ. In Elliot J, Grauer GF (eds): BSAVA Manual of Canine and Feline Nephrology and Urology, 2nd ed—Gloucester: Woodrow House, 2007, pp 264-281.