urethrospams

Re: urethrospams

Mark Holmes — Tue, 04 Jan 2011 21:56:31 GMT

Thanks for the advice. Aware of the reactions to Baytril and diazepam very careful with Baytril dosing. I understood it was dose dependent but idioosyncratic suggests non dose dependent. Some years ago a nurse dispensed 150mg tablets as opposed to 15mg. That cat came back blind. Did feel I should congratulate the owners on getting the tablets down.

Re: urethrospams

angie hibbert — Tue, 04 Jan 2011 19:28:12 GMT

ignore above re culture...for some reason that part of the post didn't come up, only the initial post!

one point probably worth mentioning is possible drug reactions-baytril in cats has been associated with an idiosyncratic retinal degeneration and diazepam with a idiosyncratic fatal hepatopathy.

Re: urethrospams

angie hibbert — Tue, 04 Jan 2011 19:25:08 GMT

hi Mark,

this may be too late after your post, however you could also add in buprenorphine (the owners could give this at home sublingually or I usually tell them to aim for inside cheek onto buccal membranes). Combining meds together in gelatin capsule will help minimise the number of pills to give (which in itself can be a stress for the cat). In our experience at Langford, addressing all possible stressors at home is critical in managing cats with cystitis, and until that is addressed recurrence can be an issue, despite appropriate medical treatment. We work closely with veterinary behaviourists and it my be worth considering getting a behaviourists input with this cat. Other than that wet diet, increasing water intake, addressing any obesity is helpful too. Steroids probably unlikely to be helpful, and metacam probably a better option provided renal/heptic function ok. Have you also run a cysto sample for culture and sensitivity?

hope that helps,

best wishes,

angie hibbert

Re: urethrospams

Mark Holmes — Sat, 01 Jan 2011 15:06:36 GMT

No idea about the literature but the sample was taken at the time of the initial unblocking. Sent in boric acid. Might have hung around in the post a while. To be honest don't really care. Cat improved within 24 hours of starting Baytril .... no longer irritating me!

Re: urethrospams

Anthony Todd — Sat, 01 Jan 2011 12:44:10 GMT

[[quote user="Mark Holmes"]Goes to show not all 2yo male fat cats have a sterile cystitis.[/quote]

So do you think this profuse growth enterococcus was the primary cause of the initial "obstruction" or secondary to the repeated "unblocking??

If the bacto was from the initial urine sample [and the sample wasn't old by the time it was cultured] then it must be one of the few cases of primary E. coli cystitis recorded in the cat or am I way behind the literature?

Re: urethrospams

Mark Holmes — Sat, 01 Jan 2011 08:09:48 GMT

Finally got the results of the urine sample submitted sometime ago and delayed by weather Christmas etc. Profuse growth enterococcus therefore resistant to the convenia given. Dr Baytril stepped in and 100% better. Goes to show not all 2yo male fat cats have a sterile cystitis. Diazepam helped for a couple of days until culture received, thanks. Happy NY

Re: urethrospams

Anthony Todd — Sat, 01 Jan 2011 07:57:01 GMT

What happened; update needed please, [and Happy New Year too]

Re: urethrospams

Anthony Todd — Fri, 24 Dec 2010 22:41:53 GMT

[quote user="Mark Holmes"]The cat presented 2 weeks ago obstructed[/quote]

Sorry to be picky but if the catheter passed "without any resistance" why was it "obstructed"? There must have been an obstruction. I concede that a blockage will cause a reflex urethrospasm though. The history described, high intake of anions with restricted urination are the classic precursors of a blocked cat.

Some blocked cats clear really easily with a back flush and IMHO there's always crystals, at least initially, in the first block and in a fresh sample. Lab tests often seem to give negative crystals and the current climate seems to discount their significance anyway; some say a few crystals are "normal".

Catheters IMHO have all sorts of problems, chewed off [rest in bladder...]. stiff ones puncture bladder, always cause a "cystitis/infection" and /or exacerbate the urethritis, require supervision and they often reblock when the catheter is finally removed 'cos the problem has just been bypassed and not cured.

Prior sedation followed by repeated atraumatic flushing using an I/V cannula [without the needle] with local anaesthetic then saline and infusing your favorite steroid ear prep. always seemed preferable to an urethrostomy. Drizzle local over the penis to begin will stop it twitching.

I agree that dried diet in an ex-blocked cat must be a no-no as it will generate the minimum and concentrated urine as will keeping them in a cage above a yappy dog.

Re: urethrospams

Vikki Halliday LLB — Fri, 24 Dec 2010 20:17:48 GMT

Slippery Sams should not be left in for any lengthy time without glueing the hub to the catheter as they apparently can separate , thus necessitating a more urgent perineal urethrostomy to get it out!

