The Blocked Cat

Davina Anderson
MA VetMB PhD DSAS(ST) DipECVS MRCVS
RCVS Recognised Specialist in Small Animal Surgery
EBVS® European Specialist in Small Animal Surgery

Winchester, Hampshire
Introduction
• Lower urinary tract disease in the cat
• FLUTD
• FIC 55-65% All of these could cause obstruction
• Urolithiasis
• UTI
• Neoplasia

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Urinary tract obstruction
• Physical obstruction
• Urethral debris
• Urethral stones
• Urethral spasm or dyssynergia
• Iatrogenic
• Stricture/scarring

More common in the young –middle aged male cat

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 Prostate
Anatomy
BU glands

Membranous urethra
(striated muscle)
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Introduction
• FLUTD
• 3-5% of GP consultations are related to this disease
• Dysuria
• Pollakuria
• Haematuria
• Periuria and behavioural changes
• Overgrooming
• Restlessness
• 55-65% of cases have FIC
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Introduction
• FLUTD
• Nearly always resolves without treatment within 3-5
days
• A systemic condition with abnormalities identified in the
brain, spinal cord, adrenal glands as well as the
bladder wall
• Neurogenic inflammation of the bladder
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Introduction
• FIC
• Pain
• Cystitis
• Distress
• Behavioural changes
Very common in cats

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Introduction
• Stress related disease
• Increased sympathetic activity without negative
feedback controls
• Related to chronic stress
• Other symptoms may include GI signs and behavioural
abnormalities

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Initial presentation
• Marked pain, distress
• Pollakuria
• Hard enlarged bladder UTI is rare
• Post or pre renal azotaemia
• Hyperkalaemia
• Acidosis
• Dehydration, vomiting
• Collapse, bradycardia, urinary tract rupture

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Emergency triage
• Baseline TPR
• Cardiac auscultation, pulse deficits?
• Analgesia – do not use NSAIDs at this stage
• Intravenous access
• Intravenous fluids
• Blood samples
• Screen for pre renal azotaemia
• Electrolytes - hyperkalaemia
• Signs of chronic disease
• Level of dehydration
• Body weight – important for monitoring post obstruction
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Clinical history
• Diet
• Possibility of urolithiasis
• Possibility of dilute urine/CKD
• Environmental and habitat issues

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Non obstructive FLUTD
• Minimise the severity of episodes – never curative
• Environment enrichment
• Remove other cats
• Medication
• Safe environment
• Several litter trays
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Non obstructive FLUTD
• Dietary changes, increase water intake (dilute
urine)
• Pheromones
• Early treatment with analgesics

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Equipment- obstructive FLUTD
• Prepare for anaesthesia – not sedation
• Intravenous access
• Pre- oxygenate
• Intravenous benzodiazepines*
• Reduces induction agent
• Relaxes the urethra
• Treatment for hyperkalaemia/acidosis
• Hyperkalaemia can be dysrhythmogenic

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Hyperkalaemia
• ECG bradycardia, absent P waves wide QRS
tented T wave
• Easier to diagnose with blood sample

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Hyperkalaemia
• Insulin 0.5U/kg with dextrose (25% dilution) 0.7-
1g/kg over 5 minutes
• Calcium gluconate (10%) 0.5-1.0 ml/kg iv over 5-
10 minutes
• Sodium bicarbonate 1-2mEq/kg iv over 15
minutes

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Obstruction
• Prioritise draining the bladder
• Urethral
• Percutaneous
• Temporary vs longer term

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Urethral catheterisation
• Adequate anaesthesia or sedation
• Relieve back pressure from the bladder

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Equipment
• Choice of several urinary catheters
• Sterile gel, gloves, sample pot for urine
• Urinary collection bag and suture material
• Room temperature and cold sterile saline
• Warming device/bubble wrap

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Urinary catheters

Variety of types

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Urinary catheterisation
• Withdraw prepuce, protect the penis and penile mucosa with cold
saline/cold packs
• Use different catheters, patience, very gentle tissue handling
• Relax extension of the penis as the catheter is advanced
• Lavage bladder with cool saline to remove inflammatory mediators
and debris

