Veterinary Medicine - February 2009 - (Page 93) reduction in their cats’ LUTS, fear, nervousness, and respiratory signs (coughing, sneezing, wheezing) and a trend toward reduced aggression. In 70% to 75% of the 46 cats in this study, there was no evidence of LUTS in the 10-month follow-up period.50 mones and adjusting the diet to include canned food and increased water intake. Amitriptyline and glycosaminoglycan supplementation may provide additional bene ts for chronic, recurrent episodes, but further studies are needed to establish ef cacy. REFERENCES 1. Buf ngton CAT, Chew DJ, Kendall MS, et al. Clinical evaluation of cats with nonobstructive urinary tract diseases. J Am Vet Med Assoc 1997;210(1):46-50. 2. Osborne CA, Kruger JM, Lulich JP, et al. Feline lower urinary tract diseases. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 5th ed. Philadelphia, Pa: WB Saunders Co, 2000;1734-1737. 3. Osborne CA, Lees GE, Polzin DJ, et al. Immediate relief of feline urethral obstruction. Vet Clin North Am Small Anim Pract 1984;14(3):585-597. 4. Kruger JM, Osborne CA, Goyal SM, et al. Clinical evaluation of cats with lower urinary tract disease. J Am Vet Med Assoc 1991;199(2):211-216. 5. Hostutler RA, Chew DJ, DiBartola SP. Recent concepts in feline lower urinary tract disease. Vet Clin North Am Small Anim Pract 2005;35(1):147-170. 6. Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. J Am Vet Med Assoc 2001;218(9):1429-1435. 7. Eggertsdóttir AV, Lund HS, Krontveit R, et al. Bacteriuria in cats with feline lower urinary tract disease: a clinical study of 134 cases in Norway. J Feline Med Surg 2007;9(6):458-465. 8. Abou N, Houwers DJ, van Dongen AM. PCR-based detection reveals no causative role for Mycoplasma and Ureaplasma in feline lower urinary tract disease [Letter to the editor]. Vet Microbiol 2006;116(1-3):246-247. 9. Fabricant CG. The feline urologic syndrome induced by infection with a cell-associated herpesvirus. Vet Clin North Am Small Anim Pract 1984;14(3):493-502. 10. Kalkstein TS, Kruger JM, Osborne CA. Feline idiopathic lower urinary tract disease. Part II. Potential causes. Compend Contin Educ Pract Vet 1999;21(2):148-154. 11. Rice CC, Kruger JM, Venta PJ, et al. Genetic characterization of 2 novel feline caliciviruses isolated from cats with idiopathic lower urinary tract disease. J Vet Intern Med 2002;16(3):293-302. 12. Gunn-Moore DA. Proceedings of the ESFM Feline Congress (Stockholm, 2002): feline lower urinary tract disease. J Feline Med Surg 2003;5(2):133-138. 13. Buf ngton CAT, Chew DJ, Woodworth BE. Feline interstitial cystitis. J Am Vet Med Assoc 1999;215(5):682-687. 14. Metts JF. Interstitial cystitis: urgency and frequency syndrome. Am Fam Physician 2001;64(7):1199-1206. 15. Pereira DA, Aguiar JAK, Hagiwara MK, et al. Changes in cat urinary glycosaminoglycans with age and in feline urologic syndrome. Biochem Biophys Acta 2004;1672(1):1-11. 16. Lavelle JP, Meyers SA, Ruiz WG, et al. Urothelial pathophysiological changes in feline interstitial cystitis: a human model. Am J Physiol Renal Physiol 2000;278(4):F540-F553. 17. Buf ngton CAT, Blaisdell JL, Binns SP Jr, et al. Decreased urine glycosaminoglycan excretion in cats with interstitial cystitis. J Urol 1996;155(5):1801-1804. 18. Elbadawi A. Interstitial cystitis: a critique of current concepts with a new proposal for pathologic diagnosis and pathogenesis. Urology 1997;49(5A Suppl):14-40. 19. Erickson DR. Interstitial cystitis: update on etiologies and therapeutic options. J Womens Health Gend Based Med 1999;8(6):745-758. 20. Reche Júnior A, Buf ngton CAT. Increased tyrosine hydroxylase immunoreactivity in the locus coeruleus of cats with interstitial cystitis. J Urol 1998;159(3):1045-1048. 21. Westropp JL, Kass PH, Buf ngton CAT. Evaluation of the effects of stress in cats with idiopathic cystitis. Am J Vet Res 2006;67(4):731-736. 22. Westropp JL, Kass PH, Buf ngton CAT. In vivo evaluation of alpha2-adrenoreceptors in cats with idiopathic cystitis. Am J Vet Res 2007;68(2):203-207. 23. Westropp JL, Welk KA, Buf ngton CAT. Small adrenal glands in cats with feline interstitial cystitis. J Urol 2003;170:24942497. 24. Kalkstein TS, Kruger JM, Osborne CA. Feline idiopathic lower urinary tract disease. Part I. Clinical manifestations. Compend Contin Educ Pract Vet 1999;21(1):15-26. 25. Forrester SD. Diagnostic approach to hematuria in dogs and cats. Vet Clin North Am Small Anim Pract 2004;34(4):849-866. 