Sandy's bladder stones problem

Eleven year old Sandy had previously required surgery due to repeated episodes of urinary obstruction 7 years ago. He meant that he had to have the end of his penis removed so that the opening would stop getting continually blocked. He had had no problems since then. During his routine vaccination his owner reported that Sandy had been urinating small amounts frequently and had discomfort when urinating for about a month and was also losing weight.

His physical examination showed that Sandy had lost weight. His bladder was very small, hard and painful. It was necessary to collect a sample of urine so that the cause of this problem could be found. Sandy was admitted to hospital so that we could collect this sample overnight.
His urine sample was bloody and many bacteria were visible when the sample was examined under the microscope. A sterile sample needed to be collected and when doing this, the vet noticed that the needle seemed to hit something hard and gritty. A bladder stone was suspected and this was confirmed on radiographing ( xraying) his abdomen. The bladder stones are shown clearly on this radiograph (xray). Interestingly, no crystals were evident in the urine itself.

Sandy needed an operation. Unlike his previous surgery, this time the vet needed to remove these bladder stones by opening Sandy's bladder. Stones this size can not be treated medically. He was started on intravenous fluids to keep him stable throughout the procedure. A general anaesthetic was given and his abdomen was clipped and prepped for surgery 2 big, rough stones as seen on xray, were found and removed at surgery. A sterile sample of urine was collected at surgery and submitted to the laboratory so that the type of bacteria could be identified and appropriate antibiotics chosen.

The day following surgery, Sandy was urinating normally and already seemed a lot more comfortable. It would take a while for the urinary tract infection to clear totally and the bladder to return to normal. It was necessary to keep him on antibiotics for several weeks to resolve his infection. The stone also was identified to determine it's makeup.

We presume that the infection was due to an "ascending" infection. That is, because his urethra (the opening between his bladder and penis) had been shortened, an infection was more likely to come up his urethra to his bladder.

In Sandy's case, he will need several weeks of antibiotics and repeat urine testing to ensure that the infection clears totally and monitoring to check for recurrence. His owner needs to watch his behaviour closely to look for signs of repeat cystitis ( bladder inflammation) . Increasing his fluids will help maintain good urinary tract health and special prescription food will also help keep his urine acidic.

Bladder and urethral problems are a fairly common occurrence in cats. The syndrome is referred to as Feline Lower Urinary Tract Disease (FLUDT). It can be difficult sometimes to distinguish between diseases of the bladder and urethra, and many diseases will affect both structures.

What are the signs of FLUTD?

Typical signs in cats with FLUTD are those of inflammation and irritation of the lower urinary tract. The common signs are therefore:-

* Increased frequency and urgency of urination.
* Difficulty in urinating (spending a long time straining on the litter tray while passing only small quantities of urine).
* The presence of blood in the urine or blood spots in the litter tray.
* Occasionally complete obstruction to the passage of urine (straining persistently without producing any urine).

With the latter sign particularly (straining without the passage of any urine), it is important to seek urgent veterinary attention as complete blockage to the flow of urine can be a life-threatening complication if left untreated.

What causes FLUTD?

There are a vast number of potential causes of FLUTD, but in many cats there may be severe inflammation of the bladder and/or urethra without an identifiable underlying cause (so called ‘idiopathic' FLUTD). These idiopathic cases have to be differentiated from other potential causes of the clinical signs though so that appropriate treatment can be given. Some of the potential causes of FLUTD are listed below:

* Idiopathic (inflammation for no known cause) but possibly caused by unrecognised viruses or bacteria
* Urinary calculi (‘bladder stones' as in Sandy's case.)
* Bacterial infections ( as with Sandy)
* Neoplasia (tumour)
* Anatomical abnormalities
* Urethral plugs (blockage of urethra with a mixture of crystals or small calculi/stones, mucus and inflammatory material)

How is FLUTD diagnosed?

The initial diagnosis of FLUTD is based on the identification of signs of lower urinary tract inflammation. The clinical signs displayed by the cat are often characteristic of FLUTD, but where there is doubt, analysis of a urine sample will confirm the presence of inflammation or blood.

Initially, a cat with uncomplicated FLUTD may be treated symptomatically by a veterinary surgeon (for example with a short course of tablets). However, if the signs do not respond to this treatment, or if there is recurrence of the clinical signs further investigation may be required to identify the underlying cause of the FLUTD.

Where clinical signs are persistent or recurrent, a number of investigations may be required to differentiate idiopathic FLUTD from the other known causes of urinary tract inflammation.

These investigations may include:

* Laboratory analysis of a urine sample
* Bacterial culture of a urine sample
* Blood samples to look for other evidence of urinary tract disease or other systemic disease
* Radiographs (x-rays) and/or ultrasound examination of the bladder and urethra

The information from these investigations should help to identify a specific treatable underlying cause if one is present.

What is the treatment for FLUTD?

This depends on the underlying cause. For example:

* Cases of idiopathic disease may respond to treatment with anti-inflammatory or analgesic (‘pain-relieving') drugs, but it is crucial that you only use drugs specifically prescribed by your veterinary surgeon, as may human products are extremely dangerous to use in cats.
* Bacterial infections of the lower urinary tract, although uncommon in cats, will usually respond well to antibiotic therapy.
* If a cat develops a blocked urethra (this almost exclusively occurs in males), emergency treatment is required to remove the blockage, which may require flushing of the urethra while the cat is given a short anaesthetic.
* If bladder stones (calculi) are present they may have to be removed surgically or, depending on their type, they may be able to be dissolved by using a special diet, or dietary additive

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 investigation and treatment clinical signs may still recur, requiring further therapy.

How can FLUTD be prevented?

It is impossible to completely prevent diseases of the lower urinary tract occurring. However, FLUTD is more common in cats that have a lower water consumption, and in cats that are inactive and obese. All these factors may relate, at least in part, to the frequency with which a cat urinates. Avoidance of obesity and encouraging exercise may be of some help in preventing FLUTD, and as cats tend to drink very little the feeding of at least some tinned food rather than exclusively a dry cat food product will help to maintain a higher water intake. Some cats get FLUTD whenever they eat dry cat food.

If a cat develops urinary calculi (stones), the feeding of special diets (available from veterinary surgeons) may help to prevent recurrence of stone formation

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