Perineal urethrostomy versus dietary management in prevention of recurrent lower urinary tract disease

The frequency and cause of recurrent lower urinary tract disease was compared prospectively in three groups of 10 male cats during a one year period following correction of obstructive urethropathy caused by matrix-crystalline plugs. One group of cats was managed by perineal urethrostomy, one group with a calculolytic diet, and the third group by perineal urethrostomy and the calculolytic diet. Ten episodes of bacterial urinary tract infection developed in five of 10 cats with perineal urethrostomies; six episodes of bacterial urinary tract infection developed in four of 10 cats with perineal urethrostomies and consuming the calculolytic diet. Bacterial urinary tract infections were not observed in cats managed only with the calculolytic diet. Staphylococcal-induced struvite urocystoliths developed in two cats with perineal urethrostomies. Vesicourachal diverticula detected in nine cats at the time of diagnosis of urethral obstruction healed spontaneously following restoration of urethral patency and remission of clinical signs. Transient microscopic haematuria was observed in approximately 25 per cent of the cats in all three treatment groups during the one year study. Results of this study confirm the effectiveness of dietary management in prevention of recurrent urethral obstruction caused by struvite-containing urethral precipitates, and verify that recurrent signs of lower urinary tract disease in cats may be caused by agents that are different from those that initiate the problem. They also confirm that perineal urethrostomies predispose cats to recurrent ascending bacterial urinary tract infections.     

Clinical evaluation of cats with lower urinary tract disease.

In a prospective study, 141 cats with hematuria, dysuria, urethral obstruction, or combinations of these signs were evaluated by contemporary diagnostic methods and compared with 26 clinically normal cats (controls). Specific diagnosis was established in 45% (64/141) of cats affected with lower urinary tract disease (LUTD). Crystalline matrix plug-induced urethral obstruction was diagnosed in 21% (30/141) of affected cats, uroliths were identified in 21% (30/141) of affected cats, uroliths with concomitant bacterial urinary tract infection (UTI) were identified in less than 2% (2/141) of affected cats, and bacterial UTI alone was identified in less than 2% (2/141) of cats with LUTD. Viruses, mycoplasmas, and ureaplasmas were not isolated from urine samples collected from affected or control cats. Bovine herpesvirus 4 (BHV-4)-neutralizing antibodies were not detected in any serum sample obtained from cats with LUTD or from control cats. In contrast, BHV-4 antibodies were detected by an indirect immunofluorescent antibody (IFA) test in sera obtained from 31% (44/141) of cats with LUTD and 23% (6/26) of control cats. The prevalence of positive BHV-4 IFA test results in affected cats was not significantly different from that observed in control cats. Significant association was not apparent between positive BHV-4 IFA test results and clinical diagnosis, abnormal laboratory findings, or cat age. However, the number of male cats with BHV-4 IFA titer was significantly (P less than 0.02, chi 2 test) greater than that of female cats. Detection of BHV-4 antibodies in approximately 30% of affected and control cats indicates prior virus exposure. Further investigations are warranted to clarify the specific role of BHV-4 in cats with naturally acquired LUTD.     

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.     

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.     

Elucidating the risk factors of feline lower urinary tract disease

A questionnaire-based case-control study investigating the association of a range of host-related, owner-related and environmental risk factors with feline lower urinary tract disease was conducted in New Zealand over a 2-year period from 1991 to 1993. The study was subsequently extended in two ways, to examine the influence of the use of litter trays and to correlate weather records with the appearance of the disease in one particular region of the country. A range of statistical techniques was employed to analyse the data, including univariate odds ratio and chi-squared calculations, time series analysis, Poisson regression and conditional and unconditional logistic regression. Variables that were positively associated with lower urinary tract disease included low activity levels, the use of a litter tray coupled with restriction indoors, a high number of rainfall days in the month preceding the appearance of clinical signs, stress factors such as moving house within the last 3 months or the presence of more than one cat in the household, and a diet high in dry cat food. There was some indication that high levels of fluid consumption reduced the effect of a diet high in dry cat food. Other variables that appeared to have some protective effects included a routine visit to the veterinarian in the last 12 months and the use of alternative food sources such as rodents and birds.     

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.     

Vaginal resection and anastomosis for treatment of vestibulovaginal stenosis in 4 dogs with recurrent urinary tract infections

CASE DESCRIPTION-4 dogs were evaluated because of recurrent urinary tract infections. CLINICAL FINDINGS-All dogs had recurrent urinary tract infections and similar clinical signs; 3 dogs had urinary incontinence. Digital vaginal examination revealed vestibulovaginal stenosis in all dogs, which was confirmed by results of contrast vaginourethrography. From image measurements, the vestibulovaginal ratio (ratio of the height of the vestibulovaginal junction to the maximum height of the vagina on a lateral vaginourethrogram) was calculated for each dog. Three dogs had severe stenosis (vestibulovaginal ratio, < 0.20; severe stenosis is defined as a vestibulovaginal ratio < 0.20), whereas the fourth dog had moderate stenosis (vestibulovaginal ratio, 0.24; ratio range for moderate stenosis is 0.20 to 0.25). TREATMENT AND OUTCOME-All dogs were anesthetized for surgical correction of the vestibulovaginal stenosis. Vaginal resection and anastomosis of the stenosis was performed in all 4 dogs, with 1 dog also undergoing episioplasty. Complete resolution of clinical signs was apparent in 3 dogs; 1 dog had postoperative complications including pollakiuria and stranguria, which resulted in rectal and vaginal prolapse. This dog underwent ovariohysterectomy, after which clinical signs resolved. All dogs had resolution of urinary tract infections at the time of follow-up (6 to 8 months after surgery). CLINICAL RELEVANCE-Resection and anastomosis may resolve recurrent urinary tract infections in dogs with severe or moderate vestibulovaginal stenosis. Episiotomy was not necessary for success of surgical treatment, and overall, that procedure increased morbidity, the severity of intraoperative hemorrhage, and duration of surgery.