Peer Reviewed FELINE URETHRAL OBSTRUCTION: DIAGNOSIS & MANAGEMENT

FELINE URETHRAL
OBSTRUCTION: DIAGNOSIS
& MANAGEMENT
Christopher M. George, DVM, and Gregory F. Grauer, DVM, MS,
Diplomate ACVIM (Small Animal Internal Medicine),
Kansas State University

Feline urethral obstruction (UO) is a common signs—associated with the onset of uremia—include
disorder encountered in small animal emergency anorexia, vomiting, and lethargy/collapse.
practice, with incidence estimates ranging from Clinical signs depend on the completeness and
1.5% to 9%.1,2 duration of the obstruction. The median duration
The etiology of UO was long thought to be a of signs before veterinary presentation was 3 days in
physical obstruction, such as a urethral plug, calculi, one study of 223 cats.1
stricture, or neoplasia. In a recent study,3 however,
causes of UO in 45 cats were found to be idiopathic Physical Examination
(53%), uroliths (29%), and urethral plugs (18%), The classic physical examination finding in cats with
indicating that functional obstructions may be more UO is an overdistended, turgid urinary bladder that
common than previously thought. cannot be expressed. It is important to note, however,
Feline UO is a treatable emergency, with a survival that the inability to express urine can be a normal
rate to discharge higher than 90%,1 despite the fact finding in male cats and not diagnostic for UO.
that it is potentially life threatening due to severe The penis may be reddened from self-trauma, and
electrolyte and acid–base imbalances secondary a urethral plug may be observed protruding from
to acute postrenal azotemia/uremia.1,4 Treatment the tip of the penis. Dehydration may be present
commonly involves days of hospitalization, as indicated by prolonged skin turgor and tacky
with substantial owner investment, and rates of mucous membranes.
recurrence following treatment are relatively high Moderate bradycardia (100–140 beats/min)
(range, 11%–43%).3,5 and severe bradycardia (< 100 beats/min) were
observed in 6% and 5% of cases, respectively.1
PREDISPOSING FACTORS Bradycardia and arrhythmias occur secondary to
Given their relatively long and narrow urethra, male the effects of hyperkalemia on cardiac conduction.1
cats are much more likely than female cats to develop Of cats with UO, 50% can be expected to have a
obstruction. Segev and colleagues determined that normal body temperature, 40% hypothermic, and
the mean age of cats with UO (51.7 ± 37.7 months) 10% hyperthermic.1 In one study, the combination
was significantly lower than gender-matched and of hypothermia (< 95–96.6°F) and bradycardia
time-matched (sequential hospital admissions) (< 120 beats/min) was 98% specific for severe
controls without UO (75.5 ± 61.3 months).4 In hyperkalemia (> 8 mEq/L).6
addition, obstructed cats were more likely to live Systolic blood pressure on presentation is
indoors only, weigh more, and be fed a dry diet typically normal7; in one study, 71% of cats were
exclusively.4 normotensive and 29% were hypertensive.7

CE
PRESENTATION INITIAL DIAGNOSTICS
Clinical Signs Diagnosis and management of UO are performed
The most common early clinical signs of UO are simultaneously. Diagnostics should ideally include:
Article similar to those of idiopathic cystitis, including • Minimum database, including packed cell
stranguria, dysuria, and hematuria. Delayed systemic volume/total solids, blood urea nitrogen (BUN),

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 FELINE URETHRAL OBSTRUCTION: DIAGNOSIS & MANAGEMENT Peer Reviewed

