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New Ways of Treating Blocked Urinary Tracts in Male Cats

Posted Nov 19 2013 6:00am
Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom. < Previous Post Next Post > Nov 19, 2013 New Ways of Treating Blocked Urinary Tracts in Male Cats by Dr. Jennifer Coates, DVM     Share       Save to mypetMDOver the next couple of days we are going to look at two studies that offer tantalizing glimpses into potential new ways of handling the treatment of blocked cats.
Neutered male cats have very narrow urethras (the tube that drains the bladder through the penis). A small stone or a plug made of crystals or protein-laden gunk can easily become stuck inside and completely block the flow of urine. In fact, the urethra is so narrow that involuntary muscular contractions called urethral spasms can lead to an obstruction in the absence of any foreign material.
Symptoms of urethral blockage include  

Frequent but unsuccessful attempts to urinate
Discomfort ramping up to excruciating pain as the condition progresses
Bladder rupture and death from a buildup of urinary toxins within the body if the condition is left untreated

Needless to say, if you ever suspect that your cat might be blocked, take him to a veterinary hospital immediately. Treatment can save most cats’ lives as long as it is started early enough, but the possibility that the cat may block again is a complicating factor. Studies have shown that anywhere between 22% and 36% of cats obstruct again within weeks or months of leaving the veterinary hospital. Therefore, veterinarians are always on the lookout for ways to a) lower the cost of treatment so more owners are willing to give it a try even when they know reobstruction is possible, and b) decrease the incidence of reobstruction.
Research published in 2010 indicates that a form of conservative medical treatment (in comparison to the traditional practice of placing indwelling urinary catheters) can be effective for many cats. Fifteen blocked male cats whose owners had declined standard treatment had their bladders drained with a needle and syringe (cystocentesis), were given a bolus of fluids under their skin, received medications to decrease pain and anxiety, and were housed in a quiet, dark environment to reduce stress. These treatments were repeated on an as needed basis. If the cat began to urinate on his own and could be sent home within three days, the treatment was deemed successful (11 of 15 cats).
The cost of this treatment protocol is far less than is associated with the placement and maintenance of an indwelling urinary catheter. However, cats with severe biochemical abnormalities are not candidates for this type of therapy (the four cats whose treatment was not successful had higher creatinine levels than did the cats for which it worked). Also, this study’s sample size wasn’t large enough to determine whether the chances of reobstruction in comparison to treatment with a urinary catheter might be higher, lower, or about the same, but the authors did state  
[C]ats in which treatment was successful in the present study had no episodes of reobstruction within 3 days after hospital discharge…. Only 2 cats in the present study had a recurrence within 3 weeks after hospital discharge (although 2 cats were lost to follow-up at that time), and there were no further episodes of [urinary obstructions] in the 7 cats for which the owners could be contacted 1 year after discharge.

So of the seven cats that had complete follow-up, two reobstructed, which is a rate of around 29%, which at least appears to be in line with what has been reported previously.
Tomorrow, we’ll take a look at a second study that might help decrease the likelihood of reobstruction in cats who do need a urinary catheter.

Dr. Jennifer Coates
A protocol for managing urethral obstruction in male cats without urethral catheterization. Cooper ES, Owens TJ, Chew DJ, Buffington CA. J Am Vet Med Assoc. 2010 Dec 1;237(11):1261-6. 
Image: SMA Studio / Shutterstock
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TheOldBroad Blocked! 11/19/2013 07:15pm "protein-laden gunk"

Gunk. Is that a medical term? :-)

Years ago my neutered male got blocked. Wish I had known then what I know now - he likely suffered for awhile before I figured it out and whisked him to the doctor. This was about 25 years ago and I have no idea how the doctor unblocked him, but happily he never got blocked again.

It's hard to imagine just how much this would hurt, not to mention the frustration of not being able to urinate when the kitty *HAS* to go.

I got to watch a kitty being unblocked with a catheter and copious amounts of fluids. It was amazing how small the "gunk" was, but also how many pieces there were. I've also witnessed the corrective surgery which was really amazing. Poor kitties!

Do you normally suggest starting with a cysto and fluids or do you routinely suggest unblocking with a catheter?

I'm anxious for tomorrow's post. Reply to this comment Report abuse 1 Dr. Jennifer Coates 11/20/2013 11:11am It depends on how severely affected the cat is when I first get my hands on him. If he's in rough shape, I'll perform a cystocentesis, then place and IV catheter/start fluids/stabilize him, before sedating and placing a urinary catheter. Reply to this comment Report abuse 1
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