Vol. 21, No.
1 January 1999
CE Refereed Peer Review
FOCAL POINT
★Idiopathic lower urinary tract
disease (iLUTD) is the most
common cause of hematuria,
pollakiuria, strangury, periuria,
and urethral obstruction in male
and female cats.
KEY FACTS
■ Diagnosis of iLUTD depends on
excluding other causes of lower
urinary tract signs via thorough
and appropriate diagnostic
evaluation.
■ Nonobstructive iLUTD occurs
primarily in young to middle-aged
cats with normal routine blood
test results, well-concentrated
and acidic urine, hematuria,
proteinuria, and negative urine
culture for aerobic bacteria.
■ Survey abdominal radiographs
in cats with iLUTD are
usually normal; contrast
cystourethrography may
be normal or may reveal
abnormalities.
■ Potential sequelae to
nonobstructive iLUTD
include urethral obstruction
and vesicourachal diverticulum.
20TH ANNIVERSARY
Feline Idiopathic
Lower Urinary Tract
Disease. Part I.
Clinical Manifestations*
Michigan State University
Tina S. Kalkstein, DVM, MA
John M. Kruger, DVM, PhD
University of Minnesota
Carl A. Osborne, DVM, PhD
ABSTRACT: Cats with naturally occurring lower urinary tract disease (LUTD) of unknown
cause are classified as having idiopathic LUTD (iLUTD). There are currently no diagnostic tests
or procedures that are pathognomonic for iLUTD. Because the feline urinary tract responds to
various diseases in a predictable fashion, clinical signs of iLUTD are similar to those associat-
ed with any other causes of feline LUTD. Feline iLUTD bears many similarities to an iLUTD of
humans called interstitial cystitis, although the pathogenesis of both disorders is poorly un-
derstood. This article is the first in a four-part series that reviews the clinical features, causes,
diagnostic evaluation, and management of feline iLUTD; Part I discusses the incidence, signal-
ment, clinical manifestations, and potential sequelae.
F eline lower urinary tract diseases (fLUTDs) characterized by hematuria,
dysuria, and pollakiuria have been a common veterinary problem for
decades. However, urethral obstruction caused by struvite/matrix urethral
plugs seems to be declining in frequency. Clinical observations suggest that, as
for all species, fLUTDs may result from diverse causes that are single, multiple
and interacting, or multiple and unrelated. Recognized causes of LUTDs in cats
include bacterial, fungal, or parasitic urinary tract infections (UTIs); uroliths;
urethral plugs; congenital or acquired anatomic or morphologic abnormalities of
the bladder and urethra; and iatrogenic causes (see Causes of Hematuria, Stran-
gury, Periuria, and Urethral Obstruction in Cats).1,2
The exact cause(s) of clinical signs is still unknown in a large percentage of natu-
rally occurring fLUTD cases; such cats are classified as having idiopathic LUTD
(iLUTD). In a prospective clinical study of LUTD in cats with naturally occurring
obstructive and nonobstructive disease, a specific cause could not be determined in
77 of 141 (55%) cats (Table I).3 In a more recent study of 109 cats with nonob-
*See also Part II (Potential Causes), Part III (Diagnosis), and Part IV (Therapeutic Op-
tions).
Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

structive LUTD, the prevalence annually. Although iLUTD ac-

of idiopathic disease was estimat-
ed at 64% (Table I).4 Based on
these observations, iLUTD is the
most common cause of hema-
turia, dysuria, and pollakiuria in
male and female cats. Because
there are no specific tests or di-
agnostic procedures that are
pathognomonic for iLUTD, di-
agnosis is dependent on exclu-
sion of other known causes.
INCIDENCE
The overall annual incidence
of fLUTDs in the United States
and Great Britain is reported to
be 0.5% to 1.0%.6,7 Based on
this estimate, a quarter to a half
million of the 57 million pet
cats in the United States8 are af-
fected with some form of LUTD
Causes of Hematuria, Strangury,
counts for the majority of
Periuria, and Urethral Obstruction in Cats these cases,3,4 the actual inci-
dence of idiopathic disease, its
Common recurrence rate, and the fre-
Idiopathic quency of sequelae are un-
Urolithiasis known. There have been no
Urethral plugs (crystal-matrix, matrix) contemporary controlled epi-
demiologic studies designed to
Uncommon evaluate subsets of cats with
Iatrogenic LUTDs defined on the basis of
Infectious (bacterial, fungal, parasitic, viral) specific diagnostic criteria.
Traumatic
SIGNALMENT
Rare Nonobstructive iLUTD oc-
Anatomic abnormalities (congenital or curs in male and female cats of
acquired) all ages but is more common
in young to middle-aged cats
Neoplastic
(mean age, 3.5 years; range,
Neurologic 0.5 to 17.5 years).3,4 It is un-
Coagulopathy (blood clots) common in cats younger than
1 year or older than 10 years