creatinine, blood glucose, pH, sodium, potassium, radiography to rule out urolithiasis as a cause. It
chloride, phosphorus, and ionized calcium is important to make sure the radiographs include
• Electrocardiogram the entire urinary system, which allows the kidneys,
• Urinalysis with sediment examination ureters, bladder, and entire length of the urethra to be
• Abdominal/perineal radiographs. assessed for urolithiasis.
Free abdominal fluid, as indicated by loss of serosal
Blood Analysis detail in the caudal abdomen, may be observed but is
In one study of cats with UO1: not always caused by rupture of the urinary bladder.8
• Serum creatinine concentration was above the Increased bladder permeability secondary to severe
reference range in 29% of cats distension and diffuse cystic mural disease may result
• BUN was above the reference range in 33% of cats in transmural leakage of urine without overt bladder
• Serum phosphorus was above the reference range rupture. Positive-contrast urethrography/cystography
in 25% of cats. is the most sensitive diagnostic test for bladder or
Hyperkalemia is one of the most common urethral rupture.
laboratory abnormalities observed in cats with Ideally, survey radiographs are obtained prior to
UO and can contribute to severe bradycardia and passage of a urethral catheter because the presence
arrhythmias. In one study of cats with UO, serum of the catheter can make urethral evaluation more
potassium concentration was1: difficult, and urolithiasis may be undetected. If
• Less than 6 mmol/L in 76% of cats the patient is in critical condition, steps to address
• 6 to 7.9 mmol/L in 12% of cats metabolic derangements should have priority over
• 8 to 10 mmol/L in 12% of cats radiographs.
• Above 10 mmol/L in only 0.5% of cats.
Hyperkalemia was also most often encountered PATIENT STABILIZATION
with acidosis and low serum ionized calcium The magnitude of azotemia, electrocardiographic
concentrations.1 In cats with UO and bradycardia stability, and degree of bladder distension helps
and/or arrhythmias, the magnitude of hyperkalemia dictate the order of treatment and how quickly it
should be assessed and corrected prior to sedation or must be performed. Cats in uremic crisis with very
anesthesia for urethral catheterization. large, turgid bladders require prompt intervention.
Stabilization of the patient and treatment of
Urinalysis adverse effects of UO are essential before anesthesia is
If urine is available, the urine specific gravity (USG) administered. Hypovolemia and hyperkalemia must
may be greater than 1.040 early in UO, but more be the first treatment priorities.
dilute urine can be observed with prolonged UO
as a result of increasing renal tubular dysfunction. Fluid Administration
Microscopic hematuria is almost always present, Intravenous access should be obtained soon after
and gross hematuria is common due to bladder presentation because IV fluid administration is critical
overdistension and/or the presence of underlying for severely ill cats with UO.
cystitis. Hematuria is also frequently associated with Crystalloid fluid therapy is indicated; 0.9% sodium
pyuria and proteinuria. chloride is often recommended because it does not
Nearly all cats presenting for UO have sterile urine; contain potassium. However, in a randomized study
however, urine contamination or misinterpretation comparing treatment with 0.9% sodium chloride and
of particulate matter in the urine sediment may a balanced polyelectrolyte solution (Normosol-R,
be mistaken for a urinary tract infection (UTI). hospira.com), no difference was observed in the rate
Quantitative bacterial culture of urine obtained by of decline of serum potassium; in addition, a more
cystocentesis is recommended to confirm UTI in rapid correction of acidosis was observed in the cats
patients with suspected infection. Struvite crystals treated with polyelectrolyte solution than in those
may be observed as well, especially in alkaline urine. treated with 0.9% sodium chloride.9 This suggests
Struvite crystals are more likely to form secondary to that balanced electrolyte solutions may actually be
urine stasis and alkalinuria as opposed to being the preferred for correcting acid–base imbalances in cats
primary cause of UO. with UO.
IV fluid therapy is started at a rate of 10 to 20 mL/
Imaging kg/H, and the rate adjusted as the patient stabilizes
All cats with UO should be evaluated with abdominal and urethral patency is established. Mild increases

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 FELINE URETHRAL OBSTRUCTION: DIAGNOSIS & MANAGEMENT

Degrees of Various degrees of hyperkalemia occur in cats with UO (Table). Hyperkalemia adversely affects cardiac
conduction. As a result, tall and spiked T waves, widened QRS complexes, lengthened PR intervals,
Hyperkalemia flattened P waves, atrial standstill, ventricular fibrillation, and/or asystole may be observed on a lead II
ECG rhythm strip (Figure).

