A protocol for managing urethral obstruction in male cats without urethral catheterization

Abstract

Objective To determine efficacy of a protocol for managing urethral obstruction (UO) in male cats without urethral catheterization. Design Clinical trial. Animals 15 male cats with UO in which conventional treatment had been declined. Procedures Laboratory testing and abdominal radiography were performed, and cats with severe metabolic derangements or urinary calculi were excluded. Treatment included administration of acepromazine (0.25 mg, IM, or 2.5 mg, PO, q 8 h), buprenorphine (0.075 mg, PO, q 8 h), and medetomidine (0.1 mg, IM, q 24 h) and decompressive cystocentesis and SC administration of fluids as needed. Cats were placed in a quiet, dark environment to minimize stress. Treatment success was defined as spontaneous urination within 72 hours and subsequent discharge from the hospital. Results Treatment was successful in 11 of the 15 cats. In the remaining 4 cats, treatment was considered to have failed because of development of uroabdomen (n = 3) or hemoabdomen (1). Cats in which treatment failed had significantly higher serum creatinine concentrations than did cats in which treatment was successful. Necropsy was performed on 3 cats in which treatment had failed. All 3 had severe inflammatory disease of the urinary bladder, but none had evidence of bladder rupture. Conclusions and Clinical Relevance Results suggested that in male cats, a combination of pharmacological treatment, decompressive cystocentesis, and a low-stress environment may allow for resolution of UO without the need for urethral catheterization. This low-cost protocol could serve as an alternative to euthanasia when financial constraints prevent more extensive treatment.

Blocked cats and limited finances: an ethical obstruction?

“…We tend to condemn 'Dr Google', but in the right circumstance it can be really useful. A quick browse of Google Scholar takes you to the article ‘A protocol for managing urethral obstruction in male cats without urethral catheterization’, where 11 out of 15 cats were successfully treated for urethral obstruction without catheterisation at Ohio State veterinary college at a cost of $350, rather than the $1200 to $1800 a standard workup and treatment regime would cost (Cooper and others 2010). …”

Urinary Obstruction: Urethral Obstruction

“…If delay of successful catheterization is anticipated, careful cystocentesis may decrease trauma to the urinary bladder and ease back pressure on the urethra, perhaps facilitating retrograde catheter placement [1]. In dogs, a small gauge catheter may be able to be passed around a urethral obstruction to empty the bladder of urine.…”

“…If the obstruction is not able to be overcome, emergent definitive surgery, such as a permanent urethrostomy, may be required. Medical management for FLUTD is discussed elsewhere in detail and is beyond the scope of this chapter; however, it is important to note that some FLUTD patients respond well to sedation, subcutaneous fluid therapy, maintenance of a calm environment, and administration of medications that may decrease urethral spasm [1].…”

“…Urethral obstruction without rupture is often a cause for presentation of a small animal for urgent care, and results most commonly from urolithiasis, although neoplasia and trauma may also result in obstruction [1][2][3][4]. Even though calculi may develop within the urethra as urethroliths in both male and female dogs and cats, urocystoliths developing in the urinary bladder may also pass into the urethra and cause complete or partial obstruction to urine flow and associated clinical signs.…”

“…Moreover, male and female dogs and female cats become obstructed most commonly with calculi, but male cats more commonly present emergently for clinical signs attributable to feline lower urinary tract disease (FLUTD). FLUTD is a complex syndrome of acute and/or recurrent urethral obstruction related to both mechanical and functional obstructions of the penile urethra [1].…”