TABLE I
Frequency of Disorders in Cats with Signs of Lower Urinary Tract Disease
1981–1985 3 1993–1995 4
Male Female Male Female
Disorder (%) (%) (%) (%)

Nonobstructive LUTD (n = 47) (n = 43) (n = 47) (n = 62)

Idiopathic 78.7 58.1 63.8 64.5
Uroliths 17.0 39.5 8.5 19.4
Uroliths + UTI 0 2.3 0 0
UTI 0.04 0 0.02 0
Neoplasia 0 0 4.3 0
Anatomic defect NRa NRb 10.6d 9.7d
Behavioral abnormality NAc NAc 12.8 6.5
Obstructive LUTD (n = 51) (n = 0) — —
Idiopathic 29.4 0 — —
Urethral plug 58.8 0 — —
Uroliths 9.8 0 — —
Uroliths + UTI 1.9 0 — —
a
A urachal diverticulum and urethral narrowing were identified in nine and four cats, respectively, with nonobstructive LUTD. These
anatomic abnormalities were not considered a primary cause of clinical signs.
b
A urachal diverticulum was identified in seven female cats with nonobstructive LUTD. Urachal diverticula were not considered a pri-
mary cause of clinical signs.
c
Cats with periuria in the absence of hematuria, pollakiuria, and/or urethral obstructions were excluded.
d
Six cats had a urachal diverticulum, five had a urethral stricture, and one had a malpositioned urethra. The gender of affected cats was
not specified. These anatomic abnormalities were considered primary causes of clinical signs.
LUTD = lower urinary tract disease; NA = not applicable; NR = not reported; UTI = urinary tract infection.