Table.
Cats with Urethral Obstruction: Degrees of Hyperkalemia
DEGREE OF SERUM TREATMENT OPTIONS
HYPERKALEMIA POTASSIUM
CONCENTRATION

Mild < 6 mEq/L Dilutional fluid therapy (10–20 mL/

hyperkalemia kg/H), with rate adjusted as patient
stabilizes

Moderate 6–8 mEq/L IV administration of:

hyperkalemia • Dextrose (50% solution [1 mL/kg]
diluted to final concentration of
10%–20%)
• Regular insulin (1 U)
Severe > 8 mEq/L Calcium gluconate (0.5–1 mL/kg
hyperkalemia IV), followed by regular insulin and
dextrose IV

in serum potassium concentrations will return to

reference intervals with dilutional fluid therapy
and relief of UO; however, targeted correction of
moderate to severe hyperkalemia is necessary prior
to sedation or anesthesia for relief of the UO (see
Figure. Examples of how different degrees
Degrees of Hyperkalemia).
of hyperkalemia can adversely affect cardiac
conduction. Picture the lead II rhythm strip as a
Calcium Gluconate string being pulled apart. Note the flattened P
Calcium gluconate is the treatment of choice for waves, prolonged PR interval, and widened QRS
cats with severe hyperkalemia, bradycardia, and complexes. The exception to this string analogy
electrocardiographic instability. is the tall, spiked T waves.
Calcium gluconate (10%) is administered at 0.5
to 1 mL/kg IV slowly over 2 to 3 minutes while 20%, is administered as an IV bolus. This treatment
continuously monitoring the electrocardiogram. stimulates endogenous insulin release, causing
If bradycardia worsens or QT interval shortening intracellular translocation of plasma potassium.
occurs, the infusion should be stopped. Administration of 1 unit of regular insulin IV
While this treatment rapidly stabilizes cardiac hastens the intracellular translocation process.
conduction, it does little to reduce hyperkalemia. In However, insulin should never be given without a
addition, its beneficial effects are short lived (20–30 concurrent dextrose bolus, followed by a constant
min) and other strategies to lower serum potassium rate dextrose infusion to prevent hypoglycemia.
are often needed (Table).
An IV infusion of calcium gluconate may also be Sodium Bicarbonate
administered to treat muscle twitching or seizures Sodium bicarbonate may be administered in cats with
associated with hypocalcemia. Hypocalcemia usually severe hyperkalemia to help translocate potassium
resolves rapidly after relief of obstruction as serum from the plasma into the intracellular fluid in exchange
phosphorus concentration decreases. for hydrogen ions. Sodium bicarbonate (1 mEq/kg) is
administered IV, with a maximum dose of 4 mEq/kg.
Dextrose If excessive amounts of bicarbonate are
IV dextrose is helpful for longer term control of administered, the major disadvantage of this
hyperkalemia. A 50% dextrose solution (1 mL/ treatment is the development of ionized hypocalcemia
kg), diluted to a final concentration of 10% to due to increased binding of calcium to albumin

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 FELINE URETHRAL OBSTRUCTION: DIAGNOSIS & MANAGEMENT Peer Reviewed

