Evaluation of the role of lower urinary tract disease in cats with urine-marking behavior

OBJECTIVE: To determine whether findings of urinalyses could be used to reliably distinguish gonadectomized cats with urine-marking behavior from those with no problem urination. DESIGN: Case control study. ANIMALS: 58 gonadectomized cats (47 males and 11 females) with urine-marking behavior (ie, marking of vertical surfaces) and 39 (26 males and 13 females) without problem urination or urinary tract-associated conditions. PROCEDURE: Urine was collected by cystocentesis from all cats. Findings of urinalyses of cats with urine-marking behavior were analyzed statistically for sex-related differences and differences between cats that marked vertical surfaces only and those that marked both vertical and horizontal surfaces; findings of urinalyses of control cats were compared between sexes. Subsequently, results of urinalyses of cats with urine-marking behavior were compared with those of control cats. RESULTS: With regard to variables measured via urinalysis, there were no differences between male and female cats within either group. Among cats with urine-marking behavior, there were no differences between those that only marked vertically and those that marked vertically and horizontally. Analyses of data from all cats with urine-marking behavior and control cats revealed no differences that could be associated with urine marking. CONCLUSIONS AND CLINICAL RELEVANCE: These data suggest that urine-marking behavior by gonadectomized cats is an aspect of normal behavior. Clinicians are advised to focus on behavioral history of house-soiling cats to differentiate between urine-marking behavior and inappropriate urination; for the latter, urinalysis is appropriate to rule out lower urinary tract disorders.     

Use of an orally administered combined sugar solution to evaluate intestinal absorption and permeability in cats

OBJECTIVE: To evaluate intestinal permeability and absorption in healthy cats in association with diet and normal intestinal microflora. ANIMALS: 6 healthy domestic shorthair cats. PROCEDURE: A sugar solution containing D-xylose, 30-methyl-D-glucose, L-rhamnose, lactulose, and 51Cr-EDTA was administered intragastrically to healthy cats, and urinary excretion of ingested sugars was determined 5 hours after administration. After the same cats had received metronidazole for 1 month, the study was repeated. A final study was performed while cats were maintained on a new diet differing in composition and processing. RESULTS: Lactulose-to-rhamnose ratios, reflecting intestinal permeability, were higher in cats, compared with values for humans or dogs, and values obtained before and after metronidazole administration (mean +/- SEM; before, 0.40 +/- 0.08; after, 0.45 +/- 0.09) were not significantly different. Intestinal absorption also was unaltered after antibiotic administration, and the xylose-to-glucose ratio was 0.70 +/- 0.03 before and 0.71 +/- 0.06 after metronidazole administration. Sugar recovery did not differ significantly while cats were maintained on canned or dry food. CONCLUSIONS AND CLINICAL RELEVANCE: Reference ranges were established for the percentage urinary recovery of orally administered D-xylose, 3-0-methyl-D-glucose, L-rhamnose, lactulose, and 51Cr-EDTA obtained after 5 hours in healthy cats. The intestines of cats appear to be more permeable than those of other species, although the normal bacterial microflora does not appear to influence the integrity or function of the feline intestine, because values obtained for the measured variables before or after antibiotic administration were not significantly different. In addition, differences were not detected when the diet was completely altered.     

Erythrocyte protoporphyrin concentrations in clinically normal cats and cats with lead toxicity.

Erythrocyte protoporphyrin (EPP) and blood lead concentrations were determined in 91 clinically healthy cats living in the inner suburban area of Sydney, Australia. The mean EPP concentration was 223.4 +/- 186.1 micrograms litre-1 whole blood and the mean blood lead concentration 0.62 +/- 0.25 mumol litre-1. EPP concentrations were also monitored in three cats with confirmed lead toxicity--at the time of diagnosis and one week and one month after chelation therapy with calcium EDTA. EPP concentrations were elevated in two cats and within the normal range in the third cat at the time of diagnosis. EPP concentration were higher in two cats one week after treatment than at the time of diagnosis. One month after chelation therapy, EPP concentrations were normal in two cats but still substantially elevated in the third cat although its blood lead concentration had returned to normal and all clinical signs of lead toxicity had resolved. It was determined that the predominant form of protoporphyrin present in cats with lead toxicity was zinc protoporphyrin. The EPP assay may have limited value in the diagnosis of acute lead toxicity and in monitoring the success of chelation therapy in cats.     