Re: urethrospams

Martin Atkinson — Fri, 24 Dec 2010 15:51:13 GMT

You're right about the diet Mark I forgot it was dry, I won't give any dry food to FLUTD cats not even S/D etc. If I leave an indwelling catheter in I tend to let it just drip and change the vet bed regularly, I don't find it a problem and so long as you explain to clients the abvantages they can cope at home for a few days. I've not had an issue with leaving in a catheter for a up to a week especially if you use a soft one like a slippery Joe and after saying you shouldn't do it for many years, even some specialists are saying its OK. Yup you have to suture them to the perineum and put on an E collar but if the alternative is repeatedly sedating the cat to re-catheterise, that is IMO more traumatic. That said I've not needed to leave in an indwelling catheter for years but I wouldn't baulk at it if I had to.

Re: urethrospams

Mark Holmes — Fri, 24 Dec 2010 14:37:00 GMT

Its on feliway and calm is a dry food. I really don't like indwelling catheters, don't they just irritate the urethra? They also need suturing to the perineum and then its difficult to attach the collection bag to the tail. To be honest if it keeps blocking a cystostomy tube might be the way forward, bypass any urethral involvement at all until I chop its penis off next week. Hmmm thats a thought.

Re: urethrospams

Martin Atkinson — Fri, 24 Dec 2010 14:26:59 GMT

I woudn't have a problem placing an indwelling catheter for a week to let things settle down. Clearly its a bit of a management issue over christmas but its got to be easier than unblocking it everyday. Surprised nobody seems to have mentioned Feliway as its a stressed cat and try some Calm Diet.

Re: urethrospams

Mark Holmes — Fri, 24 Dec 2010 13:33:42 GMT

The cat presented 2 weeks ago obstructed however the catheter passed without any resistance and each and every time I have catheterised the cat it has been the same. No previous hx of obstruction its 2 yo and obese and highly stressed. It normally goes outside but with the weather and being beaten up by local stray has been forced to use indoor litter tray which I don't think is helping. I think it is a primary spasm in fact you can see its penis twitching when you touch it. No bladder debris present.

Re urethrostomy, I have managed to avoid doing any for at least a couple of years. I used to do them readily but now try to avoid it unless forced. Its a long haired fat cat so I do have some concern about long term stoma care. Also particularly unhappy doing op on Christmas eve and then leaving the on call vet with angry, blocky, difficult to handle cat to manage post op on her own for 4 days.

Going to try diazepam and see if that helps.

Thanks

Re: urethrospams

Anthony Todd — Fri, 24 Dec 2010 10:53:32 GMT

[quote user="Gillian Mostyn"]I'd suggest urethrostomy - these cases are so frustrating![/quote]

Surely a urethrostomy, if curative suggests a stricture or obstruction of the urethra? [not suggesting it won't work]

Is it really really possible to get a pure urethral spasm enough to cause "obstruction" without some stricture or prior urethral damage or irritation?

Has the cat been catheterised [atraumatically?]? Has there ever been crystals discovered? Was the first incident a "blocked bladder"?

Being 7.5Kg suggests an obese cat; classic for the "blocked cat"??

Does urethral spasm to "obstruction" occur without overt urethral pathology, even in humans.

I can assure you that a traumatised urethra changes your personality, I promise you......

My bet, but it's a hobby-horse of mine, is that you've got a damaged, narrow urethra which blocks with

+-crystals+- inflammatory sludge and is just called "spasm".

But I stand to be corrected.

Re: urethrospams

jose targa — Fri, 24 Dec 2010 10:43:56 GMT

I´m with Gillian: urethrostomy is the complete solution to the problem.

Re: urethrospams

Gillian Mostyn — Fri, 24 Dec 2010 10:27:23 GMT

I'd suggest urethrostomy - these cases are so frustrating!

Re: urethrospams

Laurence Webb — Fri, 24 Dec 2010 10:07:20 GMT

Phenoxybenzamine? You could try Zylkene, diazepam, amitryptilline for the stress as well. Sounds like a candidate for perineal urethrostomy if not already done though.

Re: urethrospams

Andrew Mellor — Fri, 24 Dec 2010 10:04:33 GMT

[quote user="Mark Holmes"]Any suggestions? Very stressing cat who becomes catatonic at the clinic, will not pee here and is agressive and impossible to give oral meds to.[/quote]

HAVE YOU TRIED DIAZEPAM,

[quote user="Mark Holmes"]Running out of ideas and getting irriatable.... I might start obstructing myself before long![/quote]

maybe for you too!

These are extremely frustrating cases, have a couple of cats like this at the moment one is much better with diazepam seems to help the urethral spasm as well as the stress levels for all concerned,

also have you tried cartrofen, seems to work in some cases. no idea why or how !