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Uretral obstruction that could happen in your male cat, and correction.

URETHRAL OBSTRUCTION IN MALE CATS

Overview of the condition
Male cats can easily develop obstruction of the urethra- the tube draining urine from the bladder out of the penis- because the urethra is so small.  Obstructions are often the result of plugs of inflammatory material, or small calculi or "stones" that have formed in the kidneys and have passed down into the bladder (see "Urolithiasis").  The cause of the inflammatory materials and stone formation it not well understood, though viral infections and diet may play a role. 

Signs/Clinical presentation
Most affected cats are within 1 to 10 years of age.  Initially cats may show signs of urinary tract inflammation, such as straining to urinate, frequent urination, blood in the urine, painful urination, or inappropriate urination (urinating somewhere other than the litter box).  These bouts usually resolve in 5-7 days but will recur in many cats within 6-12 months.  Once the cats become obstructed, they may attempt to urinate in the litter box but will produce no urine. They may cry, move restlessly, or hide because of discomfort, and eventually will lose their appetites and become lethargic.  Complete obstruction can cause death of the cat in 3-6 days.  A cat with a urethral obstruction will have a large bladder that is easily felt in the back half of the belly.

Risk factorsCats that eat dry diets (and therefore get less water) or diets high in calcium, protein, or salt may be at an increased risk for developing calcium oxalate stones. Bladder inflammation leading to mucous plugs (sometimes called "Feline Urologic Syndrome" or "FUS") is more common in male cats. Congenital out-pouchings of the bladder ("vesicourachal diverticuli") can increase the risk of bladder infection, but they may also be a result of chronic inflammation.

Diagnostic tests
In cats with signs of urinary tract inflammation, blood work is evaluated to check kidney function and to determine if there is any evidence of infection or other systemic illnesses.  A urine sample is evaluated for crystals and may be sent in for culture, although bacterial infections of the bladder are uncommon in cats.  In cats with recurrent infections, x-rays of the belly may be taken to see if calculi (stones) or other material are present in the kidneys or bladder (Figure 1), and the veterinarian may inject contrast material into the bladder during x-rays to see if there are any anatomic causes for straining and bloody urine, such as a bladder wall defect or a stricture (narrowing) of the urethra.

Differential diagnosesClinical signs of straining and painful urinations can be seen in cats with bladder inflammation or calculi that do not have obstructions. Cats with constipation or anal sac disease may also strain and cry in the litter box. 

Treatment OptionsCats that have urinary obstruction require emergency treatment.  The veterinarian will sedate or anesthetize the cat and place a catheter into the urethra to flush out the plug or force the stone into the bladder.  The bladder is flushed through the catheter to remove any remaining sediment.  The urinary catheter is then removed, and the cat is placed on intravenous fluids so that it will urinate frequently.  Some cats require placement of a urinary catheter for 1-2 days until urethral swelling subsides; these cats may be placed on antibiotics.  The veterinarian may also prescribe pain medication or other drugs to make the cat more comfortable and to help it relax.

In cats with calcium oxalate stones that have been flushed into the bladder, a cystotomy (surgical opening of the bladder) is performed to remove the stones (Figure 1)  Cystotomy is also performed in cats with congenital outpouchings of the bladder ("vesicourachal divericuli").

Figure 1.  Calculus ("stone") being removed from a cat's bladder.

If the obstruction recurs, a thorough work-up (including x-rays, cultures, and contrast studies of the bladder and urethra) should be performed before any surgery is considered (Figure 2, 3).

Figure 2.  X-ray of a cat that had recurrent urinary tract obstructions for 6 months.  A urinary catheter (yellow arrows) containing calcium crystals was found in the bladder (red arrows).

Figure 3.  This urinary catheter had accidentally been left in a cat after its first bout of obstruction (the cat chewed the end of the catheter off, and the rest slipped inside the urethra and bladder).  The cat obstructed multiple times until the catheter was removed surgically.

Cats that have 3 or more recurrences, that cannot be managed medically, and that do not have any underlying conditions that could cause recurrence may undergo perineal urethrostomy ("PU"), or surgical widening of the urethra (Figures

Figure 4.  The cat's rear end has been prepped for surgery.

Figure 5.  The surgical area is draped in.

Figure 6.  The penis is dissected free from its attachments to the pelvis, and then will be opened to enlarge the urethra.

Figure 7.  The new opening is completed.

When to seek referral
Cats that have strictures of the urethra, or high obstructions, are more difficult to correct surgically.  Surgery in these cats should be performed by an ACVS Veterinary Surgeon. (Find a Surgeon)

Potential complications of surgeryAfter surgery, some cats will develop bleeding or swelling. Stricture (scarring and narrowing) of the urethrostomy site may occur if the cat traumatizes the surgery site or with incomplete dissection or urine leakage under the skin (Figure 8).  Bacterial urinary tract infections occur in 25% of cats within the first year after perineal urethrostomy.  Perineal urethrostomy does not prevent bladder inflammation or stone formation.

Figure 8.  Because of incomplete dissection, this cat developed a stricture of the urethral opening (arrow).  The cat had recurrent urinary tract infections and strained to urinate; these problems resolved once the urethrostomy was repaired properly.

Aftercare
Pelleted or paper litter may be used for several days after the surgery.  Cats that have severe swelling or leakage of urine under the skin may require placement of a urinary catheter for 2-3 days (Figure 9).  An Elizabethan collar is kept on the cat for 7-10 days after surgery to prevent self-trauma.  In some cats, absorbable sutures are used in the surgery site, while other cats may have nonabsorbable sutures that require removal in 10-14 days. Cats should be rechecked 1, 3, 6 and 12 months after the surgery for urinary tract infections.

