Blocked Bladder in 10 month ENTIRE DSH

Re: Blocked Bladder in 10 month ENTIRE DSH

Anthony Todd — Thu, 08 Apr 2010 23:20:06 GMT

[quote user="katja wagner"]the urinary catheter was kind of kinked in several places when taken out[/quote].

So it probably wasn't even draining the bladder!

The list of in-dwelling catheter sequelae grows ever longer.

Re: Blocked Bladder in 10 month ENTIRE DSH

katja wagner — Thu, 08 Apr 2010 22:34:11 GMT

Many thanks Anthony,

he came back today and owner reports less straining,he was a lot more setteled yesterday , passed a larger amount of urin this morning and only 2,3 little ones later. the bladder was less full then previous and he seemed more comfortable on palpation. i have repeated the procedure and will again tomorrow. i also found out that the urinary catheter was kind of kinked in several places when taken out so i very much belive now that this might be iatrogenic trauma.

just to clarify, this was not my case original and i did not keep him in the kennels,i am just the "lucky" one who can deal with it now.

thanks again,

katja

Re: Blocked Bladder in 10 month ENTIRE DSH

Anthony Todd — Thu, 08 Apr 2010 01:17:47 GMT

Just some comments:

1. Diet should be S/D or similar for a month exclusively which means any other animals in the household too!! [cats just love nicking their friends or enemies's food!]. Apparently it takes a month to leach the Mg++ out of the cat's system. Then onto C/D or low Mg++ with or without acidifiers for evermore for all cats in household. Then you'll never get struvite recurrence but er, watch for oxalate, and of course, watch weight as fat cats eat too much which includes too much Mg++ and oxalate. I advise measuring the cat's current intake with eggcups and feeding 2/3 of that.

2. Mirrors my experiences with indwelling catheters, at least the chewed remains aren't in the bladder or urethra and the bloody catheter didn't penetrate the bladder!! And add the inevitable infection/spasm/damage....... Wrapped round the penis is a new one to add to the list!

3. I usually rate the stream by needle jet ie an 18 or 20G stream is Ok; 25G is bad!! means you've got a narrower urethra or blockage which may block again.

4. I've catheterised [with a lubricated I/V cannula and local isolution] for three weeks in a paralysed atonic cat with total but slow return to normal. The cat got the message and seemed to get relief. Similarly blocked cats retroflushed daily for sometimes a week or so.

Push your favourite Panolog equivalent through the cannula after bladder drainage to bathe the urethra and make it easier next time. Usually you only have to go in 1cm to the block, retroflush with local then again with saline until you get the 20G flow.

5. Remember you're trying to get the cat to pee so locking it in a strange cage with a barking Staffie below it etc. etc. won't help so I get them home quick and get them back once a day at least. If you want to reduce the mythical stress hospitalisation isn't the way to go surely?

6. Can't see that X-rays of ultrasound will add to the case but I suppose there is a chance of a bladder stone so certainly advise if there is a recurrence.

7. I'm sure anything which causes reduced water intake [can you call that dypsia??] and/or urination as in a strange cage will pptate crystals so stress, is a factor, if you like.

8. I have just thought that the best lube for the cannula and urethra ie the least irritant might be an ocular ointment as the eye's pretty sensitive or that human Xylocaine jelly I mentioned.

9. Give the penis a spray of local and wait a minute too, seems to make it tolerated better.

Sounds as if it'll resolve so keep draining being gentle with that urethra.

