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Interesting Cases

Everybody Pees…Except Flapjack

FLUTD is Feline Lower Urinary Tract Disease, a common problem in middle-aged male cats that is even more likely if they are overweight. It is also exacerbated by stress, so cats in a multicat household or cats that stress easily are more likely to be affected.


Flapjack is a handsome 6 year old, long haired, orange male cat that has had some litter box mishaps, LOVES food and is a tad overweight. Suddenly, he was straining in his litter box and urinating small spots outside the box.  Dr. Lane diagnosed Flapjack with FLUTD.  Inflammation in the bladder causes the cat to feel like they need to urinate, even when there is little to no urine in the bladder, so they strain and try to go frequently with accidents. While not caused by a bacterial infection (bladder infection, UTI or cystitis), bacteria can be a contributing factor along with stress. Creating a less stressful environment can be key to controlling FLUTD in some cats. Crystals in the urine are also a contributing factor. Minerals normally leave the cat's body through the urine, but can crystalize  during FLUTD, causing increased irritation to the bladder and urethra. Without complete treatment, the crystals can stick together and eventually form bladder stones. Diet is an important part of treating FLUTD to reduce the minerals and crystallization of minerals in the bladder.

Flapjack's urine sample showed both inflammation and infection, but no crystals.  He was treated with antibiotics and antiinflammatory/pain relievers and after a day he felt much better.  His diet was not changed initially because of the lack of crystals in his urine. He went back to normal for 11 months and then...

A possible consequence of FLUTD is an emergency situation called blocking when a cat cannot pass urine at all.  The blockage is created when the inflammation causes clots of debris, cells, crystals or small stones to pack into the long narrow urethra during urination and actually blocks the urine. This is painful and distressing, with many cats straining and crying and getting in and out of the litter box frequently.  If not attended to quickly, it can result in permanent damage to the kidneys or even bladder rupture. 

Flapjack's caring owners quickly noticed his distress.  Dr. Lane admitted Flapjack to the hospital for emergency care and found with Xrays that he had a small stone blocking the urethra.  She started immediate treatment by anesthetizing Flapjack for a urinary catheter to push the debris and small stone back into the bladder and reopen the urethra. Once successful, the blockage of urine can pass through the catheter and be immediately relieving to the cat.  Typically, the catheter is left in place for 1-2 days while the cat is on IV fluids to help flush the urinary tracts and clean out any debris.  Once the urine clears, the urinary catheter is removed and the cat remains in the hospital until it is obvious that he is urinating freely.  Antibiotics, antiinflammatorys and prescription diets are all used to help treat then prevent further bouts of FLUTD.  Unfortunately, poor Flapjack has more to his story than a couple of days in the hospital!

The stone in the urethra was not willing to move with the prodding of the urinary catheter.  The pressure continues to build in Flapjack's bladder and Dr. Lane needed to relieve the obstruction immediately.  Flapjack is taken to emergency surgery for a PU (Perineal urethrostomy).  A PU involves removing the stone or other obstructions and widening the urethra, thereby fixing the current emergency and likely preventing future obstructions. The surgery was successful and Flapjack stayed in the hospital one day for post surgical care, then returned home with a new diet.

Even with diligent home care and preventative measures such as diet changes, exercise, antiinflammatories and stress reduction, cats that block once are very likely to block again. A PU (Perineal Urethrostomy) does not prevent FLUTD, but can prevent the tiny stones and plugs from getting stuck in the now wider urethra. This is why blocking is a condition almost exclusively of male cats.  Females have a naturally shorter, wider urethra that passes debris much easier. 

Dr. Lane is now happy to see that Flapjack is urinating freely and eating the prescription diet to prevent him from forming more bladder stones. He is also losing weight which helps prevent future episodes. He is on no chronic medication, but she is ready to prescribe antiinflammatories if he has a flare up of FLUTD.