Feline lower urinary tract disease (FLUTD) – treatment

> signs, causes and investigation


Feline lower urinary tract disease (FLUTD) is not a specific disease, but rather is the term used to describe conditions that can affect the urinary bladder and/or urethra (the lower urinary tract) of cats.

Clinical signs for these disorders are all very similar so it is often difficult or impossible to determine the underlying cause without doing further investigations. Although many different diseases can affect the lower urinary tract, frustratingly, a number of cats develop a disease without any obvious underlying cause - so called 'feline idiopathic cystitis' or FIC. This form of disease appears to bear many similarities to a disease in humans called 'interstitial cystitis', but in both cats and humans it can be difficult to manage.

Treatment of FLUTD

The treatment of FLUTD will depend on the underlying cause. In general, increasing water intake, and encouraging more frequent urination are good objectives in all cases of FLUTD. This may be helped by feeding wet (tinned or sachet) foods rather than dry foods, encouraging drinking, correcting obesity, encouraging exercise, and encouraging urination by considering how best to use litter boxes (if the cat is an indoor cat) - for more on this, see feline idiopathic cystitis.

Bacterial cystitis

Cases of bacterial cystitis usually respond well to appropriate antibacterial therapy. However, the choice of antibacterial drug should really be made on the basis of bacterial culture and sensitivity testing of the bacteria (this is done in the laboratory and indicates what antibiotics are most appropriate). Because bacterial cystitis is relatively uncommon in cats, antibiotics should only be used where there is a strong suspicion of bacterial infection or where this has been proven by analysis and culture of a urine sample.

Urolithiasis (bladder stones)

With bladder stones, these are most commonly removed from the bladder initially by surgery. With some type of stone (especially struvite stones) it may be possible to dissolve the stones by changing the cat's diet, and this may be something your vet will suggest to try. Special diets are available from your vet that are designed to carefully alter the composition of the urine in a way that will either dissolve the existing stones and/or help prevent them recurring. Some stones (such as calcium oxalate) cannot be dissolved and so surgery will always be needed to remove them.

Irrespective of whether surgery was performed initially, using a special diet from your vet will be helpful in avoiding recurrence of bladder stones. Also, feeding your cat a wet (tins, sachets) diet rather than a dry diet will help to increase the water intake which can also be helpful in preventing recurrence.

Urethral plugs

Urethral plugs causing obstruction to the urethra are an emergency situation. A blocked urethra in a cat can cause acute kidney failure within just 2-3 days, so rapid relief of the blockage is critical.

Urethral plugs (or urethral stones) are usually removed under an anaesthetic, as the condition is painful for the cat, and attempting to remove the blockage in a conscious cat would risk significant damage to the urethra. After the blockage is relieved, there can be quite severe inflammation of the urethra which may cause swelling and also spasm of the urethral muscles. This can make urination difficult for several days afterwards, and so some cats may need to be hospitalised for a period of time to monitor their progress. Depending on the severity, some cats will also need intravenous fluid therapy, and some may need a urinary catheter placed for a few days. Drugs to relieve pain, swelling and spasm are important.

To help prevent urethral plugs recurring, your vet will probably recommend feeding your cat a wet (tinned, sachet) diet rather than a dry diet (to encourage greater water intake and more frequent urination). Struvite (magnesium ammonium phosphate) crystals are often present in the urethral plug and while these do not cause the obstruction, they may contribute to it. Your vet may therefore recommend using a special diet that will reduce the risk of these crystals forming which may further reduce the risk of recurrence. It is also thought that many cats with urethral blockage may have underlying idiopathic cystitis (FIC) and so treatment recommendations for this disease should also be considered.

Urethral strictures

If a urethral stricture develops, these can be difficult to manage, as surgery is usually needed to correct the problem. The success of surgery will usually depend on the severity of the stricture and its location.

Feline idiopathic cystitis

Management of FIC is more complex, as the underlying causes are not fully understood. Several management options appear to be important though, including increasing the water intake of affected cats and reducing environmental stress - these are explained more fully elsewhere - see information on FIC

Bladder tumour – transitional cell carcinoma

Fortunately, bladder tumours are rare in cats. Transitional cell carcinoma is the most common tumour seen and occurs mainly in older cats. Often by the time clinical signs develop the disease is quite advanced and surgical removal of the tumour is rarely possible.

Chemotherapy may be helpful in reducing the size of the tumour and improving quality of life for the cat, and in a number of cases using non-steroidal anti-inflammatory drugs (NSAIDs) such as piroxicam or meloxicam appears to be very helpful. These drugs are usually very well tolerated and as well as relieving inflammation can have an anti-cancer effect in some tumours. Transitional cell carcinoma appears to be one of the tumours that often responds to NSAID therapy, and sometimes marked improvement can be seen (although these drugs cannot cure the disease and it will eventually recur).