How Often Do Once Blocked Cats Block Again
J Am Vet Med Assoc. Author manuscript; available in PMC 2015 Jul 22.
Published in final edited class as:
PMCID: PMC4511701
NIHMSID: NIHMS707928
A protocol for managing urethral obstruction in male cats without urethral catheterization
Edward Due south. Cooper, VMD, MS, DACVECC, Tammy J. Owens, DVM, Dennis J. Chew, DVM, DACVIM, and C. A. Tony Buffington, DVM, PHD, DACVN
Abstruse
Objective
To determine efficacy of a protocol for managing urethral obstruction (UO) in male person cats without urethral catheterization.
Animals
15 male cats with UO in which conventional treatment had been declined.
Procedures
Laboratory testing and abdominal radiography were performed, and cats with astringent metabolic derangements or urinary calculi were excluded. Treatment included assistants of acepromazine (0.25 mg, IM, or 2.5 mg, PO, q eight h), buprenorphine (0.075 mg, PO, q 8 h), and medetomidine (0.i mg, IM, q 24 h) and decompressive cystocentesis and SC assistants of fluids as needed. Cats were placed in a serenity, nighttime environment to minimize stress. Treatment success was defined as spontaneous urination within 72 hours and subsequent discharge from the infirmary.
Results
Handling was successful in eleven of the xv cats. In the remaining iv cats, handling was considered to take failed because of development of uroabdomen (n = 3) or hemoabdomen (1). Cats in which handling failed had significantly higher serum creatinine concentrations than did cats in which treatment was successful. Necropsy was performed on iii cats in which treatment had failed. All 3 had severe inflammatory disease of the urinary bladder, but none had evidence of float rupture.
Conclusions and Clinical Relevance
Results suggested that in male cats, a combination of pharmacological treatment, decompressive cystocentesis, and a low-stress environment may permit for resolution of UO without the need for urethral catheterization. This low-cost protocol could serve as an alternative to euthanasia when financial constraints prevent more all-encompassing treatment.
Urethral obstruction is a relatively mutual status in domestic male cats that typically requires emergency handling.1 The pathophysiology of UO, expected physical examination findings, biochemical and acid-base abnormalities, and typical handling course have been reviewed.1–8 Standard treatment for UO in male cats includes stabilization of cardiovascular and metabolic derangements, correction of electrolyte abnormalities through IV administration of fluids, and relief of the obstruction through urethral catheterization.two,iii Following relief of the obstruction, affected cats may crave maintenance of an indwelling urinary catheter and intensive monitoring until the catheter is removed and sustained spontaneous urination is demonstrated. Handling for UO may involve several days of hospitalization and considerable expense. As a issue, afflicted cats may exist euthanatized because of financial constraints of the owners, especially given the potentially recurrent nature of this disease process.
Although it has by and large been accepted that the physical presence of a mucous plug or calculus inside the urethra plays a primary role in the pathogenesis of UO,9–xi a contempo study12 found that the cause was idiopathic in > l% of cats and that urolithiasis and urethral plugs were less mutual (29% and 18%, respectively, of affected cats). In addition, urethral spasm and edema take been shown to play an of import role in UO.7,xiii Given these findings, nosotros speculated that pharmacological manipulation of stress, urethral tone, and discomfort could help convalesce some of the functional component of the obstructive procedure and might preclude the need for catheterization. If this treatment were successful in restoring spontaneous urination, the cost of treatment could exist decreased besides as the chance of complications associated with urethral catheterization, such every bit exacerbation of urethral inflammation, urinary tract infection, and urethral trauma.xiv–16
The purpose of the study reported here was to determine the efficacy of a protocol for managing UO in male person cats that involved pharmacological manipulation, intermittent cystocentesis, and provision of a low-stress environment. Nosotros hypothesized that this protocol would allow for spontaneous resolution of UO without the need for urethral catheterization and without a pregnant increase in recurrence rate, compared with conventional treatment.