26. Bartges JW. Urinary tract infections. In: Ettinger SJ, Feldman Bottom line. Incorporate MEMO in the management of iFLUTD, and add synthetic feline facial pheromones as a component of stress management. For more information, see The Indoor Cat Initiative through The Ohio State University College of Veterinary Medicine Web site: http:/ /www.vet.ohio-state .edu/indoorcat. THERAPEUTIC RECOMMENDATIONS Based on the current literature, the most important therapies appear to be stress management using feline facial pheromones and MEMO and increasing water intake through the use of canned diets. No speci c canned diet is recommended but rather is determined by the cat’s preference. For chronic recurrent episodes, adjunctive therapy with long-term amitriptyline and glycosaminoglycan supplementation may be bene cial. SUMMARY A frustrating and potentially lifethreatening disease in cats, iFLUTD results in pain, pollakiuria, hematuria, periuria, stranguria, and, in some cases, urethral obstruction. It is a diagnosis of exclusion made only after conducting a thorough work-up. The results of studies evaluating possible causes have been con icting and reveal that the syndrome is likely multifactorial. Further studies are needed to establish the contributions of each possible mechanism. The ef cacy of speci c treatments is dif cult to assess because of iFLUTD’s self-limiting nature. In general, drug therapies that attempt to target potential causes have had disappointing results. The management tactics that seem most promising include reducing stress through MEMO and feline facial phero- EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier Saunders Co, 2005;1800-1808. 27. Lees GE. Bacterial urinary tract infections. Vet Clin North Am Small Anim Pract 1996;26(2):297-304. 28. Carr AP. Inherited coagulopathies. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier Saunders, 2005;1929-1933. 29. Peterson JL, Couto CG, Wellman ML. Hemostatic disorders in cats: a retrospective study and review of the literature. J Vet Intern Med 1994;9(5):298-303. 30. Brooks MJ, Catalfamo JL. Platelet disorders and von Willebrand disease. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier Saunders, 2005;1918-1929. 31. Bartges JW. Diagnosis of urinary tract infections. Vet Clin North Am Small Anim Pract 2004;34(4):923-933. 32. Kalkstein TS, Kruger JM, Osborne CA. Feline idiopathic lower urinary tract disease. Part III. Diagnosis. Compend Contin Educ Pract Vet 1999;21(5):387-394. 33. Cannon AB, Westropp JL, Ruby AL, et al. Evaluation of trends in urolith composition in cats: 5,230 cases (1985-2004). J Am Vet Med Assoc 2007;231(4):570-576. 34. Lekcharoensuk C, Lulich JP, Osborne CA, et al. Association between patient-related factors and risk of calcium oxalate and magnesium ammonium phosphate urolithiasis in cats. J Am Vet Med Assoc 2000;217(4):520-525. 35. Chew DJ, Buf ngton CAT, Kendall MS, et al. Urethroscopy, cystoscopy, and biopsy of the feline lower urinary tract. Vet Clin North Am Small Anim Pract 1996;26(3):441-462. 36. Chew DJ, Buf ngton CAT, Kendall MS, et al. Amitriptyline treatment for severe recurrent idiopathic cystitis in cats. J Am Vet Med Assoc 1998;213(9):1282-1286. 37. Plumb DC. Amitriptyline. In: Plumb’s veterinary drug handbook. 5th ed. Stockholm, Wis: PharmaVet Inc;2005;35-37. 38. Kraijer M, Fink-Gremmels J, Nickel RF. The short-term clinical ef cacy of amitriptyline in the management of idiopathic feline lower urinary tract disease: a controlled clinical study. J Feline Med Surg 2003;5(3):191-196. 39. Kruger JM, Conway TS, Kaneene JB, et al. Randomized controlled trial of the ef cacy of short-term amitriptyline administration for treatment of acute, nonobstructive, idiopathic lower urinary tract disease in cats. J Am Vet Med Assoc 2003;222(6):749–758. 40. Kalkstein TS, Kruger JM, Osborne CA. Feline idiopathic lower urinary tract disease. Part IV. Therapeutic options. Compend Contin Educ Pract Vet 1999;21(6):497-509. 41. Osborne CA, Kruger JM, Lulich JP, et al. Prednisone therapy of idiopathic feline lower urinary tract disease: a double-blind clinical study. Vet Clin North Am Small Anim Pract 1996;26(3):563569. 42. Plumb DC. Pentosan polysulfate sodium. In: Plumb’s veterinary drug handbook. 6th ed. Stockholm. Wis.: PharmaVet Inc, 2008;712-713. 43. Gunn-Moore DA, Shenoy CM. Oral glucosamine and the management of feline idiopathic cystitis. J Feline Med Surg 2004;6(4):219-225. 44. Plumb DC. Glucosamine. In: Plumb’s veterinary drug handbook. 6th ed. Stockholm. Wis.: PharmaVet Inc, 2008;429-431. 45. Houston DM, Moore AEP, Favrin MG, et al. Feline urethral plugs and bladder uroliths: a review of 5484 submissions 19982003. Can Vet J 2003;44(12):974-977. 46. Markwell PJ, Buf ngton CAT, Chew DJ, et al. Clinical evaluation of commercially available urinary acidi cation diets in the management of idiopathic cystitis in cats. J Am Vet Med Assoc 1999;214(3):361-365. 47. Pageat P, Gaultier E. Current research in canine and feline pheromones. Vet Clin North Am Small Anim Pract 2003;33(2):187211. 48. Westropp JL, Buf ngton CAT. Feline idiopathic cystitis: current understanding of pathophysiology and management. Vet Clin North Am Small Anim Pract 2004;34(4):1043-1055. 49. Gunn-Moore DA, Cameron ME. A pilot study using feline facial pheromone for the management of feline idiopathic cystitis. J Feline http://www.vet.ohio-state.edu/indoorcat http://www.vet.ohio-state.edu/indoorcat http://www.vetstreamcanis.com/ACI/February09/VMD2/dis60621.asp http://www.vetstreamfelis.com/ACI/February09/VMD1/dis60685.asp http://www.dvm360.com
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