Evidence-based management of feline lower urinary tract disease.

Many treatments have been recommended for managing cats with feline urinary tract disease (FLUTD). Veterinarians making therapeutic decisions should consider the quality of evidence supporting a recommendation to use (or not use) a particular treatment for cats with FLUTD. Whenever possible, recommendations should be based on results of randomized and well-controlled scientific studies performed in clinical patients with the spontaneously occurring disease of interest. In the absence of such studies, one is left to make the best recommendation possible with consideration of all information, including the quality of the evidence. At this time, additional studies are needed to evaluate evidence for many currently recommended treatments for cats with FLUTD.     

Medical management of vesicourachal diverticula in 15 cats with lower urinary tract disease

The biological behaviour of radiographically detectable vesicourachal diverticula in 13 male and two female cats with haematuria, dysuria, and, or, urethral obstruction was evaluated following spontaneous or treatment-induced remission of lower urinary tract disease. The observation that diverticula are larger in obstructed than non-obstructed cats supports the hypothesis that the higher prevalence of diverticula in males is associated with a higher prevalence of urethral obstruction in males. Complete resolution of vesicourachal diverticula occurred in all 15 patients. Regression of diverticula following eradication of bacterial urinary tract infections with antimicrobial agents and, or, medical dissolution of urocystoliths indicates that diverticulectomy is not always warranted. It is probable that diverticula heal within two to three weeks following elimination of increased intraluminal bladder pressure.     

Medical management of male and female cats with nonobstructive lower urinary tract disease

This case is typical of recurrent urolithiasis managed by repeated surgery. Retrospective assessment of the disorder indicates the need for quantitative analyses of uroliths removed by cystotomy. Compliance of the owners with recommendations to minimize recurrent urolithiasis might have been beneficial. Results of medical therapy designed to induce dissolution of uroliths in this case are representative of preliminary findings of medical dissolution of naturally occurring struvite uroliths in ten other cats. It is of interest that the uroliths dissolved even though no effort was made to induce diuresis. The underlying cause of UTI in this patient may have been damage to the lower urinary tract induced by previous diagnostic and therapeutic procedures and/or sterile struvite uroliths that compromised local host defense mechanisms. Lack of urease production by the uropathogens suggests that they did not play a causative role in formation of uroliths. The need for preventative therapy of recurrent formation of uroliths after their medical dissolution is worthy of further comment. In this patient, specific measures to prevent urolith recurrence were not initiated because it is a part of a prospective clinical study. In the event uroliths recur, medical therapy designed to induce dissolution of uroliths would be repeated. Need for long-term preventative therapy would be dependent on the time interval between recurrent episodes (weeks, months, or years), and the effectiveness of medical therapy for urolith dissolution. Long-term prophylactic therapy would include urine acidifiers and diets low in magnesium.     

Nutrition and lower urinary tract disease in cats.

Lower urinary tract disease occurs commonly in cats and is often associated with crystal-related disease. Dietary modification is beneficial in managing some of these diseases, including idiopathic cystitis, urolithiasis, and urethral matrix-crystalline plugs. Altering dietary formulation may result in decreasing urinary concentrations of crystallogenic compounds, increasing urinary concentrations fo crystallogenic inhibitors, and diluting urine composition.     

Recent concepts in feline lower urinary tract disease.

This article presents and discusses recent concepts in feline lower urinary tract disease.     

Nutrition and aspects of feline lower urinary tract disease

Important causes of feline lower urinary tract disease (LUTD) that have been identified include urolithiasis and the formation of urethral plugs. In many cases, however, no specific cause of disease may be evident. Clinical studies in cats with apparently ‘idiopathic’ feline LUTD have suggested that some cases may respond to dietary modification, with diets designed to acidify urine, provide a good urine volume and relatively restricted magnesium intake. Nutritional research has predominantly focused on factors that may contribute to the formation of struvite uroliths, and has resulted in the development of specific recommendations for the management and subsequent prevention of recurrence of this condition. Urethral plugs have been less well studied, although recent clinical observations provide evidence that dietary modification may be of value in preventing their recurrence.     

Prevalence of bacterial urinary tract infection after perineal urethrostomy in cats.

It has been reported that the prevalence of bacterial urinary tract infection (UTI) increases after perineal urethrostomy in male cats. Perineal urethrostomy, using a surgical technique preserving striated urethral sphincter function, was performed on 2 groups of cats. The first group consisted of healthy castrated cats. The second group of cats had recurrent or persistent urethral obstruction. All cats had normal urethral sphincter function after surgery, as measured by urethral pressure profilometry and electromyography. Long-term periodic urinalysis and bacterial culturing of urine was performed on all cats. Twenty-two percent of the previously obstructed cats had recurrent bacterial UTI, compared with none of the healthy cats. On the basis of these findings, we suggest that perineal urethrostomy per se does not predispose cats to bacterial UTI, but surgical alteration of the urethral meatus combined with an underlying uropathy may increase the prevalence of ascending bacterial UTI after surgery.