SCRIPT FOR CLARA
HOOK
Video of Singapore's apartments eg. outside Queen's Vets including houses, condos and HDB.
Narrate: Singapore is a city state with over 80% of the population living in apartments. Cats are becoming more popular with their numbers increasing over the last 5 years. They are usually fed dry food and live in multi-cat households. (VIDEO OF KITTENS OR CATS VACCINATION AT QUEEN'S VETS - SEE WEBSITE). Most of the time, Singapore cats do not have medical problems.
INTRODUCTION
However, there are many cases of the male cat suffering from difficulty in passing urine. This is known as DYSURIA. Sometimes blood is seen in the urine and this is known as HAEMATURIA. The cat usually pee outside the litter box and dribbles urine in various places inside the apartment. This is known as POLLAKIURIA. The bladder becomes distended to as large as a tennis ball and the cat becomes very ill, vomiting and not eating.
TREATMENT
There are 3 ways to treat this case to relieve the bladder obstruction.
1. The vet passes a urinary catheter into the bladder and the urine flows out.
2. The vet has to open up the bladder to take out the bladder stones. This surgery is called CYSTOTOMY.
3. tHE
Cystotomy
Perineal Urethrostomy to resolve painful urination in male cats with recurrence. A very good solution rather than repeat urinary catherisation and euthanasia.
Conclusion:
Likely cause of reccurence. Anatomy of male cat (illustration). The bend of the urethra had suffered serious traumatic injury due to urethral stone embedded in July 2015. Scarring of urethral opening at this bend causes difficulty in peeing.
A final video for the July case had been produced and is at:
https://youtu.be/Zlw5XkQVB4s
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HOOK
MULTI-CAT HOUSEHOLD
1 male and 2 female. l litter box
Male cat suffers from bladder and urethral stones
URETHRAL OBSTRUCTION
TIME LINE
1. July 2015. Cystotomy
2. Sep 2015. Recurrence of dysuria. Urethrostomy
3. Mar 28, 2016. Telephone follow up. Cat is OK.
In Toa Payoh Vets, Singapore, difficulty in passing urine (dysuria) is more common in male cats than in female cats. The medical condition is called "Urethral Obstruction". The causes can be bladder stones or bladder crystals obstructing the flow of urine.
The treatment respectively will be surgery to remove the bladder stones or a catheter to "unblock" the urethra if there are no stones.
INTRODUCTION
Case No. 44399
Date: Jul 2, 2015
Patient: ANGEL, Domestic Shorthaired cat, Male, Neutered, 3 years. Shared 1 litter box with 2 other female cats in apartment. Had been fed dry food for the past 3 years.
Signs and symptoms: Vomiting 2x, Anorexia, dysuria (difficulty in urination), haematuria (blood in the urine), pollakuria (pee outside the litter box)
Palpation: The bladder is swollen to the size of an apple (illustration). Kidneys not enlarged.
MEDICAL EVIDENCE
Laboratory tests
Blood test
Blood
urea 19.8 mmol/L (7.2-10.8)
creatinine 285 umol/L (71-160)
Acute renal failure
Total white cell count 2.14 x 10(9)/L (5.5 - 19.5)
Neutrophils 95% (37-75%) Absolute (2.5-12.5)
Platelets 131 x 10(9)/L (300-800)
Septicaemia
Urine test
pH 6 (5-8) SG 1.038 (1.005-1.030)
protein 2+ (negative) blood4+ (negative)
crystals nil
X-rays
TREATMENT
Cystotomy (stones in bladder and at bend of urethra)
Urinary catheterisation and irrigate bladder.
Kidney failure - I/V infusion 5% dextrose saline (image) dialysis
Warded 3 days. Goes home
Change to feline C/D for 3 months.
10.12.15 Purchased feline CD 2 kg but did not feed CD for 3 months as advised. The owner added other food.
-----------------------------------
DYSURIA AGAIN. WHY?
Sep 22, 2015
Dysuria 2 weeks. Vomiting 1X
What to do?
Blood test - normal except low platelets 278 (300-800). No renal failure or leucocytosis.
Urine
pH 6.5 SG 1.040 Protein 4+, Blood 4+. No crystals
(Use a table to show test results for Jul and Sep 2016)
TREATMENT
Sep 25, 2016
Dr Daniel URETHOSTOMY (illustration).
FOLLOW UP MAR 28, 2016
BY TEL
Cat is OK. Fed dry food and fish.