DIAGNOSIS ■ RECURRENCE RATE ■ AGE RANGE

Compendium January 1999 20TH ANNIVERSARY Small Animal/Exotics

TABLE II Unless complicated by a concur-

rent illness, the results of complete
Clinical Features of Cats with Nonobstructive
blood counts and biochemistry pro-
Idiopathic Lower Urinary Tract Disease
files of cats with nonobstructive
Feature 1981–19853 1993–19954 iLUTD are usually normal. Urine
obtained from cats with iLUTD is
Total number of cats 62 70 usually concentrated and has an
Male 37 30 acidic pH; hematuria and protein-
Female 25 40 uria without pyuria or bacteriuria are
Breed Mixed (94%) ND
typical urinalysis findings (Table II).3
Persian (6%) ND Although microscopic hematuria
may be a consequence of cystocente-
Mean age (yr) 4.4 2.6 sis-induced trauma, the observation
(Range [yr]) (1–12) (0.5–17.5) of gross hematuria and microscopic
hematuria in 81% and 95%, respec-
Prior history of LUTD (%)a 61 90 tively, of nonobstructed cats with
iLUTD suggests that hematuria is a
Clinical signs (%) prevalent feature of this disease.3
Strangury 87 70 The prevalence, magnitude, and
Gross hematuria 81 61 type of crystalluria is variable in cats
Pollakiuria 76 79
Dysuria 29 ND
with iLUTD and does not seem to
Periuria 27 93 differ from that of unaffected control
cats (Table III). 3 Struvite crystals
Mean urine specific gravity (range) 1.051(1.006–1.077) 1.052(ND) have been the most common crystal
type identified in the urine of cats
Urine pHb Usually acidic Usually acidic with iLUTD,3,4 but their prevalence
may be decreasing (Table III).3,4 The
Hematuria (%; erythrocytes > 5/hpf ) 95 46 decreasing prevalence of crystalluria
likely reflects the widespread use of
Pyuria (%; leukocytes > 5/hpf ) 13 3 manufactured diets designed to min-
imize struvite-crystal formation.
Crystalluria (%) 50 13
The results of urine culture from
a
One or more previous episodes of clinical signs compatible with LUTD.
cats with iLUTD are invariably nega-
b
As estimated by reagent test strips. tive for aerobic bacteria,3,4 mycoplas-
hpf = high power field (450×); LUTD = lower urinary tract disease; ND = not determined. ma, ureaplasma,3,10–12 and viruses.13,14
Most cats with iLUTD are seronega-
tive for feline immunodeficiency virus
of age.3,4,9 In one study, the frequency of nonobstructive antibodies and feline leukemia virus antigen.4,15
iLUTD was somewhat higher in males than in females; Survey abdominal radiographs of cats with nonob-
however, these differences were not statistically signifi- structive iLUTD are usually normal. Contrast cystoure-
cant.3 There are no apparent breed predilections for thrography may be normal or may reveal thickening of
iLUTD.3 the bladder wall, mucosal irregularities, vesicourachal
diverticula, and/or urethral narrowing (Table IV; Figure
CLINICAL FEATURES 1). Ultrasonographic findings of iLUTD have not been
Because the feline urinary tract responds to various characterized; however, hyperechoic material presumed
diseases in a limited and predictable fashion, clinical to be crystalline in nature, blood clots, and mural irreg-
signs of iLUTD are similar to those associated with any ularities or thickening may be visualized.16
other causes of fLUTD. Periuria, dysuria, pollakiuria, Cystoscopic examination of cats with nonobstructive
strangury, and gross hematuria seem to be the most com- iLUTD may reveal increased mucosal vascularity, su-
mon clinical signs observed in cats with nonobstructive perficial urothelial desquamation, and focal areas of
iLUTD (Table II; see Clinical Profile of Nonobstructive submucosal hemorrhage (i.e., “glomerulations”).17,18 Al-
3,4
Idiopathic Lower Urinary Tract Disease) and often pre- though commonly observed in humans with an idio-
cede the obstructive form of the disorder. pathic disorder called interstitial cystitis (IC), glomeru-

