Contributors: David Godfrey, Julien Bazelle
Species: Feline | Classification: Miscellaneous
- 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.
- 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.
- Clinical examination:
- 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
- Cystitis (sterile or infectious) Idiopathic cystitis Cystitis: bacterial.
- Secondary to urolithiasis Urolithiasis.
- Vaginitis Vaginitis.
- Urolithiasis Ureter: obstruction.
- Urinary tract neoplasia:
- Blood clot.
- Urethral plug.
- Urethral stricture.
- Dyssynergia, dysautonomia Feline dysautonomia, spinal disease.
- Foreign body.
- Urethral spasm.
Urinary tract trauma
- Bladder rupture Bladder: trauma rupture.
- Urethral rupture or tear Urethra: rupture.
- Iatrogenic after catheterization Urethra: catheterization.
- 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.
- 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.
- Double contrast cystogram Radiography: double contrast cystography to rule out cystoliths and bladder neoplasia.
- Retrograde urethrogram Radiography: urethrography to check for signs of urethral disease.
- If there is urethral obstruction and a catheter cannot be passed then intravenous urography Radiography: intravenous urography may be required.
- Can be useful in the investigation of urinary tract disease Ultrasonography: bladder and urinary tract but operator dependent.
- Will be limited by the presence of gas after catheterization.
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.
- Collection of a urine sample is essential in the investigation of dysuria.
- Complete urinalysis Urinalysis: overview (including specific gravity Urinalysis: specific gravity) is indicated.
- Rule out inflammatory or infectious dysuria by examination of the sample for presence of:
- Some diseases cause immunosuppression which reduces the cellularity of urine despite infection or other disease which would normally cause inflammation. Always culture urine of cats in this situation. The presence of bacteriuria can be present in healthy animals so the finding of bacteriuria does not always indicate urinary tract infection.
Remember that a voided urine sample will not help to localize the site of inflammation.
- 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.
- Of urine sediment Urinalysis: centrifuged sediment for evidence of neoplasia.
- Also look for crystals which may be more significant if uroliths are present.
Many normal cats have crystalluria.
- 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.