Feline Lower Urinary Tract Obstruction, aka: “Blocked Cat”

Feline Lower Urinary Tract Obstruction

Matthew Kornya, DVM, ©2015

At the Veterinary Hospital of West Toronto we commonly see cats that have become blocked. Please read Dr. Kornya’s article for further information: 

Lower urinary obstruction is the end result in many cases of untreated lower urinary disease in
cats and is characterized by an inability to urinate due to blockage of the urethra (the tube leading from
the bladder to the outside). Commonly referred to as a “blockage”, lower urinary obstruction occurs
almost exclusively in male cats due to their long, narrow urethra (though blockage in female cats is
possible as well). Obstruction of the urethra results in an inability to urinate causing pain and distress.
This can progress quickly to kidney failure and potentially death due to high potassium levels and toxin buildup.
Blocked cats may vary significantly in their appearance. The most ill cats may be lying on their side,
minimally responsive, with tremors, extreme pain and difficulty breathing. On the other end of the
spectrum, cats may be walking, bright and alert, with an inability to urinate as the only complaint. Any cat
(especially a male cat) who is straining in the litter box and unable to urinate should be taken to a
veterinarian immediately, as early treatment of blockage carries a better prognosis. Cats that are urinating
outside of the litter box, urinating frequent small volumes, have blood in their urine, or experience pain
when urinating should also be treated promptly in order to prevent blockage.

Cats obstruct for many reasons, as any disease causing a decrease in the diameter of the feline urethra
may cause urinary obstruction. Causes of blockages include (but are not limited to):

Bladder stones, silt and crystals: These are all various forms of minerals that may coalesce
within a cat’s bladder. These calculi may cause irritation and inflammation to the bladder
wall, bleeding of the bladder wall, and are associated with pain and difficulty urinating.
Large stones or aggregates of smaller stones (sometimes mixed with blood or mucous) may
lodge in the urethra and cause an obstruction. While genetic factors are definitely at play in
the formation of stones and crystals, diet is also a major factor. Cats who eat primarily
dry/kibbled diets, diets with a high mineral content, and diets that predispose to very high or
low urinary acidity are much more likely to form urinary stones.

Feline Idiopathic Cystitis (FIC): This is the most common cause of feline lower urinary tract
disease and one of the most common causes of urinary obstruction. This disease is defined by
inflammation, pain, and damage to the bladder wall without an obvious external cause. While
the disease process is not fully understood, stress is known to play a major role in the
development of FIC. Diet, obesity, and genetic factors also likely play a role.

Infection: Bladder infections are actually very uncommon in healthy, adult male cats. Usually
a cat with a bladder infection has an underlying cause that has predisposed to this infection.
These may include kidney disease, diabetes, or even severe obesity.  Bladder stones in cats,
unlike dogs, are not commonly associated with infection. Infections may lead to
inflammation of the bladder wall and urethra and can lead to obstruction with blood clots,
inflammation and spasm, or even pus and bacteria.

Other: Other, less common causes of obstruction include birth defects causing malformed
urethras, cancers of the bladder and urethra, or prostate disease

