Cat with neurogenic bladder issues post RTA

Re: Cat with neurogenic bladder issues post RTA

Simon Tai — Wed, 19 Feb 2014 17:41:34 GMT

Update on Case.

Urethral catheter was due to come out today with Cat having had 5 days of phenoxybenzamine. But the owners are taking back to the original vet who handled the case 7 yrs ago when it initially presented post RTA for another opinion. The analogy being that as someone who works in the motor trade, you take your Porsche to a Porsche specialist for repair !

Re: Cat with neurogenic bladder issues post RTA

Anthony Todd — Mon, 17 Feb 2014 19:05:20 GMT

[quote user="Simon Tai"]Catheter went in easily and currently sutured in place.[/quote]

Can I suggest that a squirt of local via a venocath will avoid the irritation of the catheter and you or the owner can concurrently continue the manual "re-education" of the bladder muscles.

May have to do the local a few times though but, IMHO, in-dwelling catheters in cats and humans usually add to the problems.

Re: Cat with neurogenic bladder issues post RTA

Simon Tai — Mon, 17 Feb 2014 14:35:17 GMT

[quote user="Beats"]

[quote user="Simon Tai"]I am having difficulty sourcing phenoxybenzamine ( Dibenyline) as it's now I believe discontinued[/quote]

Generic form listed as from last year - your local pharmacy should be able to check whether their supplier has it in stock or not:

"http://www.medicines.org.uk/emc/searchresults.aspx?term=Phenoxybenzamine&searchtype=QuickSearch"

I ordered some from our veterinary supplier just last month and got the dibenyline tablets after a wait of 4 weeks (I returned them as dog had been euthanased by then; large breed bitch presenting with urinary "obstruction" and very thickened bladder but no obvious cause and had wondered about reflex dysynergia - no response to phenoxybenzamine (we had some on the shelf), diazepam, NSAID and amox/clav given for a week...)

PS - I'm not saying this is the answer to your case, haven't read whole thread - just adding info re my recent experieince of phenoxybenzamine availability

[/quote][quote user="Beats"]

[quote user="Simon Tai"]I am having difficulty sourcing phenoxybenzamine ( Dibenyline) as it's now I believe discontinued[/quote]

Generic form listed as from last year - your local pharmacy should be able to check whether their supplier has it in stock or not:

"http://www.medicines.org.uk/emc/searchresults.aspx?term=Phenoxybenzamine&searchtype=QuickSearch"

PS - I'm not saying this is the answer to your case, haven't read whole thread - just adding info re my recent experieince of phenoxybenzamine availability

[/quote]

Hi there. I managed to get some generic phenoxybenazamine through Centaur. Ordered it Thursday last week and arrived on Friday.Sadly it appears that this cat does have some type of urethral spasm as he reblocked up again on the weekend. Catheter went in easily and currently sutured in place.

Re: Cat with neurogenic bladder issues post RTA

Beats — Thu, 13 Feb 2014 17:39:01 GMT

[quote user="Simon Tai"]I am having difficulty sourcing phenoxybenzamine ( Dibenyline) as it's now I believe discontinued[/quote]

Generic form listed as from last year - your local pharmacy should be able to check whether their supplier has it in stock or not:

"http://www.medicines.org.uk/emc/searchresults.aspx?term=Phenoxybenzamine&searchtype=QuickSearch"

PS - I'm not saying this is the answer to your case, haven't read whole thread - just adding info re my recent experieince of phenoxybenzamine availability

Re: Cat with neurogenic bladder issues post RTA

Anthony Todd — Thu, 13 Feb 2014 17:02:13 GMT

[quote user="Dagmar Steele"]Second the lactulose recommendation as well to keep faces soft.[/quote]

There is a human prep called " Isogel" and others, which is supposed to be better than lactulose in humans, and gives the stool the consistency of mousse, which I always used but it is a sort of bran like stuff so needs to be mixed with tinned food which constipated cats must be on anyway.

Can't see any drugs pushing concrete up hill??

Re: Cat with neurogenic bladder issues post RTA

Rob Loxley — Thu, 13 Feb 2014 16:28:28 GMT

[quote user="Simon Tai"]producing Bethanechol under a differnt name[/quote]

I think our last lot was branded Myocholine

Re: Cat with neurogenic bladder issues post RTA

Rob Loxley — Thu, 13 Feb 2014 16:27:35 GMT

[quote user="Simon Tai"]If push came to shove(I believe you can get Cisapride in a tablet form through IDIS with a STC)[/quote]

You can get cisapride off the shelf today in tablets or liquid from Summit Pharmaceuticals

Re: Cat with neurogenic bladder issues post RTA

Simon Tai — Thu, 13 Feb 2014 12:47:43 GMT

I havent done anything in this case as yet, but Lactulose I agree would be the way to go. Thankyou for the suggestion.On a slightly different note :Oh for the days of Prepulsid to help those megacolon cases. If push came to shove(I believe you can get Cisapride in a tablet form through IDIS with a STC)

Will remove the urethral catheter tomorrow and then start manual expression and phenoxybenzamine. Will keep you updated. Thanks once again

Re: Cat with neurogenic bladder issues post RTA

Dagmar Steele — Thu, 13 Feb 2014 10:45:31 GMT

I was thinking prazosine too to replace the phenoxybenzamine. Works well in my hands. Second the lactulose recommendation as well to keep faces soft.

