Cats with FLUTD may present with mild signs or with extremely serious signs that qualify as a true medical emergency. The attending veterinarian will assess the degree of discomfort and the seriousness of the situation when deciding which diagnostic and treatment protocols to follow. The goals of treatment are to relieve or rule out any physical obstruction of the urinary tract, relieve pain, restore urine flow, restore fluid and electrolyte balance and alleviate stress.
If the cat is obstructed, the obstruction must be cleared as quickly as possible. This is a medical emergency that can quickly become life-threatening. The veterinarian will draw a blood sample and decompress the cat’s urinary bladder through a technique called cystocentesis. This involves inserting a fine needle through the abdomen and directly into the bladder, and then draining the urine out through an attached syringe. A urinalysis will be done on a sample of that urine, and probably a culture as well to determine whether a bacterial infection is present. The results of these routine tests need not be reviewed before further treatments are initiated.
If the animal is in obvious distress, a catheter normally will be placed and intravenous fluid therapy will begin. Fluid and electrolyte imbalances are common with urinary track blockages. The cat will be sedated or placed under general anesthesia if it is necessary to place a urinary catheter. Often, the stone or other source of an obstruction can be dislodged and flushed out through a soft, flexible urinary catheter. Sometimes, an indwelling urinary catheter is necessary. If an obstruction cannot be removed through these procedures, surgery may be required. Male cats with recurrent obstructions may need a perineal urethrostomy, which involves making a permanent surgical opening for the urethra, between the anus and the scrotum.
Once any blockage has been relieved, the cat should be managed medically for as long as necessary. Pain medications (called analgesics), and additional fluid therapy, can be used to facilitate restoration of kidney function and urine production. Urine output should be carefully monitored until it returns to normal levels. Antibiotics are appropriate if a bacterial infection is identified through urine analysis and culture. The contribution of steroids and non-steroidal anti-inflammatory drugs (NSAIDs) is controversial and not well-documented. An electrocardiogram may be recommended to assess the cat’s heart, which can be adversely affected from severe electrolyte abnormalities.
Affected cats may be placed on a restricted diet, depending on the particular composition of any plugs, crystals or stones that are retrieved. The veterinarian can prescribe the appropriate food.
The prognosis for cats with FLUTD is highly variable and depends on a combination of factors, including:
- The underlying cause of the condition
- The frequency and severity of symptoms, especially obstructions
- The owner’s emotional and financial commitment to treatment and environmental enrichment
- The number of and relationships between cats in the household
- The owner’s degree of tolerance to urine soiling in the house