Materials and Methods
Case pick
Male cats brought to The Ohio State University Veterinarian Teaching Hospital for treatment of naturally occurring UO between June 2007 and June 2008 were considered for inclusion in the study. Cats were eligible for inclusion in the report if a diagnosis of UO had been made on the ground of history and physical test findings and the owners had declined conventional treatment (ie, urethral catheterization and intensive intendance) because of financial considerations and were considering euthanasia. Cats with clinically of import physical examination abnormalities (ie, middle rate < 120 beats/min, rectal temperature < 35.half-dozen°C [96°F], or unresponsive mentation), severe metabolic derangements (venous pH < seven.1 or serum potassium concentration > viii.0 mEq/L), or radiographic show of cystic or urethral calculi were excluded from the written report. Severity of azotemia at the time of initial examination was not used every bit an inclusion or exclusion criterion. Possessor consent was obtained prior to initiation of handling. The treatment protocol used in the written report was approved by The Ohio State University Veterinary Instruction Hospital'south Executive Committee. At the fourth dimension this study was performed, clinical enquiry projects performed at the Veterinary Didactics Hospital and involving customer-owned subjects did non require approval from The Ohio Country Academy'due south Institutional Animal Care and Apply Committee.
Procedures
Owners of cats enrolled in the study were required to pay a set fee ($350) to cover hospital expenses associated with administering the protocol, a cost that was substantially less than the estimated cost of standard treatment ($ane,200 to $1,800). Cats were given acepromazine (0.25 mg, IM) and buprenorphine (0.075 mg, IM) to provide sedation and analgesia and help minimize stress. Approximately ten minutes later, the penis was extruded, inspected, and gently massaged in an attempt to dislodge any obstructions in the distal portion of the penis. A unmarried attempt to gently limited the bladder was then fabricated. If no urine was produced, cystocentesis was performed with a 22-estimate, i.5-inch needle connected to extension tubing, a iii-way stopcock, and a 20-mL syringe to convalesce bladder distention and discomfort. A venous blood sample was obtained, and venous pH and serum sodium, potassium, chloride, urea nitrogen, and creatinine concentrations were measured with a commercial analyzer. a Packed cell book was adamant past ways of centrifugation, and plasma TP concentration was adamant past means of refractometry. b A single lateral radiographic view of the abdomen was obtained and assessed for evidence of cystic and urethral calculi; intendance was taken to include the unabridged lower urinary tract to the tip of the penis. Cats were allowed to continue in the written report only if results of this initial diagnostic testing did not come across any of the exclusion criteria for the study. For cats that continued in the study, saline (0.nine% NaCl) solution was administered SC (100 to 200 mL, depending on hydration status and severity of azotemia). Neither urinary nor Four catheterization was performed.
Cats were then placed in a low-stress environs consisting of a darkened, low-traffic handling ward that did non firm any dogs. General condition and presence of spontaneous urination were assessed every 8 hours. Additional doses of acepromazine (0.25 mg, IM, or ii.5 mg, PO) and buprenorphine (0.075 mg, PO or IM) were administered every viii hours to provide connected sedation and analgesia. After medications were given, the urinary bladder was palpated to make up one's mind size and firmness, and cystocentesis was performed as needed (upwardly to 3 times/d) to alleviate urinary bladder distention. A physical test was performed each morning time while cats were hospitalized. Fresh food (based on the cat's typical diet) and water were offered every 8 hours. Medetomidine (0.1 mg, IM, q 24 h) was administered beginning 24 hours after initial examination to provide boosted sedation and urethral relaxation, and additional fluids were administered SC once or twice daily at the attending clinician'southward discretion.