Urinary obstruction is a medical emergency that requires aggressive and immediate treatment. The
bladder may be decompressed immediately by drainage with a needle through he skin (known as
“cystocentesis”) to provide temporary relief and facilitate catheter placement. This is then followed up
with more intensive therapy which includes placement of a urinary catheter to relieve the obstruction and
clean out the bladder; intravenous fluid administration to “flush out” the kidneys and restore normal
electrolyte balance; blood and urine testing to determine the cause of the obstruction and the extent of
kidney damage; and X-rays to examine the bladder for stones or sediment. Proper treatment usually
entails several days of hospitalization and supportive care.
Emergency stabilization may be required for very ill cats. This may entail medications to restore
proper electrolyte values (such as glucose, insulin, potassium and calcium) and aggressive fluid therapy.
Some cats may require ECG monitoring or repeated blood testing.
While in hospital, a cat with urinary obstruction is kept catheterized and the urine production
monitored closely. Pain medication is used to control any discomfort, often using a combination of
opioids, anti-inflammatories, and even epidurals. Anti-spasmodic medication is crucial to relax the
urethra and allow passage of stones. These medications may include prazosin (a urethral dilator),
benzodiazapines such as midazolam (which relax urethral muscles) and anti-inflammatories (which
should only be used in cats with normal kidney function).
X-Rays of the bladder and urethra should be taken to check for the presence of stones that may
require surgical removal. Stones should be analyzed at a laboratory to determine type and composition.
One type of medication called “glycosaminoglycans” is sometimes used to restore the normal mucous
barrier to the insider wall of the bladder. These may be given by injection or directly instilled into the
The most critical periods for a cat with lower urinary obstruction are the initial stabilization (until
electrolytes and kidney values are normalized) and the first 24hours after catheter removal. After the
urinary catheter is removed, monitoring for re-obstruction is critical. Continuing intensive medical
management in this time period is very important.
Cats are often started on a “dissolution diet” during the de-obstruction process. These foods are
formulated to dissolve stones and crystals and prevent the formation of new ones. Affected animals are
generally kept on these diets for several months to ensure normal urine is being produced, prior to
considering transition to a maintenance type diet. Some cats will need to stay on urinary diets life-long.
“Perineal Urethrostomy” is a salvage procedure intended to relive intractable obstruction and
prevent recurrence of urinary blockage. This surgery entails removal of the penis and penile urethra, with
widening of the remaining tissue to prevent re-obstruction. This effectively changes a male cat’s urologic
conformation to a more female structure. While ureterostomy is sometimes the only option (especially for
large, immobile stones), is a last resort for a blocked cat- it should not be performed until every other
option has been exhausted, including intensive medical management, proper diet change, environmental
enrichment, and catheterization. Owners considering this procedure must be made aware that cats
commonly have post-surgical complications- even years after surgery they may experience incontinence,
infections, inflammation, and potentially re-obstruction. While this surgery is a valid option for some cats,
owners must be aware that it is a last resort and not to be undertaken lightly.
Proper follow-up care is essential in cats with lower urinary obstruction. This includes feeding a
high quality urinary-specific diet, reducing environmental stress, and ensuring immediate action is taken
during any signs of reoccurrence. Increasing water intake is essential; this may entail use of a canned diet,
moistening food and adding large bowls and water fountains. For more information on the long term post-
obstructive management of lower urinary disease, please see the handout on “Non Obstructive Feline
Lower Urinary Disease”.

For more information
American Association of Feline Practitioners
http://www.catvets.com/cat-owners/disease-and-conditions/flutd
Cornell Feline Health Center
http://www.vet.cornell.edu/fhc/Health_Information/brochure_urinary.cfm

References
1. Albasan H, Osborne CA, Lulich JP, Lekcharoensuk C, Koehler LA, et al. Rate and frequency of
recurrence of uroliths after an initial ammonium urate, calcium oxalate, or struvite urolith in cats.
J Am Vet Med Assoc. 2009 Dec 15;235(12):1450-5. PubMed PMID: 20001780.
2. Buffington CA, Chew DJ, Kendall MS, Scrivani PV, Thompson SB, et al. Clinical evaluation of
cats with nonobstructive urinary tract diseases. J Am Vet Med Assoc. 1997 Jan 1;210(1):46-50.
PubMed PMID: 8977647.
3. Little, S. (2011). Lower Urinary Tract Disease. In S. Little, The Cat, Feline Medidine and
Management (pp. 980-1013). St Louis: Saunders.
4. Osborne CA, Lulich JP, Wilson JF, Weiss CH. Changing paradigms in ethical issues and
urolithiasis. Vet Clin North Am Small Anim Pract. 2009 Jan;39(1):93-109. PubMed PMID:
19038653.
5. Osborne CA, Lulich JP, Kruger JM, Ulrich LK, Koehler LA. Analysis of 451,891 canine uroliths,
feline uroliths, and feline urethral plugs from 1981 to 2007: perspectives from the Minnesota
Urolith Center. Vet Clin North Am Small Anim Pract. 2009 Jan;39(1):183-97. PubMed PMID:
19038658

