Obstructive Bladder Neoplasia (Feline)

"Sam" an 11 year old neutered male cat was presented for straining to urinate with little or no urine produced. It was initially thought that "Sam" was suffering from Feline Urinary Tract Disease (FLUTD) with secondary Urethral Obstruction (UO). Urethral obstruction in cats is caused by precipitation of crystals of minerals (struvite) in the lower urinary tract which may obstruct and totally occlude the small male urethra, rendering the cat incapable of urinating. The urinary bladder becomes greatly distended and painful and the kidneys begin to shut down. Standard treatment protocol is to anesthetize the cat, relieve the obstruction by reverse flushing, placement of a urinary catheter into the bladder, placement of an intravenous catheter, and treatment with intravenous fluids and systemic antibiotics. Normally, this treament is continued for several days, the urinary catheter is then removed, and hopefully a free flow of urine through the urethra is re-established.

In Sam's case, when the standard 6 inch polyproylene catheter was placed in the urethra, urine would not flow and the urinary bladder could not be expressed. The catheter was replaced with another one which functioned no better. The only other catheter available was a soft rubber 3 Fr catheter 18 inches long. This catheter passed freely into the bladder and the bladder could be easily expressed. Sam was continued on intravenous fluids and antibiotics for several more days.

The long urinary catheter was removed once intentionally and came out once accidentally. Each time the catheter was out, Sam was immediately obstructed again, unable to urinate.

Radiographs were taken which revealed disparate kidney size and a radiopaque density in the urinary bladder caused by the urinary catheter.

The small radiopaque urinary catheter can be seen in the urethra (1) leading to the urinary bladder. The bulk of the 18" catheter is coiled within the lumen of the bladder.

The most significant radiographic finding is the extreme thickness of the bladder wall (A) especially at the point of attachment of the urethra.

The next logical step in diagnosis would have been a diagnostic ultrasound examination of the bladder and surgical exploration and biopsy. Unfortunately, the owner felt that the prognosis was too poor to warrant proceeding further and Sam was humanely put to sleep.