Figure 9.  This cat had a high stricture or narrowing of the urethra, and had significant swelling after surgery. The bruising is from urine leakage under the skin.  A urinary catheter was placed for 2 days, and the swelling resolved.

Prevention and prognosisPrevention of urethral blockage depends on the cause of the blockage.  If the surgery is performed properly, it is unlikely that cats will develop subsequent urinary obstructions.  Perineal urethrostomy does not prevent bladder inflammation or stone formation, however, so clinical signs of urinary tract disease may continue in some cats.

Credit to Dr Karen for her sharing on her case. www.acvs.org 

Apakah yang berlaku setelah dikateter atau urinary catheterisation bagi kucing jantan

Salam sejahtera,


Kembali lagi saya kini bercerita sedikit tentang kebaikan dan pos-prosedur selepas urinary catheterisation bagi kucing jantan. Prosedur ini dijalankan untuk membuang atau flush pundi kencing yang tersumbat. Kucing jantan kita mempunyai masalah tak boleh kencing, malah dekat hujung penis kita akan dapat lihat, maybe jumpa yellowish plug atau darah beku. Ok itu simptom atau sign awal masalah saluran pundi kencing dah tersumbat.

Jadi dengan menggunakan catheter atau tiub kateter yang sesuai dengan saiz dan kegunaan, doktor haiwan akan mengukur dahulu kepanjangan tiub yang akan dimasukkan sehingga ke dalam pundi kencing kucing itu. Sebabnya kalau terlalu dalam masuk ia boleh menyebabkan tiub itu akan tertusuk dinding pundi kencing lalu menyebabkan pundi kencing bocor. Air kencing akan melimpah dalam perut dan komplikasi berlaku. Maka itulah kerja doktor haiwan terlatih perlu mengukur sedalam mana ia perlu menyalurkan tiub. Apa sebab kena salur tiub, well prinsip macam ni tiub seperti membuka saluran baru untuk air kencing keluar. Sebelum ini saluran sedia ada dah tersumbat disebabkan batu karang, darah beku mungkin, atau nanah yang menjadi plug. Ok tiub tu akan menolak halangan itu kembali ke dalam pundi kencing lalu membuatkan saluran kembali terbuka. Doktor haiwan akan menolak perlahan2 nak mengurangkan trauma pada dinding salur kencing. Apabila dah masuk pundi kencing maka dengan perlahan-lahan air kencing keluar bersama kotoran, darah dan sebagainya. Tapi selalu air kencing boleh jadi susah keluar juga, maka dengan menggunakan teknik betul, doktor haiwan akan mengepam perlahan-lahan atau menekan pundi kencing dari keluar untuk memberikan tekanan pada air kencing ditolak keluar. Ini terjadi apabila pundi kencing selama ini tersumbat, jai pressure dalam tu dah tak kuat, malah otot pundi kencing sudah lemah. Sebab itu doktor vet akan membantu kucing mengeluarkan air kencing. Tahukah anda, kalau air kencing tidak dibuang untuk beberapa masa yang lama, bukan sahaja menyebabkan air kencing boleh bertukar menjadi batu karang dalam bahasa kita atau urolith, malah normal flora dalam pundi kencing yang terdiri bakteria baik akan membiak terlalu banyak sebab keadaan dalam pundi kencing terlalu kotor. Apabila bakteria menjadi banyak ia akan mula memakan segala sumber nutrent yang ada termasukkan dermis atau tisu pundi kencing.

Ok selepas dah dijalankan prosedur catheter sehingga kempis pundi kencing dibuatnya. Adakalanya, kucing akan dicatheter untuk suatu jangka masa lama maybe seminggu dan diwajib duduk wad untuk bet monitor. Sepanjang duduk wad, tiub itu akan sentiasa berada di dalam salur kencing kucing ini untuk membantu kucing kencing.Tapi biasalah kucing tak berapa suka. Sepanjang dicatheter, vet akan beri kucing ubat untuk lawas kencing dan sentiasa kencing, seperti flush pundi kencing sampai bersih.  Malah diberi antibiotik yang sesuai untuk mengelak jangkitan sampingan dari bakteria terutama. So vet akan biarkan tiub berada dalam saluran kencing sehingga disahkan masalah ini berakhir.Apabila habis dipastikan tiada lagi tersumbat, atau ada darah, baru dikeluarkan. Apabila tiub dikeluarkan, maka kucing akan still diberi antibiotik untuk dihabiskan dose.

So selepas prosedur ini, Tuan kucing perlu pastikan ubat yang diberi digunakan sebaiknya. Selepas ini, pemakanan kucing perlu diubah, kena makan makanan khas yang baik untuk kesihatan pundi kencing untuk mengelak tersumbat lagi. Saya saran beri makanan seperti prescribtion diet dari hills diberi nama U/D diet, dan C/d diet, rasa kedai vet ada, kalau kedai petshop tak pasti. Makanan ini memang tak disukai kucing sebab takde perisa, tapi kita sebagai tuan perlu latih kucing kita makan. Ia bagus untuk penyembuhan dan mengelakkan berlaku masalah batu karang dimasa sama.



 Pada masa sama, saya saran untuk kucing yang ada masalah ini tidak digunakan pasir kucing sebagai tandas sebab ia akan membuatkan bahagian bawah trauma, jadi seeloknya dibubuh ceraian surat khabar sebagai tandas kucing. Ini lebih berguna kerana tuan kucing akan tahu berapa banyak kucing kencing, dan kalau tiada kencing maka boleh diinformkan kepada vet untuk tindakan penbetulan.

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