Food and water intake and urine composition in cats: influence of continuous versus periodic feeding

Twenty healthy, noncastrated, adult male cats had periodic (11 am to 12 am) or continuous (24 hours daily) access to food. With periodic feeding, cats ate less food, drank less water, and produced less urine than when food was available continuously. The composition of urine obtained by cystocentesis at 7:30 am, 3:30 pm, and 10 pm was influenced somewhat by feeding pattern. With periodic feeding, urine pH was lower at 7:30 am and higher at 3:30 pm than it was with continuous feeding. Most mineral concentrations and urine osmolality-specific gravity did not differ with the different feeding schedules. However, when periodic feeding was used, concentrations of magnesium and phosphorus in urine were as high or higher preprandially (7:30 am) than postprandially (3:30 pm). Frequency of urination per 24 hours was not influenced by the feeding schedule, but the time that urination occurred during the 24-hour period was somewhat different. An experimental, high magnesium diet fed to the cats for 200 days caused urethral obstruction in 7 of 10 cats fed periodically and in 7 of 10 cats fed continuously. Cats with obstruction had urinary mineral concentrations similar to concentrations in cats without obstruction, indicating that urinary mineral concentration may not be the only factor relevant to the process of obstruction. Necropsy findings and histologic evaluation of tissues from the cats indicated incidental lesions or abnormalities caused by urethral obstruction, but did not indicate anatomic abnormalities that would have predisposed the cats to obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)     

Predicting recovery of urination control in cats after sacrocaudal injury: a prospective study

O bjectives : To determine whether intact tail base pain sensation predicts control of urination after sacrocaudal fracture-subluxation in cats.
M ethods : Twenty–one cats affected by sacrocaudal fracture-subluxation were diagnosed routinely by radiography. The ability of each cat to detect a painful stimulus applied to the tail base was tested by application of pressure using a standard surgical instrument. Cats were then hospitalised for up to 30 days and categorised according to whether they showed control of urination. A value of P<0·05 was regarded as significant. The results were analysed to produce data regarding sensitivity, specificity and the positive and negative predictive value of the test.
R esults : All 11 cats that had intact tail base sensation showed control of urination within three days. Four of the 10 cats without tail base pain sensation did not recover control of urination by day 30.
C linical S ignificance : Intact tail base sensation predicts control of urination and is therefore a useful screening test.     

Transpelvic urethrostomy in 11 cats using an ischial ostectomy

OBJECTIVE: To investigate the feasibility and long-term outcome of a modified subpubic urethrostomy technique termed transpelvic urethrostomy (TPU) in cats. STUDY DESIGN: Prospective clinical study. ANIMALS: Eleven male cats with obstructive lower urinary tract disease that could not be relieved, and requiring a surgical urinary diversion, were selected for TPU. METHODS: With the cat in dorsal recumbency, the penis was exposed and the ventral pelvis was denuded by median adductor muscle elevation. An approximately 12 mm x 15 mm area of ischium was removed. The pelvic urethra, 8-20 mm cranial to the bulbourethral glands, was incised longitudinally and sutured to the skin to create a urethrostomy. RESULTS: All cats were neutered males (2-9 years); none were uremic or hyperkalemic at admission. Urine was cultured if there was leukocyturia, nitrituria, and/or bacteriua. Bacteria were isolated from 2 specimens. A patent urethrostomy was created in all cats without operative complications. Except for 1 cat without associated clinical signs, stricture was not evident between 9 and 42 months after urethrostomy. One cat had postoperative urinary incontinence (UI) that resolved within 4 weeks. Two cats each had 1 episode of idiopathic lower urinary tract disease after 6-month follow-up; both responded to medical therapy. CONCLUSIONS: TPU was used as a successful urinary diversion procedure relieving signs of urinary tract obstruction and preventing further obstruction, with few complications. The incidence of UI after TPU remains minimal. CLINICAL RELEVANCE: TPU should be considered as a salvage urinary diversion procedure in cats (as an alternative to prepubic and subpubic techniques). TPU may also be considered as a possible primary urinary diversion solution (an alternative to perineal urethrostomy) for obstructive lower urinary tract disease in cats.     