Treatment was continued as described for up to 3 days (72 hours) to permit for spontaneous urination to occur. Treatment was discontinued if the cat adult clinically important complications (eg, uroabdomen or a worsening of the cat's clinical condition) or failed to reply within 3 days. If the true cat urinated spontaneously, observation and administration of acepromazine and buprenorphine were continued for an additional 24 hours but administration of medetomidine was discontinued. The cat was discharged from the hospital if spontaneous urination continued during this period. On the twenty-four hours of discharge, serum biochemical testing was repeated and PCV and plasma TP concentration were measured to assess for resolution of electrolyte abnormalities and azotemia. Acepromazine (2.5 mg, PO, q 8 h) and buprenorphine (0.075 mg, PO, q 8 h) were dispensed for connected assistants for five days after belch. In addition, owners were given uniform instructions on methods to increase water intake, the advisable number of litter boxes for the household, and implementation of environmental enrichment.17 Follow-up telephone calls were made iii days, iii weeks, and 1 twelvemonth later on discharge to determine the incidence of reobstruction.
Treatment success was defined every bit spontaneous urination within 72 hours and subsequent discharge from the infirmary. Treatment failure was defined every bit development of clinically important complications (eg, uroabdomen or hemoabdomen) or failure to take spontaneous urination inside 3 days after initiation of handling.
Information collected for cats included in the report consisted of age; weight; rectal temperature, heart charge per unit, respiratory rate, results of serum biochemical testing (sodium, potassium, chloride, urea nitrogen, and creatinine concentrations), venous pH, PCV, and TP concentration measured at the fourth dimension of initial examination and at the fourth dimension of discharge; the number of times cystocentesis was performed; time to spontaneous urination; and full duration of hospitalization. Complete necropsies were performed on all cats that were euthanatized.
Statistical analysis
Data were summarized equally mean ± SD. The D'Agostino and Pearson double-decker normality examination was used to determine whether data were ordinarily distributed, and 2-tailed Student t tests (normally distributed information) or 1-tailed Isle of mann-Whitney tests (nonnormally distributed data) were used to compare values obtained at the fourth dimension of initial exam with values obtained at the time of belch. These tests also were used to compare information values obtained from the treatment success group and the treatment failure grouping. Standard software c was used for all analyses; values of P < 0.05 were considered meaning.
Results
Cats
Urethral obstruction was diagnosed in 33 cats during the study menstruation. Fifteen of these cats met the criteria for inclusion and were enrolled in the study. Mean ± SD age was 3.iii ± ii.3 years (range, 1.0 to seven.5 years), and mean torso weight was 6.1 ± 1.6 kg (xiii.4 ± 3.v lb). All fifteen cats were of mixed breeding (10 domestic shorthairs, three domestic medium hairs, and 2 domestic longhairs). Two were sexually intact, and 13 were castrated. Eight had reportedly previously had signs consistent with feline idiopathic cystitis, simply none had a history of previous episodes of UO.
Physical examination findings
All 15 cats were responsive on initial test, and hateful rectal temperature (mean ± SD, 38.2 ± 1.1°C [100.eight ± 2.0°F]) was within reference limits. At the time of initial examination, hateful eye charge per unit was 211 ± 33 beats/min (range, 160 to 276 beats/min) and mean respiratory rate was 48 ± 26 breaths/min (range, xx to 124 breaths/min). In all cats, the urinary bladder appeared to be of moderate to large size during abdominal palpation and attempts to limited urine were unsuccessful.
Laboratory information
Results of laboratory testing at the fourth dimension of initial examination were available for all fifteen cats included in the written report (Table 1). Although hateful serum potassium concentration was inside reference limits, some cats had clinically of import hyperkalemia (potassium concentration as high as 8 mEq/Fifty). Severity of azotemia and acidemia also varied among cats. Mean PCV was 46 ± 8%, and mean plasma TP concentration was vii.ii ± 0.6 g/dL.