-----------------------------------------------------------
DRAFT CASE REPORT IN JULY 2015 BELOW
Friday, July 17, 2015
2498. INTERN Bladder and urethral stone cat and kidney failure. Angel the cat who meows hello to me.
DRAFT
Time lines
Jul 2, 2015
Cat, MN, 3 years
Vomiting 1 day. Dysuria, pollakiuria, haematuria, urethral obstruction (urethral stones).
"Have you encountered such cases?" the lady with a baby asked me about her cat having great difficulty in peeing, sitting on the litter box all day long. He vomited twice yesterday, July 1, 2015.
"It is quite a common problem in male neutered cats," I replied. This cat eats only dry food and lives with two other female cats.
I palpated no enlarged kidneys but a big swollen bladder as big as an orange. The cat dribbled blood-tinged urine on the consultation table.
-----------------------------------------------------
---------------------------------------------
Under gas anaesthesia, the urinary cathether was not easily passed into the bladder, despite syringing normal saline. Some urine did flow out and the bladder was emptied 50%. I got the x-rays done and there were stones inside the bend of the urethra.
At home, 2 other female cats had no problem. One litter box and water bowl. Dry food only.
The owner gave permission for surgery. Dr Daniel did it in the afternoon. Body weight 4.8kg, temp = 38.3C. Sedation xylazine + ketamine 0.1 + 04 ml IM. Maintenance with isoflurane and oxygen gas.
Cystotomy. Syringed saline into the urethra to get the 2 urethral stones into the bladder.
Warded. E-collar and urinary cathether. Antibiotics and pain-killers
---------------------------------------------------------------------
1. Monday, Jul 13, 2015. The cat was admitted as the owner said he had difficulty in peeing. Bladder and urethral stones were removed some 7 days ago. The cat was given IV drips on Jul 10 and 11 and I discharged him on Saturday Jul 11, 2015 since he was eating. I took out his stitched urinary catheter as it is not good for the cat to have it for more than 3 days, in my opinion, as it irritates the bladder. However, he ate little at home, the owner said and was worried.
Dr Daniel and I discussed his treatment. Perineal urethrostomy will be the last resort.
"There is bound to be inflammation in his urethra as he had urethral stones stuck at the bend of the urethra," I said. "The bladder is not much swollen as before, not as big as an orange. Pain killers and antibiotics will be needed."
The cat was given gas anaesthesia. Dr Daniel lavaged the bladder by sucking out the bloody urine (video). An injection of painkiller and antibiotic was given.
2. Tues July 14, 2015. The cat meowed when he saw me. His bladder was not swollen. He preferred to sit inside the litter box where there is sand, than outside the box. He ate when my assistant hand- fed feline C/D with water. The owner came to visit around 6 pm and was happy to see him.
This is a case of the intense inflammation inside the bladder and urethra as the owner had delayed seeking treatment, base on blood test result showing kidney failure and the much swollen and red bladder (image).
HISTORY
Ju1 2, 2015 Cannot pee, blood in urine. Surgery. urethral stones and bladder stones removed.
Jul 5 Dr Daniel sent home 2 days after surgery.
Jul 8 Vomiting and dysuria. Had kidney failure based on blood test of high creatinine and urea. Given 2 days IV drips
Jul 11 I sent home as he was eating.
Jul 13 Warded. Bladder lavage. urine analysis. Catheter not stitched.
Jul 15 Bladder swollen 1/3 size of orange. Cat eats when hand fed dry feline C/D + water. Bladder lavage. urine analysis. Catheter not stitched. Alert.
Jul 16 Bladder small like ping pong ball, painful. --------------------------------
July 18, 2015 10am
Another bright sunny morning
Jul 18, 2015. Angel meowed to greet me as I checked on him. I lifted him out of the sand litter box which he plonked himself on instead of being out. I palpated his bladder which was small and not painful now. He had eaten all his dry and moist feline C/D overnight and had pooped. So, he should be fully recovered.
HISTORY
Angel, Cat, MN, 3 years
Jun 2, 2015 Stranguria (painful frequent urination in small amounts by straining. Muscle spasms of the urethra and bladder) for 2 days. Vomiting. I palpated a big swollen bladder the size of an orange. Urinary catheter could not be passed into the bladder.
X RAYS
I advised X-rays which showed urethral stones and bladder stones (video).