Randomized controlled trial of the efficacy of short-term amitriptyline administration for treatment of acute,nonobstructive, idiopathic lower urinary tract disease in cats

OBJECTIVE: To determine whether short-term amitriptyline administration would be efficacious in the treatment of acute, nonobstructive, idiopathic lower urinary tract disease in cats. DESIGN: Randomized controlled trial. ANIMALS: 31 untreated male and female cats with acute, nonobstructive, idiopathic lower urinary tract disease. PROCEDURES: Cats were treated with amitriptyline (5 mg/d; n = 16) or a placebo (15) for 7 days and monitored for pollakiuria, hematuria, and adverse events. Cats were reexamined 1 month after treatment, and owners were interviewed by telephone 6, 12, and 24 months after treatment. RESULTS: 2 amitriptyline-treated cats were excluded from analyses because of acquired urinary tract infection. Clinical signs resolved by day 8 in 8 amitriptyline-treated and 10 control cats. There were no apparent differences in likelihood or rate of recovery from pollakiuria or hematuria between groups. Overall, clinical signs recurred significantly faster and more frequently in amitriptyline-treated than control cats. However, after excluding recurrences within 21 days of treatment, risk of recurrence was similar in both groups. Increasing age was significantly associated with increased likelihood and rate of recovery from hematuria and with decreased risk of recurrence of signs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that short-term amitriptyline treatment has no benefit in terms of resolution of pollakiuria and hematuria in cats with idiopathic lower urinary tract disease and may be associated with an increased risk of recurrence.     

Urinary acidification in the prevention and treatment of feline struvite urolithiasis

Two groups of 12 cats were fed ad libitum an experimental dry expanded ration high in magnesium (0.37%, dry matter basis) and similar to most commercial dry cat foods in all other nutrients. The diet of one of the groups contained 1.5% ammonium chloride, which was added to the diet before processing. Urethral obstruction developed twice in 7 of the 12 cats fed the ration without ammonium chloride. Of the 5 remaining cats in that group, 2 had calculi in the urinary bladder and urethra at necropsy. In contrast, only 2 of the 12 cats fed the ration containing ammonium chloride had urethral blockage once; neither cat had another blockage. Both cats had been catheterized twice as paired controls before urethral obstruction. One of these 2 cats died from a urinary tract infection apparently introduced through the indwelling catheter, and at necropsy there were 2 small calculi in the urethra. At the end of the study, only 1 other cat fed the ammonium chloride diet had a calculus in the urinary bladder at necropsy; this cat had not had a urethral obstruction throughout the study. After each cat had 2 urethral blockages, its diet was changed. Four cats were fed the ration containing ammonium chloride and 3, a dry, commercial ration. Of the 4 cats fed the diet containing ammonium chloride, none developed another urethral obstruction within 6 months, and at necropsy, no calculi were in the urinary bladder or urethra. Two of the 3 cats fed the commercial ration experienced urethral blockage within 3 months. These 2 cats were then fed the diet containing ammonium chloride.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of urinary bladder distention on location of the urinary bladder and urethra of healthy dogs and cats

Evaluation of the anatomic location of the distended and empty urinary bladders and urethras of healthy adult male and female dogs and cats by retrograde urethrocystography revealed substantial variations. In 15 dogs in lateral recumbency with empty bladder lumens, the caudal portion of the urinary bladder was within the pelvic canal in 5 of 7 male and 5 of 8 female dogs. In female dogs examined in ventrodorsal recumbency, only 4 of 8 had the empty urinary bladders in part within the pelvic canal. After luminal distention, 3 of 7 male and 3 of 8 female dogs, while in lateral recumbency, had the urinary bladders in part intrapelvically. However, when female dogs were placed in ventrodorsal recumbency, only 1 of 7 urinary bladders was in part within the pelvis. The urinary bladders of 14 cats were consistently within the abdominal cavity, irrespective of whether the bladder lumen was distended or empty. Urethral flexures occurred in dogs with intrapelvic bladders that were distended or empty. Urethral flexures were not found in cats. The urethras of dogs and cats in lateral recumbency were generally closer to the floor of the pelvis after urinary bladder distention than when the bladder was empty. The urethra of the dogs and cats in ventrodorsal recumbency was to the left or right of or on the midsagittal plane, whether the urinary bladder was empty or distended. A greater degree of lateral displacement was encountered in ventrodorsal recumbency after urinary bladder distention.     