Table 1
Laboratory data at the time of initial examination and at the time of hospital discharge for 15 cats with UO treated with a combination of pharmacological manipulation, intermittent cystocentesis, and provision of a low-stress environs simply without urethral catheterization.
| Variable | Reference range | Initial exam | Discharge (n = 11) | ||
|---|---|---|---|---|---|
| All cats (n = 15) | Treatment success (n = eleven) | Treatment failure (n = 4) | |||
| Venous pH | vii.24–7.39 | 7.34 ± 0.06 (7.26–7.43) | seven.36 ± 0.06 (vii.26–7.43) | seven.30 ± 0.06 (vii.26–7.32) | 7.38 ± 0.06 (7.27–7.49) |
| Serum potassium (mmol/L) | 2.8–5.ix | four.viii ± 1.4 (3.4–8.0) | 4.4 ± one.0 (three.iv–7.0) | 5.eight ± 1.3 (4.1–8.0) | 4.0 ± 0.5 (3.4–iv.8) |
| SUN (mg/dL) | 5–30 | 74 ± 39 (nineteen–140) | 62 ± 38 (nineteen–128) | 105 ± 24 (83–140) | 35 ± 27 (xiv–100)* |
| Serum creatinine (mg/dL) | 0.6–2.ane | five.nine ± 4.9 (one.1–xix.5) | iv.4 ± 3.half dozen (1.1–12.seven) | x.10 ± vi.3 (6.3–19.5)† | 2.4 ± 2.1 (1.1–8.ii)* |
Results of laboratory testing at the time of infirmary discharge were available for all 11 cats that survived to discharge (Tabular array 1). Serum urea nitrogen and creatinine concentrations were significantly lower at the time of discharge, compared with values obtained at the time of initial examination; however, mean values at the fourth dimension of discharge were higher than the upper reference limit. No significant differences in venous pH, serum potassium concentration, plasma TP concentration, or PCV were identified between the time of initial examination and the time of discharge.
Radiography
In all 15 cats, a lateral abdominal radiographic view was obtained later on initial administration of acepromazine and buprenorphine and initial cystocentesis. None of the cats had radiographic evidence of cystic or urethral calculi, but 7 of the 15 did have prove of mineralized material, presumed a urethral plug, within the urethra (Effigy 1). In addition, 8 cats had radiographic evidence of balmy to moderate caudal abdominal effusion, including half-dozen of the eleven cats in which treatment was successful and 2 of the 4 cats in which treatment failed.
Left lateral radiographic view of the abdomen of a male cat examined because of UO. At that place is moderate distention of the urinary bladder with faint, linear opacities superimposed (thin arrow). Notice the linear opacity within the proximal portion of the urethra, which likely represented a mineralized urethral plug (thick arrow).
Result
Eleven of the 15 cats had a successful result, divers every bit spontaneous urination within three days and subsequent belch from the infirmary. In the remaining 4 cats, treatment was considered to have failed because of development of uroabdomen (n = three) or hemoabdomen (1). Three of the cats in which handling failed were euthanatized and submitted for necropsy. One cat was adopted by a veterinary student and was afterwards treated successfully.
For the cats in which treatment was successful, mean ± SD time to spontaneous urination after initiation of treatment was 34.6 ± 21.6 hours (range, 4 to 69 hours), with 9 of the xi cats urinating spontaneously within 48 hours after handling was initiated. Mean number of times cystocentesis was performed was 3 (range, 1 to x), and mean elapsing of hospitalization was 67 ± 23 hours (range, 36 to 96 hours). In the 4 cats in which treatment failed, uroabdomen or hemoabdomen was identified between 48 and 72 hours after treatment was initiated. The diagnosis was made on the basis of worsening of the cats' clinical condition and analysis of fluid obtained past ways of abdominocentesis, and was confirmed at necropsy in the 3 cats that were euthanatized. Mean number of times cystocentesis was performed in cats in which treatment failed was 7 (range, 4 to xi). This was significantly college than the number of times cystocentesis was performed in cats in which treatment was successful.
No pregnant differences were identified between cats in which treatment was successful and cats in which handling failed with regard to age, weight, or rectal temperature, heart rate, or respiratory rate at the time of initial test. Serum creatinine concentration at the time of initial exam was significantly college among cats in which treatment failed than among cats in which handling was successful (Table ane), merely no other significant differences between groups were identified.
