Diagnote: What's your diagnosis? - DVM
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Diagnote: What's your diagnosis?
Recurrent hematuria, pollakiuria and periuria in cat

DVM360 MAGAZINE


Management

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.

Follow-up evaluation

When should follow-up evaluation be scheduled?


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
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 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).
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).


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