Controversies in the management of feline urethral obstruction

Objective To discuss areas of differing opinion in the management of feline urethral obstruction and present current evidence to either support or refute common practices. Etiology Urethral obstruction may occur as a result from a functional obstruction (idiopathic obstruction) or a physical obstruction, such as mucous plugs or calculi within the urethra. Potential risk factors for obstruction in cats include predominantly indoor status, decreased water intake, and increased body weight. Diagnosis The diagnosis is most commonly made based on history and initial physical exam—straining to urinate, vocalizing, signs of systemic illness, moderate to large firm bladder on abdominal palpation. Therapy Treatment is based on available evidence. The type of IV isotonic crystalloid used does not seem to matter and rate should be determined by need for fluid resuscitation, and replacement of deficit and ongoing losses. Though controversial, cystocentesis appears to be safe and may offer some benefits in initial management. There is evidence to suggest a smaller urethral catheter (3.5 Fr) may be associated with decreased risk of reobstruction. Routine use of antimicrobial agents in hospital is not recommended; they should be dispensed based on culture performed at the time of catheter removal. Though commonly used, evidence in support of antispasmodics is limited and further prospective investigation is needed. Prognosis Feline urethral obstruction is associated with 90–95% survival, with reported recurrence rates of 15–40%. Potential factors affecting recurrence include size or duration of indwelling urinary catheter, use of antispasmodic agents, patient age, and indoor‐outdoor lifestyle; however, different studies offer conflicting results. Increased water intake and environmental modification do seem to decrease risk of recurrence.