and intracellular translocation of ionized calcium, • Ketamine (2–5 mg/kg IV), with either diazepam
creating an alkalemia. Sodium bicarbonate may also (0.2–0.5 mg/kg IV) or acepromazine (0.005–0.05
be less effective than dextrose or insulin in reducing mg/kg IV), is generally a safe and effective
potassium concentrations. protocol; a second dose of ketamine and diazepam
can be administered if additional time is needed to
Cystocentesis complete the procedure.
Therapeutic cystocentesis should be performed as • Diazepam may be a better choice for more
soon as possible in cats with very large bladders and critical patients because it is less likely to cause
prior to anesthesia for urethral catheter placement hypotension compared with acepromazine.
to aid in stabilizing the patient. The benefits of • Inhalational anesthesia (isoflurane or sevoflurane)
therapeutic cystocentesis almost always outweigh the via endotracheal tube may be necessary in some
potential adverse effects; benefits include: cats that are not sufficiently relaxed with the above
• Rapid reduction of bladder pressure protocols.
• Improvement in glomerular filtration rate • Propofol is also effective, but apnea and
• Collection of an uncontaminated urine sample hypotension are possible adverse effects. If
• Reduction of cystic pressure, which may facilitate propofol is used, the cat should be intubated to
urethral catheterization and back flushing. provide adequate ventilation.
Cystocentesis in cases of UO is considered Epidurals provide analgesia to the penis and
controversial by many clinicians, with the major bladder and may reduce the depth of anesthesia
concern being bladder rupture or tear. However, necessary, but these techniques require additional
clinical experience and recent evidence have shown training and expertise. A simplified method of
that the overall risk for bladder rupture is low.8,10 In coccygeal epidural with local anesthetic has been
a recent study of 47 cats with UO, decompressive described and provides safe and effective analgesia to
cystocentesis, followed by urethral catheterization, the penis and urethra.11
had no significant adverse effects on the bladder.8 In
most cases, a needle hole in the bladder resulting in a Urethral Catheter Placement
clinically significant uroabdomen is unlikely, especially Aseptic technique and a gentle hand are fundamental
if the bladder is kept decompressed by placement of a to urethral catheter placement.
urinary catheter.10 1. Clip the hair in the perineal region carefully and
To reduce potential complications of bladder prepare the skin aseptically.
laceration and aortic puncture: 2. Extrude the penis and retract it caudally to
• Perform the procedure with the cat in lateral straighten the urethra. Failure to fully retract
recumbency the penis caudally impedes the catheter from
• Use a 22-gauge needle attached to an extension navigating the sigmoid flexure of the urethra.
set with a 3-way stopcock and 35-mL syringe; the 3. Advance a urinary catheter (see What Types of
extension tubing and 3-way stopcock allow the Catheters?, page 40) into the urethra to the site of
bladder to be emptied at least partially without obstruction. Advance the catheter slowly to avoid
manipulation and movement of the needle urethral trauma; it should never be forced past an
• Advance the needle through the bladder wall at a obstruction.
45-degree angle directed toward the trigone; the 4. Urethral irrigation (hydropulsion) with sterile
45-degree angle helps the needle tract seal after physiologic saline via an extension tube is
withdrawal recommended both to dilate the urethra and to flush
• Stabilize the bladder with one hand while the other any obstructing material retrograde into the bladder.
hand guides the needle and an assistant operates 5. A 50:50 mixture of water-soluble lubricant and
the syringe. sterile physiologic saline may also be injected
through the catheter to provide lubrication along
URETHRAL OBSTRUCTION RELIEF the entire length of the urethra and aid in catheter
Anesthesia advancement.
After the cat has been stabilized, sufficient anesthesia 6. Once the urethra is patent, flush it thoroughly to
is administered to provide immobilization and ensure all debris is removed and then advance the
urethral relaxation. Many effective anesthesia catheter into the bladder.
protocols are available and can be chosen based on 7. After catheterization, flush and drain the bladder
clinician comfort and drug availability. multiple times with sterile saline to remove