Re: Cat with neurogenic bladder issues post RTA

Martin Atkinson — Thu, 13 Feb 2014 10:22:04 GMT

[quote user="Simon Tai"] This cat has always had a "problem "defaecating . The faeces just drop out and they are always hard. [/quote]So do you do anything for this? A bit different I know but In cats with chronic constipation due to mega-colon I've found lactulose at a dose that keeps the faeces soft and just formed does the job but keeping the client on-board and insisting they come back at least once a month for a check-up to make sure there isn't a build up of faecoliths has saved several from sub-total colonectomy.

Re: Cat with neurogenic bladder issues post RTA

Simon Tai — Thu, 13 Feb 2014 09:25:55 GMT

Thankyou Guys for all your answers. I must admit I have had some success with myotonin/Bethanechol or it might just have been the passage of time in previous similar cases.It does look as if I can source Phenoxybenzamine as a generic through our wholesaler, but will also try local hospital for this and Myotonin/Bethanechol. This cat has always had a "problem "defaecating . The faeces just drop out and they are always hard. This latest problem has been compounded by constipation and yesterday had to have a manual debung/soapy water enema. Will keep you updated.

Re: Cat with neurogenic bladder issues post RTA

Andrew Kent — Wed, 12 Feb 2014 19:52:16 GMT

[quote user="Simon Tai"]

I am having difficulty sourcing phenoxybenzamine ( Dibenyline) as it's now I believe discontinued and Bethanechol ( Myotonin) I just cannot get hold of. I do remember vaguely seeing an advert in one of the veterinary journals about a new? pharma company now producing Bethanechol under a differnt name. I could be imagining this, but does anyone know of any other sources or drug combos which may help?Thanks

[/quote]

You can try prazosin instead of phenoxybenzamine (doses in BSAVA formulary). We still have bethanechol, I think as a generic so maybe try your local pharmacy?

Andy

Re: Cat with neurogenic bladder issues post RTA

Anthony Todd — Wed, 12 Feb 2014 18:45:47 GMT

[quote user="Martin Atkinson"]

My experience of using medication like bethenecol in these cases is one of universal failure. If they are true neurological cases you can normally manually express the bladder to a manageable level conscious but I've never yet had an owner who has developed the requisite confidence/skills to do this reliably. If the cat has gone 7 years since the accident with no real issues then it is more likely that the problem is due to the FLUTD and that he is having some difficulty urinating due to pain/spasms so pain relief and a relaxant is possibly more appropriate like phenoxybenzamine or even diazepam. Phenoxybenzamine is available under the generic name from NVS - at least its on their system.

[/quote]

+1 with the exception of: teaching owners to express bladders is not impossible, and often following a typical un-block. May need to do it for 6 weeks, can always be done conscious. If a query stricture etc a bit of local via a venocath helps a lot first.

Sorry to state obvious things [which are never obvious to even the most intelligent owner, in fact there is a reverse correlation usually!]

Tell the owner to do it in the cat's usual peeing place, at the cat's usual time with everything as usual as possible, flat hands, constant but gentle persistent pressure etc.

This one sounds like a typical post-blocked cat with atonic or dystonic bladder muscles, particularly if the cat has been peeing normally for 7 years.

Any signs of constipation; mightn't help?

Drugs in my hands have been a waste of time; patient expression has been much more successful

Re: Cat with neurogenic bladder issues post RTA

Martin Atkinson — Wed, 12 Feb 2014 18:30:18 GMT

Re: Cat with neurogenic bladder issues post RTA

Simon Tai — Wed, 12 Feb 2014 17:01:26 GMT

Apologies for the brevity above. It would be for a 9 y.o M(n) DSH cat that I've only just recently seen for the 1st time 2 days ago. The history isnt all there but I believe he got HBC 7 yrs ago and sustained sacrococcygeal injuries which necessitated a tail amputation. The owners do see him urinating outside but also he leaks urine when sleeping. I dont know if this is overflow incontinence or not . He presented to me with a "blocked bladder"- depressed, bladder full, tense and painful. Under GA, I managed to catheterise his urethra easily, emptied the bladder and flushed. There were no urine abnormalities other than multiple coliforms on microscopy. The next day , he hadnt urinated and his bladder was full and tense again. I reGA'd him , recatheterised and sutured in place. He is with us now, but at some stage I need to remove his catheter and I guess wait and see. I can see him "blocking up" again or he may be a candidate for manual expression indefinitely . I used to use dibenyline/myotionin on these cases in the past , but cant seem to get hold of any now. Thankyou all in advance