CRYSTALLURIA ■ URINE CULTURE ■ RADIOGRAPHY ■ CYSTOSCOPY

Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

and submucosal hemorrhage

Clinical Profile of Nonobstructive were present in approximate-
Idiopathic Lower Urinary Tract Disease ly half of the specimens. 23
Varying degrees of submu-
■ Young to middle age ■ +/– Crystalluria cosal fibrosis and/or forma-
■ Male or female ■ Negative urine culture tion of granulation tissue
■ Normal complete blood count ■ +/– Thickened bladder wall on contrast were observed in more than
■ Normal biochemistry profile radiographs 80% of the specimens (Fig-
ure 4). Diffuse submucosal
■ Concentrated urine ■ Increased vascularity on cystoscopy
or perivascular mononuclear
■ Acidic urine pH ■ Superficial urothelial desquamation on cell infiltrates were observed
■ Hematuria without pyuria cystoscopy in approximately one third
■ Proteinuria ■ Submucosal hemorrhage on cystoscopy of the patients. One cat had
a moderately severe submu-
cosal cellular infiltrate com-
lations are nonspecific and may be associated with bac- posed predominantly of eosinophils. Mucosal hyperpla-
terial, chemical, or radiation cystitis or with any other sia, submucosal edema, neovascularization, and
urinary bladder disorder characterized by small bladder mineralization and fibrosis of the muscularis were ob-
capacity.19 In addition, cystoscopy-induced urothelial served less frequently. Increased numbers of mast cells
trauma may be confused with primary pathologic le- have been observed in the urinary bladders of some cats
sions.18,20 Until more information is available, cysto- with iLUTD.24,25 The significance of these observations
scopic findings of glomerulations in fLUTDs should be is unclear. Detection and quantitation of mast cells in
interpreted in the context of the results of other diag- tissue sections is difficult and often confounded by dif-
nostic evaluations.
The urinary bladder of cats with TABLE III
nonobstructive iLUTD may be dif-
Prevalence and Compositiona of Crystalluria in
fusely thickened. Focal to multifocal
Cats with Idiopathic Lower Urinary Tract Disease
areas of mucosal ulceration and sub-
mucosal hemorrhage may also be pre- Time Period Frequency Mineral Type
sent (Figure 2).21 Light microscopic 3
1981–1985 31 of 62 cats (50%) Struvite (96%)
abnormalities detected in the lower Struvite + calcium oxalate (1%)
urinary tract of cats with iLUTD are Calcium oxalate (1%)
variable and depend on the severity Uric acid (1%)
and duration of the disease, presence Amorphous phosphate (1%)
of sequelae (e.g., urethral obstruc-
tion), and alterations induced by diag- 1993–19954 9 of 70 cats (13%) Struvite (100%)
nostic and therapeutic interventions.
a
Superficial urothelial erosions/ulcera- Mineral composition determined by light microscopic observation of crystal habit.
tions and submucosal hemorrhage
and edema without a significant in- TABLE IV
flammatory response are common Radiographic Findings in 62 Cats with Nonobstructive
findings observed in bladder biopsy Idiopathic Lower Urinary Tract Disease3
specimens obtained from cats with
acute nonobstructive iLUTD (Figure Male Female Total
a
3). 4,21,22
Cats with persistent clinical Finding (n = 371) (n = 25) (n = 62)
signs or recurrent episodes of iLUTD No abnormalities 13 (35%) 4 (16%) 17 (27%)
tend to have light microscopic lesions Thickened bladder wall 21 (57%) 19 (16%) 40 (65%)
characteristic of chronic disease. Irregular bladder mucosa 11 (30%) 7 (28%) 18 (29%)
In a retrospective study of full- Vesicourachal diverticulum 4 (11%) 3 (12%) 7 (11%)
thickness bladder biopsy specimens Narrowing of urethral lumen 4 (11%) 0 (0%) 4 (6%)
obtained from 70 cats with chronic
a
iLUTD evaluated at Michigan State Results of survey abdominal radiography, positive-contrast urethrography, and double-
University, mucosal erosion/ulceration contrast cystography.

BIOPSY FINDINGS ■ ULCERATION ■ HEMORRHAGE ■ MAST CELLS

Small Animal/Exotics 20TH ANNIVERSARY
Figure 1—Lateral view of a double-contrast cystogram from a
3-year-old, spayed, female mixed-breed cat with a 12-month
history of chronic idiopathic lower urinary tract disease. The
cat had been treated unsuccessfully with antibiotics, α-inter-
feron, amitriptyline, and hydroxyzine. Note marked thicken-
ing of the cranial ventral bladder wall.
Figure 3—Photomicrograph of a urinary bladder biopsy spec-
imen obtained from an 8-year-old, castrated, male mixed-
breed cat with acute idiopathic lower urinary tract disease of
7 days duration. Note mucosal ulceration and marked expan-
sion of the submucosa caused by hemorrhage and edema.
(H&E stain, original magnification ×40)
ferential stain affinities of various mast-cell subpopula-
tions and by mast-cell degranulation prior to fixation.
Further studies are needed to quantitate and characterize
urinary bladder mast-cell populations in normal cats and
in those affected with iLUTD or other LUTDs (e.g.,
bacterial cystitis, urolithiasis, neoplasia).
BIOLOGIC BEHAVIOR
The biologic behavior of iLUTD has not been evalu-
ated by prospective studies of large populations of un-
treated cats. However, clinical signs of hematuria, dys-
RECURRENT SIGNS ■ DELAYED MANIFESTATION ■ URETHRAL STRICTURE
Compendium January 1999
Figure 2—The urinary bladder of the cat in Figure 1. Note
the diffuse bladder-wall thickening and multifocal mucosal
ulceration and hemorrhage.
Figure 4—Photomicrograph of a urinary bladder obtained
from the cat in Figure 1. Note mucosal ulceration and
marked expansion of the submucosa associated with neovas-
cularization, formation of granulation tissue, and fibrosis.
(H&E stain, original magnification ×40)
uria, and pollakiuria frequently subside in many un-
treated nonobstructed cats with acute iLUTD within 5
to 7 days.2,26–29 These signs may recur after variable pe-
riods of time and again subside without therapy.27 Our
impression is that recurrent episodes of acute iLUTD
tend to decrease in frequency and severity over time.28
Although recurrent clinical signs in iLUTD patients are
often assumed to be a recurrence of the original disease,
they may also result from a delayed manifestation of
the original disease (e.g., spontaneous or iatrogenic ure-
thral stricture), onset of a different disease associated
Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