Sharp brown stones
-----
Jul 2, 2015
BLOOD TEST
Urea 19.8 (7.2-10.8)
Creatinine 285 (71-160)
Total white cell count 21.4 (5.5-19.5)
N 95% (35-75%). Absolute 20.3 (2.5 -12.5)
Platelets 131 (300-800)
Blood test show kidney failure and bacterial infections of the blood. So, this is not a simple cystitis or FIC (Feline Interstitial Cystitis) case.
Jul 2, 2015
URINE TEST
red, turbid. pH 7 (5-8) SG 1.015 (1.005-1.030) Protein 3+ (negative), Glucose + (negative), blood 4+ (negative). Bacteria (Occasional), Crystals Nil
Surgery by Dr Daniel. Cystotomy. bladder and urethral stone removal. Urethral stones flushed into the bladder and removed.
Jul 14, 2015
URINE TEST
yellow, turbid. pH 6, SG 1.038. Protein 2+, Blood 4+, No bacteria or crystals. Health improves.
STONE ANALYSIS
Owner did not want stone analysis. Small sharp brown stones, biggest 4 mm across. Probably calcium oxalate?
Jun 5. Cat goes home.
---------------------------
Jun 8. Cat admitted. Vomiting and dysuria. Bladder is swollen. I diagnose kidney failure.
Bladder catheterised and lavaged with normal saline. 2 days of IV drip of Hartmann and dextrose saline to flush out toxins. Meloxicam oral for 4 days
Jul 11. I sent the cat home as he was eating and drinking. He was vocal, meowing to greet me.
Urinary catheter was taken out.
Owner to continue with hand feeding A/D and dry feline C/D. Leave C/D overnight.
----------------------------------------------
Jul 19, Ate food by himself. Sat outside the litterbox. That means he has recovered. Sent home.
FOLLOW UP FRIDAY JUL 24, 2015
I sms the owner as she did not answer the phone call:
10.36 am "Is Angel back to normal urination? Dr Sing, Toa Payoh Vets?"
Her reply
10.58 am "Hi Dr Sing, thank you for following up on Angel. He is coping well. Have a good day!"
11.24 I sms "Is he eating 100% the dry feline C/D and no other food or treats?"
11.37 am "He is eating the CD mainly but I do feed him canned food once in a while."
11.46 am My reply
"Try not to include other food as this affects the urine acidity and cause recurrence of urinary stones or cystitis."
Outcome good.
Case closed.
Time lines
Thursday, July 2, 2015
A cat sits on the litter box
Cat, MN, 3 years
Vomiting 1 day. Dysuria, pollakiuria, haematuria, urethral obstruction (urethral stones).
"Have you encountered such cases?" the lady with a baby asked me about her cat having great difficulty in peeing, sitting on the litter box all day long. He vomited twice yesterday, July 1, 2015.
"It is quite a common problem in male neutered cats," I replied. This cat eats only dry food and lives with two other female cats.
I palpated no enlarged kidneys but a big swollen bladder as big as an orange. The cat dribbled blood-tinged urine on the consultation table.
-----------------------------------------------------
---------------------------------------------
Under gas anaesthesia, the urinary cathether was not easily passed into the bladder, despite syringing normal saline. Some urine did flow out and the bladder was emptied 50%. I got the x-rays done and there were stones inside the bend of the urethra.
The owner gave permission for surgery. Dr Daniel did it in the afternoon. Body weight 4.8kg, temp = 38.3C. Sedation xylazine + ketamine 0.1 + 04 ml IM. Maintenance with isoflurane and oxygen gas.
Cystotomy. Syringed saline into the urethra to get the 2 urethral stones into the bladder.
Warded. E-collar and urinary cathether. Antibiotics and pain-killers
---------------------------------------------------------------------
Tuesday, July 14, 2015
2495. Angel the cat is admitted for dysuria
1. Monday, Jul 13, 2015. The cat was admitted as the owner said he had difficulty in peeing. Bladder and urethral stones were removed some 7 days ago. The cat was given IV drips on Jul 10 and 11 and I discharged him on Saturday Jul 11, 2015 since he was eating. I took out his stitched urinary catheter as it is not good for the cat to have it for more than 3 days, in my opinion, as it irritates the bladder. However, he ate little at home, the owner said and was worried.
Dr Daniel and I discussed his treatment. Perineal urethrostomy will be the last resort.
"There is bound to be inflammation in his urethra as he had urethral stones stuck at the bend of the urethra," I said. "The bladder is not much swollen as before, not as big as an orange. Pain killers and antibiotics will be needed."