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 FELINE URETHRAL OBSTRUCTION: DIAGNOSIS & MANAGEMENT

postobstructive diuresis (requiring measurement of

What Types of For urethral catheter placement, use a well- urine production to guide fluid therapy; see After
lubricated, rigid, open-ended urinary catheter Relief of Urethral Obstruction)
Catheters? (eg, 3.5- or 5-Fr, 10-cm polypropylene). A 20- to
• Severe bladder distension, which often results in
22-gauge over-the-needle catheter (without the
detrusor atony and inability to void
needle) or olive-tip catheter may also be used;
however, these are not usually long enough to • Grossly abnormal urine or cystic calculi, both of
reach the trigone and drain the bladder. which increase the risk for immediate recurrent UO.
For indwelling catheter placement, use To avoid trauma to the bladder mucosa and the
a longer, softer catheter; material options catheter tangling inside the bladder, indwelling
include polyvinyl (red rubber catheter or urethral catheters (see What Types of Catheters?)
infant feeding tube), polytetrafluroethylene should not be inserted fully into the bladder.
(Slippery Sam Tomcat Urethral Catheters,
Catheters should be “premeasured” and inserted only
surgivet.com), or polyurethane. A 3.5-Fr
catheter is preferred over a 5-Fr catheter to the level of the trigone. The indwelling catheter is
because the smaller diameter catheter is then secured to the prepuce using a nonabsorbable
associated with a decreased incidence of suture and finger trap technique, tape butterfly and
recurrent UO within 24 hours (in one study, suture, or other technique depending on clinician
6.7% of cats with a 3.5-Fr catheter versus 19% preference.
of cats with a 5-Fr catheter).5 Polypropylene A sterile collection system should always be
catheters should not be used as indwelling attached and secured to the cat’s tail. It is never
catheters because they tend to be more
acceptable to leave an indwelling catheter exposed
irritating to the urethra than other types of
urinary catheters.12 to the environment due to the risk for bacterial
infection. An Elizabethan collar or hind leg hobbles
should be used to prevent the cat from chewing out
debris and help prevent rapid recurrent UO. We the catheter.
use refrigerated sterile saline to help promote
vasoconstriction and reduce hemorrhage. AFTER RELIEF OF URETHRAL
OBSTRUCTION
Role of Atracurium Besylate After obtaining urethral patency, intensive supportive
One study evaluated the effect of intraurethral care is indicated until resolution of metabolic
atracurium besylate—a neuromuscular blocking agent derangements. This care includes:
that causes paralysis of striated muscle—in male cats • Maintenance of urethral catheter
with urethral plugs in aiding the resolution of UO.13 • Monitoring for postobstructive diuresis and
• A solution of 0.5 mg/mL atracurium besylate was secondary UTI
infused into the urethral lumen of treated cats for • Administration of IV fluid therapy, analgesia, and
5 minutes prior to retrograde flushing; the control urethral relaxants/antispasmodics
group was infused with saline. • Potential supplementation with potassium.
• The percentage of cats with urethral plug removal
at the first attempt was significantly higher in the Postobstructive Diuresis
atracurium group (64%) compared with the saline Postobstructive diuresis (POD) is a well-described
group (15%). phenomenon in human medicine that may result
• The mean time required for removal of the UO secondary to UO in cats as well. In one study, 46%
was also significantly reduced in the atracurium (13/28) of cats developed POD, defined as urine
group. production exceeding 2 mL/kg/H within 6 hours
Use of this protocol may result in shorter anes- after relief of UO.15 Several cats had diuresis up to 84
thetic events and easier urethral catheterization in hours following relief of UO.15
cats with UO. The high incidence of POD calls for close
measurement of urine output and continued IV fluid
Indwelling Catheters administration using an “ins and outs” fluid therapy
Indwelling urethral catheters are not necessary in protocol after resolution of hypovolemia. This
all cases of UO because the presence of the catheter protocol involves administering balanced electrolyte
causes urethral irritation. However, indwelling fluids at a rate to replace the urine volume produced
urethral catheters are necessary in patients with: hourly, plus 20 mL/kg/day for insensible losses to
• Severe azotemia, which often results in prevent negative fluid balance.

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 FELINE URETHRAL OBSTRUCTION: DIAGNOSIS & MANAGEMENT Peer Reviewed

Conventional management of UO can involve 4. Acepromazine (2.5 mg PO Q 8 H) and Avoiding

substantial owner expense. Financial constraints buprenorphine (0.075 mg PO Q 8 H) are
may result in euthanasia of cats with UO, administered, with cystocentesis repeated Euthanasia:
especially those with recurrent UO. While every 8 hours. Medetomidine (0.1 mg IM Q 24
conventional management with urethral catheter H) can be administered if no urination is noted Nonconventional
and intensive care should always be offered as within 24 hours, and SC fluids can be given as Management
the first treatment choice, a noncatheterization needed.
protocol may be a viable alternative to Treatment success, defined as spontaneous
euthanasia. urination within 72 hours, occurred in 11 of 15
In a 2010 study, Cooper and colleagues (73%) cats; treatment failure occurred in 4 of
described a protocol for managing UO in male 15 (27%) cats. Cats that experienced treatment
cats without urethral catheterization14: failure had significantly higher serum creatinine
1. Acepromazine (0.25 mg IM) and buprenorphine concentrations, although the magnitude of
(0.075 mg IM) are administered to provide pretreatment azotemia was not an exclusionary
sedation and analgesia. criterion. Necropsy of 3 of the cats with treatment
2. The penis is inspected and gently massaged in failure showed no evidence of bladder rupture.14
an attempt to dislodge any obstruction in the Cats with unresponsive mentation, severe
distal penis, followed by a single attempt to metabolic derangements (severe acidosis or
express the bladder. hyperkalemia), or radiographic evidence of
3. If no urine is expressed, therapeutic cystocen- uroliths were excluded from the study and are
tesis is performed and the cat is housed in a not good candidates for this protocol.14
dark, quiet room to minimize stress.