with clinical manifestations TABLE V bumin, globulins, cells, cel-

similar to those of the origi- lular debris, microorgan-
Mineral Composition of 1284 Feline Urethral
nal disorder (e.g., urolithia- isms) mixed with variable
Plugs Analyzed by Quantitative Methodsa at the
sis), or combinations of quantities of mineral (crys-
Minnesota Urolith Center
these. tals). Some urethral plugs,
We have occasionally en- Number of Plugs however, are composed al-
countered cats with hema- Predominant Mineral Type b (%) most exclusively of matrix;
turia and dysuria that have Magnesium ammonium phosphate 6 982 (76.5) some consist of sloughed tis-
persisted for weeks to months H2O sue, blood, and inflammato-
and for which a specific Newberyite 7 (0.6) ry reactants; and a few are
cause was not identified. composed of aggregates of
Calcium oxalate 19 (1.5)
Whether chronic iLUTD crystalline material. Some
represents one extreme in Calcium apatite 23 (1.8) urethral plugs may contain
the spectrum of clinical Ammonium acid urate 6 (0.5) crystals and matrix in distal
manifestations associated Xanthine 1 (0.1) portions and inflammatory
with similar etiologic factors Sulfadiazine 1 (0.1) reactants in more proximal
or an entirely different Mixed c 39 (3.0) portions. Although struvite
mechanism of disease than is the most common miner-
Matrix 206 (16.1)
that associated with acute, al encountered in urethral
self-limiting idiopathic dis- a Uroliths analyzed by optical crystallography, x-ray spectros-
plugs, a variety of different
ease is unknown. copy, and infrared spectroscopy. mineral types have been
bUrethral plug composed of 70% to 99% of the mineral type
identified (Table V).
listed.
POTENTIAL SEQUELAE cUrethral plug contained less than 70% of the predominant We have hypothesized
Urethral Obstruction mineral. that the formation of some
Urethral obstruction in matrix–crystalline urethral
cats with iLUTD may result from (1) inflammatory plugs may require two concomitant but etiologically un-
swelling of the urethra; (2) urethral muscular spasm; related disorders (Figure 5).30 Urinary tract inflamma-
(3) reflex dyssynergia; (4) intraluminal accumulations tion, which may be idiopathic or secondary to infectious
of sloughed tissue, inflammatory cells, or erythrocytes; agents but occurs without concomitant crystalluria,
and (5) formation of matrix–crystalline urethral plugs.30 results in nonobstructive dysuria and hematuria. Al-
Urethral plugs are seemingly unorganized concretions though large quantities of mucoprotein and/or inflam-
composed predominantly of matrix (mucoproteins, al- matory reactants may accumulate in the urine of affect-
ed patients, urethral obstruction is
unlikely because a noncrystalline gel of
Urinary tract Crystalluria
inflammation (struvite, calcium
mucoprotein and inflammatory reac-
(infection, idiopathic, other?) oxalate, calcium tants can be voided readily through the
Concomitant phosphate, ammonium urethra. We envision this process as be-
occurrence acid urate, cystine, etc.) ing similar to the expulsion of tooth-
Matrix paste through the narrow opening of a
tube.
Persistent and Alternatively, the presence of risk
Not retained retained factors that promote crystal growth in
Urethral
plugs urine but the absence of inflammatory
Hematuria and dysuria Uroliths
or infectious disorders that cause pro-
duction of large quantities of muco-
protein or inflammatory reactants may
Urethral Hematuria and result in the formation of classical ma-
obstruction dysuria trix-poor uroliths (Figure 5). We hy-
pothesize that the concomitant occur-
Figure 5—Schematic illustration of different manifestations of feline lower urinary rence of urinary tract inflammation
tract disease associated with single or interacting underlying causes. (From Osborne
and crystalluria may lead to the forma-
CA, Kruger JM, Lulich JP, et al: Feline matrix-crystalline urethral plugs: A unifying
hypothesis of causes. J Small Anim Pract 33:172, 1992. Modified with permission.)
tion of matrix–crystalline plugs that
obstruct various portions of the ure-