Necropsy findings
Ii of the 3 cats that were euthanatized had approximately 70 to 100 mL of reddish cloudy fluid that appeared to exist urine in the abdomen at the time of necropsy. The urinary bladder was diffusely thickened and dark cerise to black in advent. Histologic exam of the urethra and urinary float revealed astringent congestion, hemorrhage, and edema, along with neutrophilic urethritis and cystitis. The third cat had 250 mL of hemorrhagic fluid in the abdominal cavity at the fourth dimension of necropsy. The serosal surface of the urinary bladder was diffusely dark red, and the bladder wall was thickened. The bladder mucosa was diffusely nighttime cherry-red to black; numerous strands of fibrin were loosely adhered to the mucosa. No urethral abnormalities were observed on gross inspection. Histologic examination of the kidneys revealed mild hydronephrosis with coagulation necrosis, acute tubular necrosis, and hemorrhage. The urinary bladder was found to have astringent widespread transmural hemorrhage with necrosis and reactive fibrosis. Diffuse loss of the urothelium also was noted. The urethra was found to accept severe multifocal fibronectrotizing urethritis with urethral plugs yet present. The source of the hemoabdomen was not apparent. No bear witness of overt rupture of the bladder or visible defects in the bladder wall that could have produced the uroabdomen or hemoabdomen in these cats were identified.
Follow-up information
Of the xi cats successfully treated and discharged, none had had a recurrence of UO by 3 days afterwards belch. Nevertheless, by 3 weeks after discharge, ii of the eleven cats had had an additional episode of obstruction. One of these cats was returned to the Veterinary Pedagogy Hospital and was again successfully treated by utilise of the study protocol. The other was examined by the owner's regular veterinarian and was successfully treated with the same protocol. Nonetheless, the cat had another episode of UO immediately later and was euthanatized. Owners of 2 cats could not be reached past telephone iii weeks after belch; owners of the remaining seven cats reported no recurrence of signs.
Owners of 7 cats were bachelor for long-term (1-yr) follow-up. None of the 7 cats had had boosted episodes of UO, although 2 of them had reported signs consistent with feline idiopathic cystitis. Despite repeated attempts to contact the owners, the remaining three cats were lost to follow-upwards.
Discussion
Results of the present study suggested that in male cats, a combination of pharmacological treatment, decompressive cystocentesis, and a low-stress environment may issue in resolution of UO without the need for urethral catheterization. Urethral obstruction was successfully treated in 11 of fifteen cats with this protocol, and cats in which treatment was successful did not appear to have a greater run a risk of recurrence with this protocol, compared with perceived recurrence rates for cats that receive conventional treatment.
Treatment recommendations for cats with UO unremarkably include placement of a urinary catheter and flushing of the urethra to relieve the presumed concrete obstruction.two,iii,7 Withal, in cats with idiopathic cystitis, urethral obstruction may be functional, rather than physical, developing secondary to inflammation-induced urethral spasm and edema. Environmental stress, pain, and agitation could potential exacerbate the autonomic imbalance associated with feline idiopathic cystitis and contribute to the development of UO.xviii,19 Thus, interventions that serve to reduce stress could facilitate resolution of functional obstruction. One aspect of stress reduction incorporated in the treatment protocol evaluated in the present study was placement of the cats in a night, quiet, secluded environment complimentary from dogs. In addition, we sought to provide analgesia and sedation and possibly reduce urethral tone through the employ of medications. A previous written reporttwenty involving 20 male person cats with UO found that administration of amitriptyline, a tricyclic antidepressant, was associated with a high rate of spontaneous resolution, just the methodology used in that written report was unclear. In the present study, we chose to use a combination of acepromazine and buprenorphine. Acepromazine appears to cause sedation, thereby reducing stress responsiveness, by decreasing the activity of dopamine in the CNS. Acepromazine besides exerts α1-adrenergic receptor antagonistic effects, which could result in urethral sphincter relaxation and has been shown to cause a significant reduction in intraurethral pressures, equally measured by means of urethral force per unit area profilometry, in anesthetized male person cats.21 Buprenorphine is a partial μ-opioid receptor agonist that provides mild to moderate analgesia, thereby helping address discomfort associated with UO and underlying idiopathic cystitis.22 Medetomidine, an α2-adrenergic receptor agonist, also was used once daily if spontaneous urination did not occur within 24 hours to provide additional sedation and analgesia and to help reduce the catecholamine excess documented in cats with idiopathic cystitis.19,23,24 The presynaptic αii-adrenergic receptors serve to subtract sympathetic outflow; thus, stimulation of them might outcome in decreased stress response and promote urethral relaxation.23 Despite the potential benefits of these medications, we accept no direct evidence that urethral relaxation occurred or that use of these medications had any impact on issue.