 

Transcribed from the Winn Feline Foundation, see link below. The Author Dr. Matt Kornya works part time with us here at the Veterinary Emergency Hospital of West Toronto on weekends.

http://www.winnfelinefoundation.org/docs/default-source/cat-health-library-educational-articles/feline-lower-urinary-tract-obstruction-copy.pdf?sfvrsn=6

Top 10 Animal Emergencies

Written by Dawn Paterson RVT

Have you ever wondered what types of emergencies we see here at the Veterinary Emergency Hospital of West Toronto? We get asked all the time what kinds of things come in to see us, especially in the middle of the night and on holidays and weekends. I thought I would make a short list of the top emergencies we see and are capable of dealing with after hours when your family veterinarian is closed.

 

  1. Vomiting and Diarrhea – This is probably the most common ailment we see in both dogs and cats. Continuous vomiting and diarrhea can lead to dehydration and electrolyte imbalances requiring medical intervention. Some diagnostics that may be recommended are radiographs, to check for any possible obstructions and bloodwork to determine the severity of the dehydration.  In some cases we can treat the patient as an outpatient with some medication and send them home and in other cases that are more severe, we will hospitalize them on IV fluids and administer medications IV until they are able to keep food and water down on their own.

  2. Toxin Ingestion – Pets are very curious and they don’t know what isn’t good for them. We see pets that have eaten chocolate, human medications like tylenol or advil, pesticides, rodenticides like rat poison, fertilizer, chemicals like antifreeze, illegal substances like marijuana, and lots of other things. You name it, they might eat it! All toxins are different in how they affect the body, some may cause vomiting and diarrhea and nervous system depression causing your pet to appear “drunk”. And others can cause kidney or liver failure which may not be apparent until a couple days to a week after ingestion. We can effectively induce vomiting if indicated and provide support and/or protectants for the kidney and liver if needed. The ASPCA has a mobile app which you can download to give you up to date information on animal toxicities.

  3. Inability to Urinate – Both dogs and cats are presented with the complaint “he/she hasn’t peed since . . . “ . This is a very serious emergency as the bladder will explode if stretched too far. Sometimes this is also confused with constipation or vice versa. Usually when they are unable to urinate it becomes extremely uncomfortable and the animal will vocalize, strain, and may start vomiting. The inability to urinate is usually due to a blockage in the urethra. Sometimes we can see on an x-ray where the blockage is. We are also able to pass a urinary catheter to relieve the blockage which stabilizes them until we can find out why the blockage occurred.

  4. Breathing Difficulties – We consider any breathing difficulties to be an emergency and when presented with a patient who is in distress we can provide oxygen therapy immediately upon arrival to the hospital. We have flow by oxygen and oxygen chamber’s to optimize the oxygenating ability of the patient. Breathing difficulties can be due to a number of different reasons, so it’s important to have your pet seen by a veterinarian as soon as possible to determine the cause and to avoid respiratory arrest. Once we know what’s causing them distress, we are able to offer treatments and hopefully make them more comfortable. 
  5. Animal Altercations – We will often see patients who were attacked by other animals. Some of these attacks cause only minor scratches and hurt ego’s. Other times the attack causes severe trauma and may need emergency surgery to fix the wounds before infection sets in. Our ER Veterinarians are able to provide emergency surgery at any time of night to ensure your pet has the best chance of healing and recovery.

  6. Hit By Car – Unfortunately pet’s don’t understand the rules of the road. Most times the pet is presented immediately following the accident. They are usually in shock and require supportive care and pain management even before we can fully appreciate any injuries that were caused by the accident. We will measure their blood pressure, provide oxygen therapy and possibly perform radiographs or an ultrasound to rule out life threatening internal injuries you can’t see with the naked eye.