Monitoring & IV Fluid Rate Indwelling Catheter Removal

Serum electrolytes should be monitored at minimum The duration of indwelling urethral catheterization is
every 24 hours, and potassium supplementation may controversial. Removing the indwelling catheter too
be required to prevent hypokalemia, especially in the soon may not allow for adequate clearing of bladder
face of substantial POD. Reduced urine production debris, clots, or crystals. However, the presence of a
typically occurs after resolution of azotemia. urinary catheter causes irritation and inflammation of
If urine production does not decrease, the high the lower urinary tract.13
rates of IV fluids may be driving the diuresis. The IV The duration of urethral catheterization should
fluid rate in these patients should be tapered initially be based on the patient’s clinical status rather
by 25%. If urine production decreases, continued than a specific amount of time. Guidelines for
reduction of IV fluids by 25% every 6 to 12 hours is catheter removal include resolution of metabolic
recommended. If urine production is not reduced, the derangements (such as azotemia) and POD as well as
fluid rate should be increased to its previous level and improvement in the gross character of the urine (clear
tapering attempted again 24 hours later. versus cloudy/hemorrhagic).10 The average duration
of indwelling catheterization is 48 hours.
Analgesics
Continued treatment with analgesics for 5 to 7 days Use of Antimicrobials
after relief of UO is indicated in all patients. Opioid Antimicrobials are not recommended unless
derivatives (eg, buprenorphine) are used most quantitative bacterial culture demonstrates the
commonly. presence of a UTI. The majority of cats presenting for
Use of the nonsteroidal anti-inflammatory drug their first UO do not have a UTI, and antimicrobials
(NSAID) meloxicam was evaluated recently in the do not prevent the development of catheter-associated
treatment of obstructive feline idiopathic cystitis.16 UTI.
Cats were separated into 2 treatment groups: one A prospective study of cats with UO found zero
receiving buprenorphine and meloxicam and the other positive cultures on presentation, but 6 of 18 (33%)
receiving buprenorphine and a placebo. Meloxicam cats developed UTI while catheterized.17 Cats treated
did not influence the recurrence rate of UO or rate with an indwelling urethral catheter should have a
of recovery from clinical signs. Due to these findings quantitative bacterial culture performed on urine at
and the risk associated with NSAIDs in the face of the time of catheter removal or 7 to 10 days later.
hypovolemia and decreased renal function, NSAIDs Antimicrobials should be prescribed based on culture
should be used with caution in cats with post-UO. and sensitivity results.

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 FELINE URETHRAL OBSTRUCTION: DIAGNOSIS
FELINE URETHRAL OBSTRUCTION
& MANAGEMENT

Urethral Relaxants
Because urethral irritation and spasm can contribute
to UO, the use of urethral relaxants has become
standard. Medications most commonly used include
acepromazine, phenoxybenzamine, and prazosin, all
of which function as alpha-1 antagonists, which cause
smooth muscle relaxation. Since smooth muscle is
located in the proximal 1/3 of the penile urethra only,
whereas striated muscle comprises the remainder of
the urethra, urethral relaxants may not be effective
in improving outcome in cats with more distal
obstructions.
One retrospective study evaluating factors affecting
recurrent UO rates found that patients receiving
prazosin had significantly lower recurrent UO rates
than those receiving phenoxybenzamine at 24 hours
(7% versus 22%, respectively) and 30 days (18%
versus 39%, respectively).5 This may be due to the
more rapid onset of action of prazosin compared with
phenoxybenzamine as well as the effects of prazosin
on both the preprostatic and prostatic urethra.
Therefore, prazosin (0.25–1 mg/cat PO Q
8–12 hours) is recommended in cats for 5 to 10
days post-UO. However, phenoxybenzamine or
acepromazine may be substituted based on availability.
It is important to consider the sedative effects of
acepromazine, as these may be beneficial in reducing
stress or contraindicated based on the individual
patient.
Further prospective studies are needed to evaluate
the effects of other alpha-1 antagonists on recurrent
UO.