Considering urinary catheterization was not performed in cats enrolled in the present study, it was necessary to perform intermittent cystocentesis to decompress the bladder until spontaneous urination occurred. Although its employ is controversial, there are potential benefits to performing cystocentesis in cats with UO, even when catheterization is to be performed. Potential benefits include allowing more immediate decompression of the bladder, reducing urethral backpressure, and obtaining an unadulterated diagnostic sample for urinalysis and bacterial civilisation.25 The major concern in performing cystocentesis in a true cat with UO is that the needle might cause damage to or rupture of the bladder wall considering of bladder wall distension and friability, which could lead to uroabdomen. The take a chance of complications is well-nigh likely related to the extent of disease in the urinary float and the technique used.25
In the present study, iv of fifteen cats developed uroabdomen (n = 3) or hemoabdomen (ane). The obvious concern in these patients is that repeated cystocentesis was responsible for these complications. This is potentially supported by the fact that cats in which treatment failed underwent cystocentesis a significantly higher number of times than did cats in which handling was successful. However, 1 cat in which treatment was successful underwent cystocentesis 10 times without complications. Furthermore, there was no gross evidence of a bladder rupture or defect in the 3 cats that underwent necropsy, although it is possible that a defect had sealed or was non apparent at the fourth dimension of necropsy. Information technology also is possible that a combination of severe, lengthened cystic landscape illness and high intramural pressure could have resulted in leakage of fluid or claret beyond the float wall. Cats in which treatment failed too were mostly sicker, with more than severe azotemia, college serum potassium concentrations, and lower venous pH. These cats may take had UO for a longer fourth dimension, which could have resulted in more severe bladder wall disease and predisposed them to develop complications.
8 cats in the present study had radiographic evidence of mild to moderate caudal intestinal effusion. Because cystocentesis was performed prior to radiography, it was not possible to decide whether abdominal effusion was nowadays before cystocentesis was performed or just developed afterward. The presence of effusion on an abdominal radiograph at the time of initial examination did not seem to reverberate the likelihood of treatment failure, in that the incidence for cats in which treatment failed was similar to the incidence for cats in which handling was successful. Of the 15 cats considered for enrollment in the written report, none were excluded because of urethral calculi, although 7 had radiopaque urethral plugs. Although it is generally recommended that abdominal radiography exist performed in cats with UO to rule out the presence of uroliths, the overall low incidence of uroliths as the crusade of physical obstacle (reportedly betwixt 5% and 12%x,11) could support the omission of this stride in the application of this protocol to further reduce costs.
