How would you manage this patient? Would you recommend surgical treatment, medical treatment, or a combination of the two?
In a prospective clinical trial of medical dissolution of feline struvite urocystoliths performed at the Minnesota Urolith
Center, consumption of a diet designed to dissolve feline sterile struvite uroliths resulted in urolith dissolution in approximately
two to four weeks.
Furthermore, in our experience, most feline vesicourachal diverticula are a consequence rather than a cause of lower urinary
tract disease. After elimination of predisposing causes (e.g., urocystoliths, infections, urethral obstructions), most vesicourachal
diverticula will heal in approximately two to three weeks.
The client was given the option of surgery or medical therapy. Surgical removal of the urocystolith and vesicourachal diverticulum
has the advantage of rapid correction of these components of the disease process. However, surgery cannot be relied on to
remove subvisual uroliths or to prevent their recurrence. Likewise, surgery is associated with a higher risk of mortality
than medical management, although the risk of mortality associated with both types of therapy in this patient are low.
The client requested medical therapy consisting of a diet (Prescription Diet s/d Feline—Hill's Pet Nutrition) designed to
dissolve sterile struvite uroliths.
When should follow-up evaluation be scheduled?
In our opinion, a follow-up evaluation scheduled approximately four weeks after the onset of therapy is satisfactory, unless
unexpected developments warrant more frequent evaluation.
Figure 3: A double-contrast cystogram of the cat described in Figure 1 obtained 28 days after initiation of a struvitolytic
diet. Note the small urocystolith (arrow) and marked reduction in the size of the vesicourachal diverticulum
At the follow-up, radiodense uroliths were not identified by survey abdominal radiography. Double-contrast cystography revealed
a small urocystolith (Figure 3) and marked reduction in the size of the vesicourachal diverticulum (Figures 3 and 4).
Figure 4: A positive contrast urethrocystogram of the cat described in Figure 1 obtained 28 days after initiation of therapy.
Note the marked reduction in size of the vesicourachal diverticulum (see Figure 2).