The cat was given gas anaesthesia. Dr Daniel lavaged the bladder by sucking out the bloody urine (video). An injection of painkiller and antibiotic was given.
2. Tues July 14, 2015. The cat meowed when he saw me. His bladder was not swollen. He preferred to sit inside the litter box where there is sand, than outside the box. He ate when my assistant hand- fed feline C/D with water. The owner came to visit around 6 pm and was happy to see him.
This is a case of the intense inflammation inside the bladder and urethra as the owner had delayed seeking treatment, base on blood test result showing kidney failure and the much swollen and red bladder (image).
HISTORY
Ju1 2, 2015 Cannot pee, blood in urine. Surgery. urethral stones and bladder stones removed.
Jul 5 Dr Daniel sent home 2 days after surgery.
Jul 8 Vomiting and dysuria. Had kidney failure based on blood test of high creatinine and urea. Given 2 days IV drips
Jul 11 I sent home as he was eating.
Jul 13 Warded. Bladder lavage. urine analysis. Catheter not stitched.
Jul 15 Bladder swollen 1/3 size of orange. Cat eats when hand fed dry feline C/D + water. Bladder lavage. urine analysis. Catheter not stitched. Alert.
Jul 16 Bladder small like ping pong ball, painful. --------------------------------
July 18, 2015 10am
Another bright sunny morning
Jul 18, 2015. Angel meowed to greet me as I checked on him. I lifted him out of the sand litter box which he plonked himself on instead of being out. I palpated his bladder which was small and not painful now. He had eaten all his dry and moist feline C/D overnight and had pooped. So, he should be fully recovered.
HISTORY
Angel, Cat, MN, 3 years
Jun 2, 2015 Stranguria (painful frequent urination in small amounts by straining. Muscle spasms of the urethra and bladder) for 2 days. Vomiting. I palpated a big swollen bladder the size of an orange. Urinary catheter could not be passed into the bladder.
X RAYS
I advised X-rays which showed urethral stones and bladder stones (video).
Sharp brown stones
-----
Jul 2, 2015
BLOOD TEST
Urea 19.8 (7.2-10.8)
Creatinine 285 (71-160)
Total white cell count 21.4 (5.5-19.5)
N 95% (35-75%). Absolute 20.3 (2.5 -12.5)
Platelets 131 (300-800)
Blood test show kidney failure and bacterial infections of the blood. So, this is not a simple cystitis or FIC (Feline Interstitial Cystitis) case.
Jul 2, 2015
URINE TEST
red, turbid. pH 7 (5-8) SG 1.015 (1.005-1.030) Protein 3+ (negative), Glucose + (negative), blood 4+ (negative). Bacteria (Occasional), Crystals Nil
Surgery by Dr Daniel. Cystotomy. bladder and urethral stone removal. Urethral stones flushed into the bladder and removed.
Jul 14, 2015
URINE TEST
yellow, turbid. pH 6, SG 1.038. Protein 2+, Blood 4+, No bacteria or crystals. Health improves.
STONE ANALYSIS
Owner did not want stone analysis. Small sharp brown stones, biggest 4 mm across. Probably calcium oxalate?
Jun 5. Cat goes home.
---------------------------
Jun 8. Cat admitted. Vomiting and dysuria. Bladder is swollen. I diagnose kidney failure.
Bladder catheterised and lavaged with normal saline. 2 days of IV drip of Hartmann and dextrose saline to flush out toxins. Meloxicam oral for 4 days
Jul 11. I sent the cat home as he was eating and drinking. He was vocal, meowing to greet me.
Urinary catheter was taken out.
Owner to continue with hand feeding A/D and dry feline C/D. Leave C/D overnight.
----------------------------------------------
Jul 19, Ate food by himself. Sat outside the litterbox. That means he has recovered. Sent home.
FOLLOW UP FRIDAY JUL 24, 2015
I sms the owner as she did not answer the phone call:
10.36 am "Is Angel back to normal urination? Dr Sing, Toa Payoh Vets?"
Her reply
10.58 am "Hi Dr Sing, thank you for following up on Angel. He is coping well. Have a good day!"
11.24 I sms "Is he eating 100% the dry feline C/D and no other food or treats?"
11.37 am "He is eating the CD mainly but I do feed him canned food once in a while."
11.46 am My reply
"Try not to include other food as this affects the urine acidity and cause recurrence of urinary stones or cystitis."
Outcome good.
Case closed.
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