Bladder paralysis

Re: Bladder paralysis

CatherineThomas — Wed, 12 Jan 2011 11:13:36 GMT

Well I thought I would update you:

After about a week and a half she started urinating by herself, sometimes on her bed and sometimes in her litter tray. Although sometimes she wouldn't go and then it seemed that once the bladder was too full she couldn't urinate by herself. There was gradual improvement and she was able to go more and more for herself. She was kept in with us for quite a while so that we could ensure her bladder was being expressed if she couldn't manage it and we even filmed her to make sure she was actually knowingly urinating, particularly as it was often on her bed. And the video showed that she was squatting and urinating normally.

At week 4 her tail was amputated as we thought it was getting in the way and causing problems. At this point she was able to urinate by herself most of the time. The owners weren't able to express her bladder at home but they could feel when her bladder was large and so they would bring her in when they did. But she was still faecally incontinent and getting constipated. She was on 4mls lactulose 3 times a day. We increased the lactulose to 5mls 3 tmes a day and was sent home over the christmas period, also with daily micralax.

Unfortunately at week 6 she was still having difficulties particualarly with faeces. The owner felt that they could not cope and so she was put to sleep.

It was such as shame that we didn't have a positive outcome. She was such a sweet little cat and we all spent so much time trying to get her sorted. I wonder if she would have ever got full control back if we did continue.

Re: Bladder paralysis

Michael Woodhouse — Wed, 01 Dec 2010 22:42:50 GMT

[quote user="CatherineBoden"]I would like to put her on myotonine but we can't get any[/quote]

Have you tried your local hospital pharmacy? It's listed on the BNF.

Re: Bladder paralysis

Rob Loxley — Wed, 01 Dec 2010 17:27:24 GMT

[quote user="CatherineBoden"]I would like to put her on myotonine but we can't get any[/quote]

It is fairly easy to import but not cheap; you need the correct paperwork from the VMD. Not necessarily a comment on this case but more generally.

Re: Bladder paralysis

Gillian Mostyn — Tue, 30 Nov 2010 17:58:14 GMT

I said 'rarely' - not 'never'. I am happy to persevere for a few weeks if the owner requests it - but am just honest with them about the odds!

Re: Bladder paralysis

Bob Russell — Mon, 29 Nov 2010 15:35:05 GMT

[quote user="Gillian Mostyn"]

Yep - we have one long-term case that the owner expresses herself.

Prognosis-wise for the client, personally I'd say that if no improvement at all is seen in the first week, it rarely does after that.....

[/quote]

We said the same thing but used 10 days until one individual showed marked improvement at 12 days!!!

Re: Bladder paralysis

HMC — Mon, 29 Nov 2010 15:32:33 GMT

I may be remembering wrong, it was several months ago, but I called one of the referral hospitals in the south (Fitzpatricks or Anderson Sturgess, probably Fitzpatricks) regarding a tail pull injury and the advice was to amputate the tail sooner rather than later in cases of bladder atony. I think the theory was to do with limp tail pulling on nerves --> less able to heal. I should have kept notes for my own records, it was at a clinic where I locumed for a month only and I definitely did a partial caudectomy there... I just can't remember any more specifics, sorry!

Maybe it's worth calling either referral practice?

Re: Bladder paralysis

Simon Neuhoff — Thu, 25 Nov 2010 11:05:18 GMT

[quote user="CatherineBoden"]

Thanks everyone.

This case is made even more difficult by the fact that the owner is going through IVF at the moment and is not suposed to be under any stress during the implantation stage, which is happening on this coming Saturday. She really loves the cat, and is giving up a night in a hotel before her treatment to save money so that they can spend it on the cats treatment. I don't know whether it would cause her more stress if I suggest putting the cat to sleep before the end of the week or causing her to go through weeks of hoping that the cat will get better with limited chances of sucess. But then should I be advising based on what is best for the owner rather than the cat?