Frequency of urination and ultrasonographic estimation of residual urine in normal and dysuric dogs

The aim of this study was to determine residual urine and frequency of urination in normal male and female dogs and to compare these with dogs with neurogenic and obstructive dysuria. The bladder volume before urination was estimated ultrasonographically in 99 dogs (48 normal and 51 abnormal dogs). Each animal was then taken outdoors and walked on grass for 10 minutes. The number of attempts to urinate (successful or not) was recorded. Bladder urine volume after urination was then calculated. Normal females made only one or two (100 per cent successful) attempts to urinate while males a mean of 6.9 attempts (mean 75.4 per cent successful) within 10 minutes. The residual urine per kg body weight of normal dogs varied from 0.1 to 3.4 ml kg(-1)(median 0.2 ml kg(-1)). The residual urine volumes of normal dogs were significantly less (P<0.0001) than those of dogs with neurological disorders or obstructive disease. Ultrasonographic estimation of residual urine volumes could be valuable in diagnosing suspected neurological or obstructive bladder disease and in monitoring the response to treatment.     

Rupture of the cranial pubic tendon in the cat

Seven cats with rupture of the cranial pubic tendon (CPT) were presented to the authors between 1992 and 2001. The causal aetiology was unclear in each case. Diagnosis was made on physical examination (five animals) or surgical exploration (two animals). Concurrent injuries were present in four cats, including injury to the urinary tract and musculoskeletal system. All ruptures were surgically explored and primary repair of the CPT rupture was performed in five cats. Repair was not possible in two cats, and follow-up examination showed that scar tissue had apparently formed to support the deficit. All cats were asymptomatic at follow-up examination. The prognosis for CPT rupture in the cat is favourable.     

Symptomatic Capillaria plica infection in a young European cat

An 8-month-old owned European cat showing abdominal pain, fever, distended painful bladder and urinary blockage was presented. Intravenous fluids were immediately administered and, after sedation, a urinary catheter was applied. Blood and urine analysis revealed cystitis and a moderate-to-severe degree of renal failure. About 20 thread-like nematodes, identified as Capillaria plica larvae and fragments of adult stages, were found in the urine sediment. After treatment with an oral formulation of fenbendazole at 25 mg/kg q 12 h for 10 days, urinary signs and bladder worms disappeared. Cases of Capillaria species bladder worms in cats are rarely reported and most infected cats show no clinical signs, presumably because of a low parasite burden. In the present study, feline capillariosis was associated to urethral obstruction, severe difficulties in urination, cystitis and renal failures.     

Urinary orotic acid-to-creatinine ratios in cats with hepatic lipidosis.

OBJECTIVE: To determine urinary orotic acid (OA) concentration and evaluate the urinary OA-to-creatinine ratio (OACR) in cats with hepatic lipidosis (HL). ANIMALS: 20 cats with HL and 20 clinically normal cats. PROCEDURE: Hepatic lipidosis was diagnosed on the basis of clinical signs, results of serum biochemical analyses, exclusion of other concurrent illness, and cytologic or histologic evaluation of liver biopsy specimens. Urine samples were collected from each cat and frozen at -20 C until assayed. Urine creatinine concentrations were determined, using an alkaline picrate method followed by spectrophotometric assay. Urine OA concentration was determined, using high-performance liquid chromatography. Minimum amount of detectable OA in feline urine was 1 microg/ml. Because of small interfering peaks near the base of the OA peak, the minimum quantifiable concentration of OA was determined to be 5 microg/ml. Urinary OACR was compared in both groups of cats. RESULTS: Differences in urinary OACR were not detected between clinically normal cats and cats with HL. Peaks were not detected for urinary OA in any of the 20 clinically normal cats. Of the 20 HL cats, 14 did not have detectable peaks for urinary OA. Of the 6 HL cats that had detectable urinary OA peaks, 3 had values of <5 microg/ml. CONCLUSIONS: Apparently, OACR does not increase significantly in cats with HL. CLINICAL RELEVANCE: Urinary OACR is not a useful diagnostic test for HL in cats.     

