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An Urban Experience
R. Dorsch1
1Medizinische Kleintierklinik, Department für klinische Tiermedizin, München, Germany
Feline idiopathic cystitis – Where are we now?
Roswitha Dorsch, Dipl. ECVIM-CA (CA), Dr. med. vet., Dr. habil.
Center for Clinical Veterinary Medicine, Ludwig Maximilian University Munich
Feline idiopathic cystitis (FIC) is a disorder of the lower urinary tract in cats causing a combination of clinical signs, such as hematuria, pollakiuria, and periuria, as well as stranguria and urethral obstruction. The etiology of FIC is unknown but there is a consensus that FIC appears to be multifactorial disease syndrome involving the urinary bladder. Known contributing factors are environmental in uences and changes in the autonomic nervous system, which generate an increased stress response in affected cats, alterations in the glycosaminoglycan layer of the urinary bladder, neurogenic in ammation, and increased mast cell density in the bladder wall. Studies investigating the urine protein pattern in cats with FIC have identi ed differences compared to healthy cats
and cats with other urinary tract disorders. It has also been shown that certain signal transduction pathways important for in ammation and apoptosis are altered (1).
There are different forms of FIC. FIC can occur without urethral obstruction (UO) (non-obstructive FIC) or
with urethral obstruction (obstructive FIC). The non- obstructive form affects males and females equally.
UO occurs almost exclusively in male cats and may be caused by in ammation and spasms, or by formation of matrix-crystalline plugs.
FIC is a diagnosis of exclusion, and a diagnostic work- up must be performed to rule out other speci c causes. This includes a urinalysis (dipstick, urine sediment, aerobic urine culture), abdominal radiographs to identify radio-dense cystoliths or urethroliths, and ultrasound of the urinary tract to exclude focal bladder abnormalities such as polyps or neoplasms. Contrast radiographs
can also be used to rule out radiolucent cystoliths, and cystoscopy can be performed to rule out other causes of lower urinary tract disease and to con rm a diagnosis of FIC.
There is no proven effective therapy for FIC. In cats
with non-obstructive FIC, clinical signs resolve without therapy within 5 to 7 days. It is well known that interstitial cystitis in humans, which shares many similarities with FIC, is very painful. In cats, clinical observations have shown that analgetic treatment reduces the severity of clinical signs. A good analgetic option is Buprenorphin, which can also be given orally (0.01-0.02 mg/kg PO
BID to QID). Meloxicam has not been shown to have a bene cial effect on the course of obstructive FIC (2), but non-steroidal anti-in ammatory drugs can still be used for their analgetic effect in well-hydrated animals with no renal impairment.
There is no prospective study investigating the effect
of alpha-sympatholytic drugs; however, female cats
with FIC have been shown to have an increased
urethral sphincter tone (3). In addition, lowest rates of recurrent urethral obstruction of 17% to 18% in cats
with obstructive FIC have been observed in studies that included alpha-sympatholytic drugs in the treatment protocol (4, 5). In one retrospective study cats treated with prazosin, a selective α1-antagoniste, had a signi cantly lower risk of recurrent UO than cats treated with phenoxybenzamin, a non-selective α-antagonist (6). However, there are no prospective clinical studies for any of these drugs.
Systemic treatments that have been investigated in randomized, placebo-controlled clinical studies in cats with non-obstructive FIC include subcutaneous PPS
(7), oral N-Acetly-D-Glucosamin (8), and oral PPS (9).
In obstructive FIC, the effects of oral Meloxicam (2)
and Prednisolon (10) were investigated. PPS had a bene cial effect on cystoscopic lesions but it was not possible to demonstrate a signi cant positive clinical effect compared to the placebo for any of the treatments mentioned.
Intravesical treatments have been investigated in cats with obstructive FIC in placebo-controlled clinical trials with the aim of reducing the risk of recurrent urethral obstruction. These include: buffered Lidocain (11),
a combination of different glycosaminoglykans (5),
and pentosanspolysulfate (4). None of these drugs signi cantly lowered the rate of recurrent UO compared to the placebo.
Optimizing the cats’ environment to reduce stress
and motivating them to increase their water intake are the most important measures for reducing the risk of recurrent episodes. Many authors recommend that cats with FIC should be fed exclusively with a canned diet (12). This recommendation derives from the results of
a prospective study of cats with non-obstructive FIC (12). In this study, only 11% of cats on the canned diet,

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