Contributors: David Godfrey, Julien Bazelle

 Species: Feline   |   Classification: Miscellaneous

Introduction

  • Dysuria is defined as painful and/or difficult urination.
  • Clinical evaluation of urinary function can be accomplished by a series of diagnostic procedures.
  • Physical examination and a full history of the patient are important in the diagnosis of urinary tract disease.
  • Observation of the patient during urination is very helpful.

Is it likely that the patient has urinary tract disease?

  • Signs may be due to primary urinary tract disease or extra-urinary structures impinging on urinary tract.

Signalment

Age 
  • Young: increased likelihood of congenital disease.
  • Adult: consider urethral obstruction Urethra: obstruction or FLUTD Feline lower urinary tract disease (FLUTD).
  • Geriatric: may have neoplastic obstruction Urethra: neoplasia. Increased risk of urinary tract infection Cystitis: bacterial.
  • Clinical signs:
    • Non-productive straining.
    • Signs of pain when urinating.
    • Urinating in unusual or inappropriate places.
    • Frequent attempts to urinate (normal cats urinate about 2-4 times daily).
    • Discolored urine.
    • Passing small amounts of urine.

  • Care not to confuse fecal tenesmus with urinary straining.

Systemic signs 
  • Clinical examination:
    • Depression.
    • Aggressive behavior.
    • Polyuria/polydipsia Polyuria/polydipsia (PU/PD).
    • Constipation Constipation or straining to defecate.
    • Palpation of bladder size and shape:
      • Empty bladder may indicate bladder irritation and frequent urinations or, rarely, poor filling.
      • Large bladder may indicate outflow obstruction.
      • Observe urine stream during urination.

Causes of dysuria

Inflammation or infection

Obstruction

Urinary tract trauma

Further investigation

  • Try to answer the following questions:
    • Is there evidence of difficulty urinating?
    • Is there ever normal urine voiding?
    • Is there increased frequency of micturition attempts?
    • Is there obstruction to urine outflow?
    • Is total amount of urine production normal?
    • Is the urine color normal?
  • In all cases of dysuria when the bladder is full on examination attempts should be made to pass a urethral catheter.

Only after any necessary supportive care and suitable anesthesia.

  • In functional (neurogenic) obstruction the catheter should pass easily and the bladder can be drained.

Exercise great caution when passing a catheter in an animal with potential urethral obstruction as force can result in urethral rupture or damage resulting in stricture formation.

  • Per rectal palpation, after anesthesia can be used to detect intra urethral stores or masses.

Imaging

Radiography

  • Limited usefulness.
  • Can confirm size of bladder, if this cannot be palpated Radiography: abdomen Radiography: urethrography:
    • Small supports diagnosis of inflammation and increased micturition.
    • Large suggests outflow obstruction.
    • May reveal uroliths.
  • Assess extra-urinary tract structures for abnormalities.

Contrast radiography

Ultrasonography

Visibility of urethra may be limited.

  • Examination of bladder and lower urinary tract for presence of mass or urolith causing obstruction.
  • Evaluate regional lymph nodes.
  • Examine renal pelvis dilatation.

Laboratory investigation

Urinalysis

Remember that a voided urine sample will not help to localize the site of inflammation.

Urine culture

  • Obtain a urine sample preferably by cystocentesis Cystocentesis for culture if any evidence of urinary tract infection, or if urine is abnormal or if disease is recurrent.

A very distended bladder, especially if chronically distended may be at increased risk of rupturing during cystocentesis.

Cytological examination

Many normal cats have crystalluria.

Blood samples

  • Always check renal function Renal function assessment in animals with lower urinary tract disease.
  • Obstructed cats will often have a hyperkalemia Hyperkalemia which can be life-threatening.
  • Post-renal azotemia Azotemia may be present in cases with urinary tract obstruction.
  • Post-obstructive diuresis can be associated with hypokalemia Hypokalemia. 
  • Other causes of lower urinary tract disease may necessitate additional blood tests, eg serum calcium Blood biochemistry: ionized calcium in cats with oxalate urolithiasis, liver enzymes in cats with idiopathic cystitis being treated with amitryptiline Amitryptiline.