[/quote]

All you can do is be as honest and open about the prognosis as you can - the owner must decide what is best for her. In the long run even if they can manage the bladder additional problems often occur - I have had one such cat (it had been adopted as the practice cat) develop rectal fistulas, others battle with recurrent UTI's etc.

One of the more potentially heartbreaking cases!

Re: Bladder paralysis

CatherineThomas — Wed, 24 Nov 2010 21:04:45 GMT

Thanks everyone.

Re: Bladder paralysis

Gillian Mostyn — Wed, 24 Nov 2010 18:49:38 GMT

Yep - we have one long-term case that the owner expresses herself.

Prognosis-wise for the client, personally I'd say that if no improvement at all is seen in the first week, it rarely does after that.....

Re: Bladder paralysis

Jillian Hall — Wed, 24 Nov 2010 18:30:37 GMT

I know of 2 separate cat owners who, post tail-pull injuries, decided to give the cat some time and learnt to evacuate the bladder at home (one was a faster learner than the other but they both were managing it eventually). After 4-6 weeks they had accepted that bladder control was not going to return but they were so used to expressing the bladder the were happy to continue this indefinately.

I'm not saying this is ideal, and I know I wouldn't do it if it were my cat - just that there are people out there who are willing to express the bladder in the longer term. One could argue that its similar to insulin injections twice daily (as long as the cat is compliant!).

Re: Bladder paralysis

Kate Richardson — Wed, 24 Nov 2010 14:59:33 GMT

It is really difficult to know how long to give and 4-6 weeks is good as long as the cat is amenable to regular expression or place a cystotomy tube. Agree, need to empty bladder regularly or you risk bladder atony from overstretching- so it is finding a balance between allowing it to fill so cat can detect that it needs to urinate and not allowing it to get overfull. Unless the owner can express the bladder competently (which is unlikely as it takes experience) I wouldn't be keen on sending the cat home for them to do, so it may mean twice daily visits to the vets if the cat can cope with this. I usually find bladder function returns within 2 weeks though. However, tails can take 6 weeks to regain function, so if cat does start urinating again, don't be in a hurry to amputate the tail.

Re: Bladder paralysis

Martin Atkinson — Wed, 24 Nov 2010 12:55:14 GMT

Whether there is a spinal injury is probably largely irrelevant, but it may be cauda-equina syndrome from a tail pull injury, as only time will tell if it recovers or not. I wouldn't worry about the inablity to get myotonine as IME it is rarely of much use. What is important though is to empty the bladder twice a day to avoid over-stretching, retention cystitis and incontenance. A number will return to function but as many won't. Sadly I've yet to find a client who is competant or willing enough to manually empty their cat's bladder in the long term. However you may need to amputate the tail if that doesn't recover.

Re: Bladder paralysis

Rob Reid — Wed, 24 Nov 2010 12:42:34 GMT

How does the bladder feel to express? Is it quite solid or easy to express? Do you get any urinary overflow? Is there any anal tone?

If there is nothing obvious on your xray (have you taken several views and would it be worth repating this?) this will help you to differentiate an upper motor lesion from a lower motor neuron lesion. from what I rememeber, lesions cranial to the sacral cord initially result in a flaccid bladder that is easy to express, followed by a solid (spastic) bladder which is difficult to express, whereas lesions from S1 down tend to result in a flaccid bladder only, though this can distend and overflow. This is quite important as dibenyline has no effect on the parasympathetic system. In these cases myotonine will be of more use. If you do think it is a sympathetic lesion then remember you need to give dibenyline 5 days before you assess your response. (I always dig out the neurology textbook with these cases and I am sure it will explain it better than me!!)

I have had one case where bladder function returned about 4 weeks post tail injury - I put a tube cystotomy in this case which made management far easier. A surgical colleague of mine at the time said she used to give her cases 6 weeks.

Hope this helps - good luck, but be warned these are frustrating cases.