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 Catheterisation
• Do not extend during
initial catheterization
• Extend once the
catheter is at the
ischium

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 Urinary decompression
• If catheterisation is not possible what options are there?
• Try bladder decompression with cystocentesis, cold pack and try
one more time
• More analgesia and relaxation
• Cystocentesis and emergency referral
• Surgical placement of temporary cystostomy tube
• Perineal urethrostomy
…but continue iv support/ rehydration/ treatment of hyperkalaemia

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Timing
• Leave the urinary catheter in until the episode is
fully resolved (3-6 days)
• Ensure that the urethra is fully relaxed before the
catheter is removed
• Perineal urethrostomy is a final stage choice, not
a first choice

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Perineal Urethrostomy
• PU relieves penile
urethral obstruction
• PU does not prevent
membranous urethral
spasm
• PU does not prevent
FLUTD/FIC

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Bladder decompression
• Resolution of inflammation
• Pain relief
• Recovery of detrusor
muscle
• Management of post
obstructive diuresis

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Post catheterisation
• Fluid therapy
• Monitor electrolytes
• Blood pressure, pulse rate and body weight useful
monitors of effectiveness of fluid therapy
• Match fluids to output – ensure that you keep up with
post obstruction diuresis

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Post catheterisation
• Analgesia
• NSAID not indicated due to renal compromise,
dehydration and inappetence
• Use opiates and pain scoring to modify doses
• Epidural, local analgesia
• Gabapentin*, amantine* and ketamine* CRI can be
useful
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Investigations
• Radiography – include the kidneys
• Negative contrast cystogram
• If a repeat episode, contrast urethrogram may be indicated
• Abdominal ultrasound
• Culture of urine
• Analysis of urine

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Urolithiasis

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Post obstruction management
• Daily biochemistry to check resolution of azotaemia and
hyperkalaemia
• Daily PCV/TP
• Monitor fluid therapy – post obstruction diuresis
• Match ‘ins’ and ‘outs’
• Weigh TID
• Feed normal diet

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Post obstruction management
• Hospitalisation
• Stress will contribute to FLUTD
• Places to hide
• Cat ward, or in a ward on its own
• Grooming/handling by someone who does not give treatments
• Normal diet
• Litter tray away from sleeping area
• ‘time out’

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Recognition of behaviour

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Post obstruction management
• Urethral spasm
• Phenoxybenzamine*/prazosin*
• Diazepam* - care
• Analgesics
• Leave the u/catheter in place for several days
• Act on culture results
• Confirm correct diagnosis

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Preparation for discharge
• Do not discharge until urination is normal
• Keep on iv fluids to ensure urine is dilute
• Continue medications post discharge

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Discharge appointment
• Explain to the owner what the syndrome is
• Explain it will never ‘go away’
• Change to a urinary acidifying diet – no treats!
• Increase water intake
• Unproven medications
• Glycosaminoglycans*
• Antidepressants*
• Pheromones

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Owner information
• Home environment may need to change
• Consider relationship with other cats
• Consider ‘safe place’ in household
• Multiple litter trays
• Consider stressors in the household – kids, builders, new
boyfriend/girlfriends etc
• www.icatcare.org

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Home environment
• Other cats – may have to rehome a dominant one
• Toys, increase activity
• Water fountains
• Secure cat flaps

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Recurrence
• Commonest reason is lack of follow up
• Arrange nurse check ups every 3 months
• Urinalysis – look at pH and sediment
• Check diet, weight, activity and home environment
• Acidifying diet 11% recurrence vs 39%

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Further Reading
• Urethra in Ladlow JF Chapter 38 Feline Soft Tissue Surgery eds Langley
Hobbs, Demetriou, Ladlow Saunders Elsevier 2014
• Understanding feline idiopathic cystitis Sparkes A In Practice 2018; 40:95-101
• International Cat Care website: www.icatcare.org
• Minnesota Urolith Center (analysis of uroliths as well as advice on prevention
and long term monitoring and treatment) : www.urolithcenter.org

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 Winchester, Hampshire

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