  7. Seizures – This is very scary for pet owners to witness! A seizure can start out as facial twitching and progress to full out convulsions with loss of bladder and bowels as well as drooling. We have medications here to stop the seizure so as to limit the amount of brain damage that may occur due to prolonged seizuring. We are able to provide 24 hour monitoring by a Registered Veterinary Technician with an ER Veterinarian for any additional seizures.

  8. Bone Fractures – With 4 legs, it can be hard to keep track of where they’re all supposed to be going at all times! Some dogs break their leg by jumping off the bed or chasing squirrels. We can diagnose a bone fracture with x-rays and provide splinting and pain medication until the fracture can be fixed by a veterinary surgeon. Dr. Craig Miller is a board certified veterinary surgeon with more than 25 years experience. He works out of our location and we can facilitate a direct transfer for a consultation with him if needed. Visit his website for more information.

  9. Generalized Non-Specific Pain – Animals can’t talk, so when they are painful, it’s usually the owner’s that notice something is off, but they can’t put their finger on it. The veterinarian can perform a full physical exam to try to pinpoint the area(s) that may be painful based on the animal’s response during the exam. We can also perform blood analysis in house with full results in under an hour to see if the pain is stemming from an infection or organ dysfunction. We also are able to prescribe pain medication specifically formulated for animals that won’t cause toxicities like tylenol and advil!

  10. Bloat – Otherwise known as Gastric Dilation Volvulus, the stomach fills up with gas and twists on itself. We mostly see this is deep chested dogs, they will be lethargic, have non-productive vomiting, increased salivation, and the stomach will appear distended or “bloated”. When the stomach twists, it causes a decrease in blood flow essentially causing the stomach to “die”. We are able to perform an emergency surgery in which we flip the stomach back to it’s normal position to regain blood flow to the tissue, and tack it onto the body wall to hopefully prevent it from twisting again in the future.

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Vacation Ready Tips for Your Furry Kids

Lily Poisoning


By Dr. Camilla Amundsen

Usually lilies are kept as cut-flower arrangements or as household potted plants. Any lily could potentially be poisonous, (Lilium species as well as Hemerocallis species).

Both cats and dogs can be affected from eating lilies, however dogs will only exhibit mild gastrointestinal upset whereas 2-3 leaves for a cat may be lethal. All cats of all ages can be affected even though at the Veterinary Emergency Hospital of West Toronto we see it more in the playful kitten and curious young adults. Symptoms may start as early as 2-4 hours, vomiting is most commonly noted by the owner followed by lethargy but patients may present with any depression, anorexia, dehydration and/or polyuria (urinating frequently).

If treatment is not sought, renal insufficiency, renal failure and death can follow in 4-7 days.
Sometimes the owner does not observe the cat eating the plants, but will come home and find the bouquet of lilies torn up, the big question is always, did little Princess eat it or not? Of course the cats will not tell us until it’s maybe too late so its up to us to make the call to treat or not.

Here at West Toronto Emergency we always advise to treat since renal insufficiency can develop even without any previous warning signs. Prognosis is usually good if treatment is initiated BEFORE renal impairment occurs.

There is no antidote against the lilies itself but a safe treatment option is available and includes

1/ Initial bloodwork

2/ Early decontamination , induce vomiting if cat has not already vomited at home

3/ Toxin binding with activated charcoal

4/ Intravenous fluid treatment to cause diuresis of kidneys and help them combat the plant toxins

5/ Recheck of bloodwork


The only way to monitor subclinical renal disease is with bloodwork and urinalysis, at the Veterinary Emergency Hospital we have blood analyzer onsite and in house urinalysis that can help us with early detection of insulted kidneys and follow their progress and response to treatment.

*Lily-of-the-valley and Peace lily are not true lilies and do not cause renal insult in cats*