The overall success rate in the present study (11/15) was lower than the reported survival rate associated with standard handling of cats with UO (91% to 94%1,12). In addition, given the minimalist arroyo to handling dictated past this protocol, we excluded the sickest patients, including cats with profound physiologic and metabolic derangements. Patients with severe hypothermia (rectal temperature < 35.6°C), bradycardia (heart charge per unit < 120 beats/min), signs of low, or astringent hyperkalemia (serum potassium concentration > 8 mmol/Fifty) or acidemia (venous pH < vii.1) would typically exist at a loftier adventure of decease without emergency intervention and intensive intendance so were excluded. Physical examination parameters used to screen cats for inclusion in the study were selected on the basis of their ability to predict the presence of astringent hyperkalemia,4 and none of the cats that were considered qualified for inclusion on the ground of concrete examination findings had to be excluded later on the basis of serum potassium concentration or venous pH. The severity of azotemia at the fourth dimension of initial examination was not used every bit an exclusion benchmark because accumulation of uremic toxins, although deleterious, is not immediately life threatening. As previously stated, cats in which handling failed had significantly college creatinine concentrations at the time of initial examination than did cats in which treatment was successful. Although a significant deviation between groups was not identified with regard to SUN concentration, this may accept been because the analyzer that was used did not report concentrations higher than 140 mg/dL. All 4 cats in which treatment failed had an SUN concentration > 80 mg/dL and serum creatinine concentration > 6.0 mg/dL at the time of initial examination. This may have reflected a longer duration of obstruction and greater compromise to the integrity of the bladder wall. In addition, these cats may take been more likely to have postobstructive diuresis, leading to more rapid distention of the bladder following cystocentesis. There were, yet, iii cats in which handling was successful that had Lord's day and serum creatinine concentrations higher than these values, including 1 cat that still had severe azotemia at the time of hospital discharge (Dominicus concentration > 140 mg/dL and serum creatinine concentration of eight.two mg/dL) but recovered without complications and did not accept recurrences of UO. Unfortunately, there were not enough patients in the written report to perform regression assay to determine whether specific values of Lord's day or serum creatinine concentration could be used to predict the likelihood of success. Nevertheless, clients should be made aware of the greater adventure of complications and lower hazard of success in patients with severe azotemia when this protocol is used as an culling to euthanasia.
Another potential concern related to the protocol used in the nowadays study was whether cats would accept a substantial take chances for reobstruction, given that the lack of urethral catheterization meant that at that place was not a sustained conduit for egress of any further debris, mucous, or clots that might have resulted in urethral plugging. Fifty-fifty if euthanasia were the but other culling, frequent reobstruction might have precluded the utilise of this protocol. However, cats in which treatment was successful in the present written report had no episodes of reobstruction within 3 days after hospital discharge. In contrast, the reported rate of reobstruction after catheter removal is 14%.1 Given the limited number of cases in the nowadays study, no conclusions can exist drawn. However, it is possible that less urethral injury and inflammation occurred in these cats considering of the lack of urethral catheterization. Only 2 cats in the present written report had a recurrence inside iii weeks subsequently hospital discharge (although two cats were lost to follow-up at that time), and in that location were no farther episodes of UO in the vii cats for which the owners could be contacted 1 yr after belch. Compared with reported recurrence rates of 35% and 36% following conventional management,12,26 this suggests that the treatment protocol used in the present study was not associated with a greater risk of recurrence.
In that location were several limitations to the nowadays report. In particular, the small sample size prevented accurate estimation of the short- and long-term efficacy of this protocol and made it impossible to place factors that could be used to predict outcome or identify cats in which this protocol should not be considered. Further, because the handling protocol involved multiple components, we were unable to determine which aspects of treatment (ie, sedation, analgesia, cystocentesis, and low-stress surround) played a part in having a successful outcome.
Finally, findings of the present study lend support to the hypothesis that a substantial portion of the obstructive process in male cats with UO is functional in nature (ie, a result of urethral spasm and edema), rather than physical (ie, a result of a urethral plug or calculi). The protocol used in the present study could allow for handling of UO at a reduced cost, compared with conventional management, thereby serving as an alternative to euthanasia owing to financial constraints. However, no direct comparison to conventional direction was made, so this protocol cannot be recommended as an alternative to conventional management at this time. Farther investigation, including a prospective comparing, is warranted to determine the optimal use of this protocol.
Abbreviations
| TP | Total protein |
| UO | Urethral obstruction |
Footnotes
aDisquisitional Intendance Xpress, Nova Biomedical, Waltham, Mass.
bClinical Refractometer, Jorgensen Laboratories Inc, Loveland, Colo.
cGraphPad Prism, version 4.00 for Windows, GraphPad Software, San Diego, Calif.
Presented in abstract form at the International Veterinary Emergency and Disquisitional Intendance Symposium, San Antonio, Tex, September 2008.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511701/
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