URETHRAL PLUGS ■ MATRIX ■ URINARY TRACT INFLAMMATION

Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

thra, especially in male cats adult healthy cats32 and are

(Figure 5). This process of characterized by microscop-
matrix–crystalline urethral ic lumina in the submucosa
plug formation can be com- of the bladder vertex lined
pared to the preparation of by transitional epithelium.32
fruit jello; the matrix (i.e., In a study of 80 feline uri-
gelatin) entraps various types nary bladders, more than
of crystals (i.e., fruit). In ad- 40% had microscopic urachal
dition to various types of diverticula. 33 Microscopic
crystals, the matrix may trap remnants persisting in the
other elements, including urinary bladder vertex after
erythrocytes, leukocytes, ep- birth are usually clinically
ithelial cells, bacteria, and silent. However, recent stud-
cells containing viruses. Figure 6—Lateral view of a positive-contrast cystogram of a ies suggest that macroscopic
Supporting our hypothesis 3-year-old, castrated, male mixed-breed cat with a solitary diverticula may develop
is the observation of recur- urocystolith and a vesicourachal diverticulum. Note the large from microscopic diverticula
rent episodes of nonobstruc- diverticulum protruding from the ventral aspect of the blad- in cats (and dogs) after the
tive hematuria and dysuria der vertex. (From Kruger JM, Osborne CA, Lulich JP, et al: onset of concurrent—but
and episodes of plug-induced Inherited and congenital diseases of the feline lower urinary unrelated—acquired dis-
urethral obstruction in a cat tract. Vet Clin North Am Small Anim Pract 26:270, 1996. eases of the lower urinary
with iLUTD.28 A neutered Reproduced with permission.) tract (e.g., bacterial infec-
male Persian cat diagnosed tions, urolithiasis, crystalline–
with iLUTD at 2.5 years of age was enrolled in a long- matrix urethral plugs, idiopathic disease) (Figure 6).34,35
term study designed to evaluate the efficacy and safety of Urethral obstruction and/or detrusor hyperactivity in-
an acidifying, magnesium-restricted diet. Over the next duced by inflammation presumably results in increased
5.5 years, the cat experienced four episodes of LUTD intraluminal pressure and subsequent enlargement of
unassociated with bacterial UTI or uroliths. Two episodes microscopic diverticula.32 This hypothesis is supported
associated with hematuria and dysuria (not crystalluria) by the observation that many macroscopic diverticula
did not result in urethral obstruction. However, two in cats resolve within 2 to 3 weeks after amelioration of
episodes characterized by hematuria and concomitant clinical signs of LUTD.2,35
crystalluria were associated with the formation of ma-
trix–struvite crystalline urethral plugs. Both episodes of IDIOPATHIC LOWER URINARY TRACT
urethral obstruction corresponded with periods of owner DISEASE IN OTHER SPECIES
noncompliance with dietary recommendations. With the exception of humans, naturally occurring
These observations suggest that male cats with iLUTD iLUTDs have not been well characterized in other
and concomitant crystalluria are susceptible to the for- species. IC is a human iLUTD characterized clinically
mation of matrix–crystalline urethral plugs and urethral by pollakiuria, dysuria, lower abdominal pain, normal
obstruction. The observations may also support the use urinalysis, and distinctive cystoscopic lesions (Table
of acidifying, magnesium-restricted diets to minimize re- VI).19,36,37 Proposed causes include bacterial and viral in-
currence of matrix–crystalline urethral plugs containing fections, autoimmune disease, mast cell–mediated dis-
struvite. It is noteworthy, however, that dietary modifica- ease, lymphatic or vascular obstruction, neurogenic dis-
tion apparently did not prevent recurrence of signs of ease, endocrinopathies, and defective urinary bladder
iLUTD unassociated with struvite crystalluria and ure- urothelium.19 There is currently no consistently reliable
thral plug formation. and effective treatment of IC. Although symptomatic
treatment may be associated with a decrease in the
Vesicourachal Diverticula severity of clinical signs, complete and permanent re-
Vesicourachal diverticula are common abnormalities mission of IC has been rare.19
detected by positive-contrast radiography in cats with Some cats with iLUTD have findings similar to those
iLUTD (Figure 6; Table IV). The urachus is the fetal observed in humans with IC, including increased uri-
conduit that allows urine to pass from the developing nary bladder permeability, decreased urine concentra-
urinary bladder to the placenta31; it normally becomes tions of glycosaminoglycans, characteristic cystoscopic
nonfunctional at birth. Microscopic remnants of the fe- findings, similar gross and light microscopic changes,
tal urachus have been detected at the bladder vertex in and lack of effective treatment.17,24,38,39 These similarities