Re: Blocked Bladder in 10 month ENTIRE DSH

katja wagner — Wed, 07 Apr 2010 20:36:04 GMT

Hi Anthony,

i have tried your approach with iv catheter/lignocaine flush/fuciderm this afternoon on a 2 year old male cat who has been tx by colleague 7 days ago for blocked bladder presented after beeing in a cattery. my colleague deblocked him under ga,urin was positiv for blood+++,few struvites, ph 7, he was hospil. with indwe. catheter,iv fluids, nsaids,veterg,antbi,hypovase,cystaid,urinary diet for about a week ,went home yesterday, i was the lucky one to recheck his bladder today which was pretty full,firm,cat squatting a lot at home,passing little puddles only with a poor streem.

after my tx which he tolerated amazingly well, concious, he was able to pass urin with a nice ,good streem,i have send him home and recheck tomorrow,owner rather unhappy as not insured,lots of money spend and still not right. no x rays have been performed yet ,no ultrasound in practice,i recommended x rays first but owner very relucant for financial reasons. how often do you think could i repeat or would it make sense to do so?

any further advice much welcome ,my personel impression is that it might all have started with stress due cattery and possible some damage caused with cather. of urethra , he had a drip line with bag attached in the first night which had to be removed as he managed to twist it around his penis.

many thanks, sorry for the long essay,

katja

Re: Blocked Bladder in 10 month ENTIRE DSH

Anthony Todd — Mon, 05 Apr 2010 13:21:45 GMT

I have to say we used acetylpromazine which gave enough sedation for gentle manipulation. The rationale was that if pain was evident then it was likely that trauma was occurring and more patience and a softer touch was needed. The lignocaine did not prevent a pain response and I used to squirt lignocaine over the penis and wait before I started so the introduction of the cannula was virtually ignored.

BTW there is now a lignocaine prep [Xylocaine 2% jelly] now available in Australia certainly, for "topical anaesthesia of the urethra" in humans which might be even better.

Hypovase, which I haven't used but have seen in use, seems to give too much anaesthesia making trauma a possibility.

Re: Blocked Bladder in 10 month ENTIRE DSH

Anthony Todd — Mon, 05 Apr 2010 13:12:04 GMT

The lignocaine is used as a local anaesthetic [procaine was better as it was acidic and helped to dissolve the struvite crystals] but also to wash out and/or retroflush the blockage.

Often 2ml is enough, as the usual site is about 1cm into the urethra but I've used up to 20ml and never had a problem.

With the urgency of a blockage confirming the unlikely if not impossible event of a bacterial cystitis, if such a diagnosis can ever be made in primary cystitis/blockage, and as Panolog and other similar preps contains A/Bs I don't think it's contraindicated.

Re: Blocked Bladder in 10 month ENTIRE DSH

John Goacher — Sun, 04 Apr 2010 18:59:58 GMT

Thanks v much for the advice, do you also use hypovase etc in the hope that you might not need to do anything in terms of iv catheters/lignocaine etc ?

Re: Blocked Bladder in 10 month ENTIRE DSH

katja wagner — Sun, 04 Apr 2010 14:30:02 GMT

Hi Anthony,

i would like to know how much lignocaine one can safely use and if you think that using panolog or similar would be contraindicated with a confirmed bacterial cystitis?

thanks for your answer,

katja

Re: Blocked Bladder in 10 month ENTIRE DSH

Anthony Todd — Sun, 04 Apr 2010 00:27:06 GMT

The above is a typical example of a post unblocking scenario which may well end up as "stress related" through no fault of the attending VS.

Firstly, IMHO, bladder atony is a very common sequel and can take up to three weeks to resolve. Manual expression is a bit of an art but works well and most cats can accept the owner's efforts on the litter tray or in the garden.

I suggest infusing the urethra using a lubricated 20G I/V cannula [without the needle!] with lignocaine. Most cats pee normally then or with minimal prolonged bladder compression. I then fill the urethra with discontinued Panolog or some other A/B/steroid preparation.

Catheters indwelling, apart from the inevitable bacturia seem to cause urethral spasm, penetrate the bladder or get chewed up or off and are unnecessary if you follow the procedure above which you can do in the conscious cat. Doing it conscious, if possible, has the advantage of signalling pain and therefore urethral trauma which is thereby avoided. If you like you can pass a 3FG catheter into the bladder but use an open ended so that you don't blow the urethral wall further to bits with a whistle tip. The lignocaine removes the pain reflex and may block the spasm.

The "firm and enlarged" penis in the above case suggests the possibility of previous trauma.