AFTER DISCHARGE
Home Environment
The home environment of cats with UO should be
changed as needed to help decrease stress and increase
water consumption. Alterations may include:
• Increasing contact time between the cat and owner
• Improving litter box hygiene and increasing
number of litter boxes
• Switching to a canned food diet and increasing
water availability
• Environmental enrichment, such as vertical perches
and hiding places
• Increasing hunter behavior and use of pheromones
(Feliway spray, feliway.com) to help reduce stress.18
In a prospective study evaluating risk factors
associated with recurrent UO, the combination of
environmental modifications significantly lowered
the risk for recurrent UO, but increasing water
consumption was the only independent factor
associated with a decreased risk for recurrent UO.19

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Peer reviewed FELINE UrETHrAL OBSTrUCTION: DIAGNOSIS & MANAGEMENT

Follow-Up with feline urethral obstruction recurrence rate: 192 cases

(2004-2010). JAVMA 2013; 243(4):512-519.
re-evaluation 7 to 10 days after discharge is
6. Lee JA, Drobatz KJ. Historical and physical parameters as
recommended. Factors to evaluate include: predictors of severe hyperkalemia in male cats with urethral
• Urinalysis to monitor USG (goal of < 1.030), obstruction. J Vet Emerg Crit Care 2006; 16(2):104-111.
urine pH, and crystalluria 7. Malouin A, Milligan JA, Drobatz KJ. Assessment of blood
pressure in cats presented with urethral obstruction. J Vet
• Quantitative bacterial culture (obtained by Emerg Crit Care 2007; 17(1):15-21.
cystocentesis) to rule out UTI that may 8. Hall J, Hall K, Powell L, Lulich J. Outcome of male cats
have occurred during indwelling urethral managed for urethral obstruction with decompressive
cystocentesis and urinary catheterization: 47 cats (2009-
catheterization. 2012). J Vet Emerg Crit Care 2015; 25(2):256-262.
9. Drobatz KJ, Cole SG. The influence of crystalloid type
IN SUMMARY on acid-base and electrolyte status of cats with urethral
obstruction. J Vet Emerg Crit Care 2008; 18(4):355-361.
UO is a common but complex disorder encountered
10. Cooper ES. Controversies in the management of feline
in cats. A great deal remains to be learned about the urethral obstruction. J Vet Emerg Crit Care 2015; 25(1):130-
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UO to help standardize care. Despite the severe 11. O’Hearn AK, Wright BD. Coccygeal epidural with local
anesthetic for catheterization and pain management in the
metabolic consequences associated with UO, treatment of feline urethral obstruction. J Vet Emerg Crit Care
aggressive treatment results in high success rates. 2011; 21(1):50-52.
When aggressive conventional treatment is not 12. Lees GE, Osborne CA, Stevens JB, Ward GE. Adverse
effects caused by polypropylene and polyvinyl feline urinary
an option, nonconventional management may be catheters. Am J Vet Res 1980; 41(11):1836-1840.
successful. 13. Galluzzi F, De rensis F, Menozzi A, Spattini G. Effect of
intraurethral administration of atracurium besylate in male
cats with urethral plugs. J Small Anim Pract 2012; 53:411-
BUN = blood urea nitrogen; NSAID = nonsteroidal
415.
anti-inflammatory drug; POD = postobstructive 14. Cooper ES, Owens TJ, Chew DJ, Buffington CA. A protocol
diuresis; UO = urethral obstruction; USG = urine for managing urethral obstruction in male cats without
urethral catheterization. JAVMA 2010; 237(11):1261-1266.
specific gravity; UTI = urinary tract infection
15. Francis BJ, Wells rJ, rao S, Hackett TB. retrospective study
to characterize post-obstructive diuresis in cats with urethral
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trends in frequency of urethrostomy for treatment of urethral obstructive lower urinary tract disease: A pilot study. J Feline
obstruction in cats. JAVMA 2002; 221(4):502-505. Med Surg 2013; 15(10):843-848.
3. Gerber B, Eichenberger S, reusch CE. Guarded long-term 18. Pereira JS, Fragoso S, Beck A, et al. Improving the feline
prognosis in male cats with urethral obstruction. J Feline Med veterinary consultation: The usefulness of Feliway spray in
Surg 2008; 10:16-23. reducing cats’ stress. J Feline Med Surg August 2015 [Epub
4. Segev G, Livne H, ranen E, Lavy E. Urethral obstruction ahead of print]; DOI: 10.1177/1098612X15599420.
in cats: Predisposing factors, clinical, clinicopathological 19. Eisenberg BW, Waldrop JE, Allen SE, et al. Evaluation of
characteristics and prognosis. J Feline Med Surg 2011; risk factors associated with recurrent obstruction in cats
13:101-108. treated medically for urethral obstruction. JAVMA 2013;
5. Hetrick PF, Davidow EB. Initial treatment factors associated 243(8):1140-1146.