Prevalence of the polycystic kidney disease and renal and urinary bladder ultrasonographic abnormalities in Persian and Exotic Shorthair cats in Italy

The ultrasonographic findings of kidneys, liver and urinary bladder of 288 Persian and 44 Exotic Shorthair clinically normal cats that underwent screening for polycystic kidney disease (PKD) between July 2003 and December 2005 were reviewed. Cats were divided into two groups, one including cats aged <9 months (group 1) and one cats aged >/=9 months (group 2). Cats were classified as PKD-positive when at least one renal cyst was found. One hundred and thirty-six cats (41.0%) had more than one cyst in at least one kidney. The prevalence of PKD was similar in both groups. Eight PKD-positive cats had cystic livers (5.9%). Other renal abnormalities included a pelvic calculus and a medullary rim sign (MRS). The difference in prevalence of an MRS in group 2 compared to group 1 and the difference between PKD-positive and -negative cats in group 2 were not significant. There was no difference in mean kidney length between PKD-positive and -negative cats in group 2. Urinary bladder anomalies were principally represented by urinary sediment, with prevalence significantly higher in group 2. No difference was detected in group 2 between PKD-positive and -negative cats. In conclusion feline PKD is common in Italy. The ultrasonographic findings of MRS and urinary bladder sediment did not correlate with feline PKD. Urinary bladder sediment is common in Persians and Exotic Shorthairs and more likely in adults.     

Clinical evaluation of commercially available urinary acidification diets in the management of idiopathic cystitis in cats

OBJECTIVE: To compare recurrence of signs of lower urinary tract disease (LUTD) in cats with idiopathic cystitis that were fed the dry or canned formulation of a commercial diet designed to result in production of an acidic urine. DESIGN: Prospective trial. ANIMALS: 54 client-owned cats with idiopathic cystitis that was diagnosed on the basis of a history of abnormal micturition, abnormal results on urinalysis, radiography, or cystoscopy, and lack of an alternative diagnosis. PROCEDURE: Cats were assigned to be fed the canned or dry formulation of the diet. Reevaluations conducted at 2 and 16 weeks, and at 6 and 12 months included a physical examination, CBC and serum biochemical analysis (except week 2), blood gas analysis, and urinalysis. Regular telephone contacts were also made. The study was discontinued after 12 months or if signs of LUTD recurred. RESULTS: Signs of LUTD did not recur in 16 of 18 cats fed the canned diet, and 17 of 28 cats fed the dry diet (chi 2, P < 0.05). Seven cats were reevaluated at recurrence. Owners of remaining cats in which signs of LUTD recurred declined to have their pets reexamined. A different problem (bacterial urinary tract infection) was identified in only 1 cat on reevaluation. Eight cats were lost to follow-up evaluation. CLINICAL IMPLICATIONS: Feeding this commercial canned urinary acidifying diet may reduce the proportion of cats with idiopathic cystitis that will have recurrence of signs of LUTD within a 12-month period.     

Bite wounds involving the spine: characteristics, therapy and outcome in seven cases

Medical records of five dogs and two cats with bite wounds to the spine were reviewed. All dogs were bitten in the cervical spine and presented as quadriparetic. Both cats were bitten at the lumbar spine; one was paraparetic and the other paraplegic. Concomitant injuries to structures other than the spine were seen in two cases. Radiographic findings included vertebral fractures in all cases. Medical therapy included antibiotics (7/7), methylprednisolone sodium succinate (4/7) and analgesia (7/7). Five cases underwent minor (4/5) or extensive (1/5) surgical debridement. All cervical fractures were stabilized with fiberglass casts and animals with lumbar injury were cage rested for a month. Six of the cases survived, five of which regained good to excellent ambulatory ability within the first month. Although, the numbers of reported cases are limited, this study shows that adequate surgical debridement and wound drainage combined with external coaptation can be sufficient to manage bite wounds that involve the spine.     

