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Tony Johnson, DVM, DACVECC
It is a frustrating condition with many names: Feline Lower Urinary Tract Disease, Feline Urologic Syndrome, Feline Interstitial Cystitis, even the rather whimsical Pandora Syndrome. Anyone who has treated it knows the stress and anxiety it can induce in those treating the disease, as well as in patients suffering from it, not to mention their anxious owners.

That same stress and anxiety also contribute to the disease process itself. As an ER vet, I know the plumbing aspect of the disease very well and can usually get them unblocked and on more stable footing in short order. What I don’t usually have to deal with are the softer aspects of the disease – softer, but no less important. That usually falls to general practice veterinarians, who have to take the reins from ER vets like me and manage their patients long-term.

In the spirit of adhering to the Veterinarian’s Oath and reducing animal pain and suffering, I’d like to offer up some points to consider when either treating a cat with a urinary obstruction or managing a non-obstructed cat with signs of lower urinary tract disease.

1. Are you incorporating appropriate analgesia and sedation in your treatment protocol?

This is a painful condition. Pain causes stress, which can exacerbate the disease – and make future trips to the vet even more stressful. Making sure you have incorporated appropriate analgesia when unblocking a cat, and when managing a catheterized cat in the hospital, is a vital part of treatment – and one that is often overlooked. Proper (and safely chosen) sedation, and incorporation of a sacrococcygeal block while unblocking, good pain control with buprenorphine or a full-mu opioid agonist, and home analgesia for three to five days after discharge will help to minimize the pain and anxiety of an episode of urethral obstruction. Owners will appreciate advanced pain control protocols and knowing that you are taking their pet’s emotional wellbeing into consideration. It also makes cats easier to handle in the hospital and more likely to come back for future visits – everybody wins!

Suggested Protocols

Sacrococcygeal block:

• Use 0.1 mL/kg of either lidocaine or bupivacaine
• Unless the cat is very sick and moribund, this is typically done under heavy sedation or anesthesia
• Move the tail up and down in a “pumping” motion, palpating the sacrococcygeal region.
• The first movable space at the caudal end of the sacrum is either the sacrococcygeal or intercoccygeal space. Either site is okay and there’s no need to differentiate which site you are in.
• Insert a 25-ga needle through the skin on midline at a ~45° angle.
• If bone is encountered, withdraw the needle a few mm, redirect slightly at a steeper or flatter angle and reinsert. This is known as “walking” off the bone.
• Repeat this process until the needle is in intervertebral space. A “pop” may be felt and there should be no resistance to injection.

Buprenorphine – while in hospital:

• 24 mg/kg Simbadol® SC q 24 hr up to 3 d
• 01–0.02 mg/kg IM, IV, SC q 4–8 hr

Buprenorphine – sublingual/outpatient: 0.01–0.02 mg/kg transmucosal q 4–12 hr

Fentanyl CRI – 1-5 ug/kg/hr IV

Note: Since many cats who are blocked may also have some degree of acute kidney injury, NSAIDs should be used cautiously or not at all in acute obstructions. They may be helpful in cats with normal renal function for non-obstructive episodes.

2. Are you reducing stress in the household? In your hospital?

Imagine you are a hospitalized blocked cat: fluorescent lights, a painful catheter, Elizabethan collar, barking dogs – sounds awful, right?

Do everything you can to reduce the stress of hospitalized cats. Put yourself in the patient’s position and imagine what their existence in your hospital is like. If you don’t have a “cat room,” try and keep cats in the quietest part of the hospital, out of sight and sound of dogs. Allow time for rest and a break from medical procedures and provide a box or other structure in the kennel where the cat can hide.

Both at home and in the hospital, use of feline facial pheromones (Feliway®) may help alleviate stress and anxiety. Consider installing one in your ICU and changing it regularly. A few sprays of Feliway® on your patient’s bedding may also help. The Feliway® diffuser can be particularly helpful at home.

Make sure cats at home have distractions and safe spaces to hide from dogs, children, and other cats. During stressful times (moving, boarding, redecorating, addition of new pets or children to the home) consider advising clients to spend extra time with their cats or discuss safe sedation  and anti-anxiety protocols and environmental enrichment to reduce fear, anxiety, and stress.

Stress can bring on this condition, and the things we have to do to treat it are often stressful and uncomfortable, creating a continuous positive feedback loop. Owners are stressed, vets are stressed, and (most of all) patients are stressed. Do everything you can to reduce the anxiety and discomfort of feline urologic conditions and you will not only be keeping up your part of the Veterinarian’s Oath, you’ll be practicing better medicine as well.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Dr. Tony Johnson, DVM, DACVECC, is a 1996 Washington State University grad and obtained board certification in emergency medicine and critical care in 2003. He is currently Minister of Happiness for VIN, the Veterinary Information Network, an online community of 75,000 worldwide veterinarians, and is a former clinical assistant professor at Purdue University School of Veterinary Medicine in Indiana. He has lectured for several international veterinary conferences (winning the small animal speaker of the year award for the Western Veterinary Conference in 2010) and is an active blogger and writer.