Recurrent Cystitis in Cats
Dr. Bari Spielman
A complete blood count (CBC) is often within normal limits; however, an elevated white blood cell count may be present in cases with systemic infection, and mild anemia (low red blood cell count) may be present with chronic urinary bleeding.
Certain diagnostic tests must be performed to make a definitive diagnosis of recurrent cystitis and exclude other disease processes that may cause similar symptoms. A complete history, description of clinical signs, and thorough physical examination are all an important part of obtaining a diagnosis, and potential underlying cause. In addition, the following tests are recommended:
A biochemical profile may be within normal limits, although it may reveal elevations in kidney enzymes, electrolyte abnormalities or may have other changes suggestive of other metabolic or endocrine disorders that may predispose the individual to recurrent cystitis.
A urinalysis may reveal hematuria (blood in the urine), pyuria (white blood cells in the urine), proteinuria (protein in the urine), bacteriuria (bacteria in the urine) and/or white blood cell casts. The absence of any or all of these does not rule out cystitis.
A bacterial urine culture to confirm a urinary tract infection.
Abdominal radiographs (x-rays) are an important part of any baseline work-up. Although they may be within normal limits, they may reveal stones or tumors associated with the urinary tract, or rule out other diseases and causes of the patients' clinical signs.
Abdominal ultrasound is recommended in individuals with recurrent cystitis. It is very helpful in evaluating the urinary tract structures. There are characteristic changes seen within the renal pelvis (inside of the kidney) that are consistent with pyelonephritis, which may be chronically seeding the lower urinary tract. Ultrasound is also helpful in evaluating for the presence of stones or tumors throughout the urinary tract. It is a noninvasive procedure that often necessitates the expertise of a specialist and/or referral hospital.
Your veterinarian may recommend additional tests to exclude or diagnose concurrent conditions. These tests are not always necessary in every case, but they may be of benefit in certain individuals, and are selected on a case-by-case basis. These include;
Cystoscopy. This procedure allows your veterinarian to visualize and sample tissue from the lower urinary tract. It does necessitate general anesthesia, as well as the expertise of a specialist, and transfer to a facility that has the proper equipment. It may be very helpful in making a definitive diagnosis in certain cases.
Endocrine testing to include an ACTH stimulation test and a thyroid profile to rule out hyperadrenocorticism (Cushing's disease) and hyperthyroidism, respectively. They are blood tests that can usually be performed at your local veterinary hospital.
A contrast cystourethrogram. This dye study evaluates the entire urinary bladder and urethra. It may confirm the presence of a tumor, stone or structural abnormality.
Excretory urography. This intravenous dye study "lights up" the upper urinary tract (kidneys and ureters). It is very helpful in documenting pyelonephritis, and is also of benefit in some cases as it helps detect stones in the urinary tract, and may identify other abnormalities, such as ectopic ureters. An ectopic ureter is a congenital abnormality in which the ureter (the tube that drains the kidney into the bladder) joins the bladder in an abnormal position, causing a host of clinical signs, most commonly, urinary incontinence (leaking) and recurrent infections.
In a small handful of cases, a bladder biopsy may be of benefit. This is an invasive procedure that often necessitates abdominal surgery.
Most patients are stable, and can be treated as outpatients as long as they are monitored closely for response to therapy. With appropriate therapy, and/or the identification and treatment of an underlying disorder, most patients do well, and can expect to see a full recovery. Correction or treatment of any underlying predisposing factors such as stones, prostatitis/metritis or cancer is imperative to treatment.
In more chronic cases, response to therapy can take longer and occasionally, response may be poor. Chronic, recurring cystitis can cause the development of stones, or cause the extension of infection to other parts of the urinary tract and body. It is very important that all recommendations by your veterinarian are followed very closely, and any questions or concerns that arise during the treatment protocol are addressed immediately.
Antibiotic therapy selected on the basis of bacterial culture and sensitivity of the urine or bladder mucosa (tissue) is the most important part if therapy. It is important to administer all medication as directed by your veterinarian. Usually, a minimum of 4-6 week treatment protocol is indicated in these recurring cases. Occasionally, extended or repeat antibiotic courses are in order. In some cases, long term (months) before bedtime administration is recommended.
Dietary modification is recommended in animals with concurrent kidney failure or stones. Surgical intervention may be necessary in cases of stones or tumors.
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.
Administer all prescribed medication as directed. Alert your veterinarian if you are experiencing problems treating your pet. The exact dose, frequency and length of proper antibiotic administration are imperative.
Repeat the urine culture approximately 7-10 days into treatment, and 1-2 weeks after the entire course of treatment has been completed. It is important to obtain urine cultures every 2-3 months until 3 negative cultures are obtained in these cases of chronic, recurrent cystitis. If at any point the culture is positive, an additional course of antibiotics, often longer than the original course, is generally recommended. Infection may persist in some animals despite appropriate, repeated courses of antibiotics.
General blood work (complete blood count, biochemical profile, etc.) may need to be reevaluated as recommended by your veterinarian.