Urinary albumin and transferrin as early diagnostic markers of chronic kidney disease

Feline renal diseases are increasingly noted in veterinary practice. It is important to diagnose and identify the pathological basis of renal dysfunction accurately at an early stage, but there are only a few reports on this area in clinical veterinary medicine. We investigated the efficacy of measurement of urinary albumin (u-Alb) and urinary transferrin (u-Tf) for early diagnosis using 5-µl urine samples collected noninvasively by catheterization from normal (IRIS stage I) cats and cats with stage I chronic kidney disease (CKD). The u-Alb levels in normal and stage I CKD cats were 6.0 ± 4.5 and 11.2 ± 8.4 mg/dl, respectively, and the u-Tf levels were 0.09 ± 0.42 and 0.52 ± 0.79 mg/dl, respectively. Based on ROC curve analysis, the sensitivity and specificity of u-Alb and u-Tf were higher than those of the currently used biomarker, the plasma creatinine level. The sensitivity of u-Alb was higher than that of u-Tf, whereas the specificity of u-Tf was higher than that of u-Alb. The validity of the threshold albumin level (20 mg/dl) was confirmed by measurements using SDS-PAGE. Since leakage of u-Tf in urine precedes leakage of u-Alb, inclusion of u-Tf in biochemistry tests may be appropriate for IRIS staging as a diagnostic marker of early diagnosis of renal disorder in cats.     

A case of interstitial cystitis and Hunner's ulcer in a domestic shorthaired cat

An 8-year-old spayed, domestic, shorthaired cat was examined with signs of feline urological syndrome which were unresponsive to previous therapy with antibiotics and urinary acidifiers. Biopsy of the bladder revealed signs of cystitis similar to interstitial cystitis in humans. Treatment with sodium pentosan polysulphate resulted in a decreased frequency of urination and resolution of haematuria. This condition may be more widespread in cats than realised, as it is only by bladder biopsy that diagnosis can be made.     

Subtotal Colectomy for the Treatment of Obstipation Secondary to Pelvic Fracture Malunion in Cats

Eleven cats in which subtotal colectomy with end-to-end jejunocolostomy was performed for the treatment of chronic obstipation secondary to pelvic fracture malunion were followed for at least 18 months. Seven cats had no recurrence of clinical signs and no longterm complications. In two cats, constipation was less severe and occurred less frequently; however, medical treatment was still required. In one cat, watery diarrhea gradually changed to semiformed feces of normal consistency by month 6; the cat was clinically normal at month 18. One cat had recurrence of constipation and was euthanatized after 2 years of medical treatment.     

Correlation of Urine Protein/Creatinine Ratio and Twenty-Four-Hour Urinary Protein Excretion in Normal Cats and Cats with Surgically Induced Chronic Renal Failure

Urine protein/creatinine (UP/C) ratios and 24-hour urinary protein excretion were compared in clinically normal cats and cats with surgically induced chronic renal failure (CRF). Mean 24-hour urinary protein excretion in 30 clinically normal cats fed a 28% protein diet (dry weight basis) was 4.93 mg/kg/24-hour (SD = 1.34) with a range of 2.99 to 8.88. Mean UP/C ratio in these cats was 0.134 (SD = 0.037) with a range of 0.073 to 0.239. Mean 24-hour urinary protein excretion in CRF cats was 10.49 mg/kg/24-hour (SD = 11.28) with a range of 2.16 to 62.93. Mean UP/C ratio in the CRF cats was 0.359 (SD = 0.374) with a range of 0.061 to 1.916. Linear regression showed high correlation (R2 = 0.973, P less than 0.001) between 24-hour urinary protein excretion and UP/C ratio in clinically normal cats and cats with surgically induced chronic renal failure. The regression equation for 24-hour urinary protein excretion versus UP/C ratio was: 24-hour urinary protein excretion = 29.39 (UP/C) + 0.18. Results of this study indicate that UP/C ratios are a valid estimate of 24-hour urinary protein excretion in clinically normal and CRF cats. Dietary protein intake significantly affected UP/C ratios in clinically normal cats and cats with surgically induced CRF. Therefore, the influence of dietary protein should be considered when interpreting UP/C ratios.