URACHUS ■ MACROSCOPIC DIVERTICULA ■ HUMAN INTERSTITIAL CYSTITIS

Compendium January 1999 20TH ANNIVERSARY Small Animal/Exotics

TABLE VI
Comparative Clinical Features of Nonobstructive Feline Idiopathic
Lower Urinary Tract Disease and Human Interstitial Cystitis
Feature Idiopathic Lower Urinary Tract Disease Interstitial Cystitis
Signalment Young to middle age Middle age
Male and female Female

Signs Pollakiuria Pollakiuria

Hematuria +/– Hematuria
Strangury Nocturia
Periuria Pelvic pain
Clinical course Episodic Chronic
Self-limiting Persistent
Chronic
Urinalysis Hematuria +/– Hematuria
Proteinuria +/– Pyuria
+/– Pyuria +/– Deficient or defective glycosaminoglycans
+/– Decreased glycosaminoglycans
Urine culture Sterile Sterile
Radiography Normal Normal
Thickened bladder wall
Irregular mucosa
Cystography Glomerulations Glomerulations
Reduced bladder capacity
Hunner’s ulcers
Histopathology Ulceration Ulceration
Hemorrhage Hemorrhage
Mononuclear cell infiltrate Mononuclear cell infiltrate
Increased mast cells? Increased mast cells?
Granulation tissue Granulation tissue
Fibrosis Fibrosis
Vasculitis
Perineural inflammatory infiltrates

have prompted the hypothesis that feline iLUTD is an
analog of human IC. Similarities between the two dis-
orders may also be coincidental, however, and represent
the finite ability of the bladder and urethra to respond
to a wide variety of disease processes. Further studies
defining the specific causative relationship between fe-
line iLUTD and human IC are essential.
SUMMARY
Feline LUTDs are a heterogeneous group of disorders
that may result from fundamentally different causes. Idio-
pathic LUTD is the most common cause of lower urinary
tract signs in young to middle-aged male and female cats.
The diagnosis of iLUTD is established by excluding other
common causes of hematuria, dysuria, periuria, and pol-
lakiuria. Clinical signs of nonobstructive disease usually
subside within 5 to 7 days without therapy but may per-
sist for weeks to months in a small subset of cats.
Episodes of iLUTD may recur and again subside in an
unpredictable fashion. Potential sequelae of iLUTD in-
clude urethral obstruction and vesicourachal diverticula.
About the Authors
Dr. Kalkstein is currently a resident in Small Animal Inter-
nal Medicine and Dr. Kruger is affiliated with the Depart-
ment of Small Animal Clinical Sciences at the College of
Veterinary Medicine, Michigan State University, East
Lansing, Michigan. Dr. Osborne is affiliated with the De-
partment of Small Animal Clinical Sciences, College of
Veterinary Medicine, University of Minnesota, St. Paul,
Minnesota. Drs. Kruger and Osborne are Diplomates of
the American College of Veterinary Internal Medicine.

DIAGNOSIS ■ DURATION OF SIGNS ■ SEQUELAE

Small Animal/Exotics 20TH ANNIVERSARY
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