CHRISTOPHER M. GEORGE GREGORY F. GRAUER

Christopher M. George, DVM, is a Gregory F. Grauer, DVM, MS, Diplomate ACVIM
small animal internal medicine resident (Small Animal Internal Medicine), is a professor
at Kansas State University College and Jarvis Chair of Medicine, Department of
of Veterinary Medicine. Dr. George Clinical Sciences, at Kansas State University
received his DVM degree from Kansas College of Veterinary Medicine. His clinical
State University and completed a small and research interests involve the small animal
animal surgery and medicine internship urinary system. He is on the board of directors
at VCA Mission Animal Referral and of the IRIS and American Society of Veterinary
Emergency Center before returning Nephrology and Urology. Dr. Grauer received
to Kansas State University for his his postgraduate training in internal medicine
residency training. His clinical interests at Colorado State University. He has been a
and Master’s research include feline faculty member at University of Wisconsin
chronic kidney disease and urology. and Colorado State University Colleges of
Veterinary Medicine.

44 TODAY’S VETErINArY PrACTICE | July/August 2016 | tvpjournal.com

 Peer reviewed FELINE UrETHrAL OBSTrUCTION: DIAGNOSIS & MANAGEMENT

CE TEST. FELINE URETHRAL OBSTRUCTION:

DIAGNOSIS & MANAGEMENT
This article is RACE-approved for 1 hour of continuing education credit. To receive credit,
take the approved test online at VetMedTeam.com/tvp.aspx (CE fee of $5/article).

Learning Objectives
Upon completion of this article, readers should be able to formulate a plan for appropriate diagnostics
that will facilitate patient stabilization prior to relief of a urethral obstruction (UO). Readers should also
have an increased understanding of traditional and nontraditional methods of relieving UO as well as
some of the factors that may contribute to recurrent obstruction.

1. Cats treated for UO have a survival rate to 6. True/False: Therapeutic cystocentesis is

discharge of: contraindicated in cats with UO.
Note a. < 70%
Questions online b. 70–80% 7. What type of urinary catheter is not
may differ from c. 80–90% recommended for use as an indwelling
those here; answers d. > 90% catheter?
are available once a. Polypropylene (Tomcat catheter)
CE test is taken at 2. Classic historical and physical examination b. Polyvinyl (red rubber catheter or infant
vetmedteam.com/ findings in cats with UO include all of the feeding tube)
tvp.aspx. Tests are following except: c. Polytetrafluroethylene (Slippery Sam Tomcat
valid for 2 years from a. Stranguria, dysuria, and/or hematuria
date of approval. Urethral Catheter)
b. Anorexia and vomiting d. Polyurethane
c. Perineal and hindlimb edema
d. A large, turgid urinary bladder
8. True/False: Cats with UO must be treated
with urethral catheterization; other
3. What is the most significant laboratory
treatment protocols are ineffective.
abnormality requiring emergent treatment in
cats with UO?
9. When are antimicrobials indicated in the
a. Hyperkalemia
treatment of UO?
b. Hypercalcemia
a. When cats present for recurrent UO
c. Hyponatremia
b. When quantitative bacterial culture
d. Hypochloremia
suggests significant bacteriuria
4. What type of imaging is recommended for all c. To prevent UTI during urethral
cats presenting with UO? catheterization
a. Abdominal ultrasonography d. In all cats being discharged after urethral
b. Abdominal radiography catheterization
c. Thoracic radiography
d. Abdominal computed tomography 10. The use of _________ has become standard
in cats with UO to help prevent recurrent
5. What emergent IV therapy is most effective UO secondary to urethral irritation and
in rapidly reducing serum potassium levels? spasms.
a. Calcium gluconate a. Meloxicam
b. Sodium bicarbonate b. Diazepam
c. Dilutional fluid therapy c. Alpha-1 antagonists
d. Regular insulin and dextrose d. Calcium gluconate

46 TODAY’S VETErINArY PrACTICE | July/August 2016 | tvpjournal.com