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Date:   05 May, 2011  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
 
The Cat That Can't Pee For 2 days
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   05 May, 2011  
Case was first recorded: Around 2000
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On Sunday, May 1, 2011 (Labour Day in Singapore), a man in his early 50s phoned me as his cat could not urinate normally for the past two days.

I had a discussion with Dr Vanessa Lin on the management of this case as I would be having the afternoon off.  As each vet handles a case of urethral obstruction differently, I wanted to make sure that this case would be handled the way I would have had done since this worried gentleman phoned me and I had assured him that there would be no problem in his case.

When the patient recovers, everybody is happy. But should the patient gets worse or dies, litigation and complaints may occur and I don't want that to happen to any vet in Toa Payoh Vets. As a licensee, I am ultimately responsible for any complaints against my vets and staff and the working life is full of changes and worries when there are more members in a team.  

There are certain standard operating procedures I will want to advise the owner and be recorded in case of medical negligence litigation. So I had to inform my associate vets as I was taking the afternoon off. These are:

1. urine collection for analysis of crystals, bacteria and blood - mandatory. Some vets do not do this and may be sued for possessing a lower standard of care if the cat dies since the vet has no defence of urine or blood tests. This is mandatory in this case.

2. blood collection for health screening is strongly advised esp. to check whether the kidney is affected and whether there is a severe bacterial infection. Fever may or may not be an indicative sign of this infection. If the owner does not want to pay for this test, this objection must be recorded in the case sheets.
 
3. As to whether the urinary catheter should stay in this cat for 2 days, I left that option to her. However, I said: "Usually I don't stitch the catheter after thoroughly irrigating the bladder if the urethra obstruction is a recent event as in this case. There are different opinions as to whether the catheter will irritate the bladder if left inside for more than 2 days, but I leave this option up to you."

For long-standing cases, I do stitch the catheter for 2 days and may irrigate the bladder again.  See my procedures at: The hissing cat has difficulty peeing again  

CAUSE OF THE URETHRAL OBSTRUCTION/URINARY TRACT INFECTION?
In this cat, there was no urethral obstruction as the catheter passed into the bladder easily. I spoke to the owner the next day as he came for the cat. Monday, May 2, 2011 was a public holiday as May 1 (Labour Day) happened on a Sunday.

What was the cause of this cat's dysuria problem?

"FLUTD (Feline Lower Urinary Tract Disease) usually occurs in a male neutered cat over 5 years of age," I was thinking that this cat could have some injury or infection.

"My cat is only one and a half years old and he is not neutered!" the IT man said to me.    

"5-years is the average age," I said. "Some cases happen in younger cats. Is your cat busy mating with other cats and thereby suffering from traumatic injury?"

"Well, my other cat keeps humping him every month. But this has been going on for several months and there has been no problem with urination."

I try to be impatient and explained: "Many events don't happen until they are performed often enough. For example, people don't get prawn allergies till they are eat prawns for many times. It is possible that your cat has traumatic injury to the penile area."

I don't want to appear soliciting for business by advising neutering of the humping cats and therefore let sleeping dogs lie. This cat's dysuria was likely to be a case of traumatic injury but it was pure conjecture at this stage.

FOLLOW UP:
Calcium oxalate ++ crystals were present in the cat's urine. The first of 3 FLUTD cases, described in The hissing cat has difficulty peeing again had no crystals in the urine during my examination. Dr Vanessa prescribed the Hills' CD and would do other tests. I was glad that she had done the urine tests as not all vets test for urine for urethral obstruction for various reasons, as seen in my 3rd of the 3 FLUTD cases, described in 3rd FLUTD - The cat drips urine all over the apartment.       

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