19 | How to give great care to your blocked bladder cats as a vet nurse

PodcastRenalUrinary
Written By Laura Jones

We’ve all been in the position where we’ve been busy clearing up after a busy ops day… when the vet rushes through that painful, stressed, straining cat with a bladder like an overinflated balloon.

 

And whilst this is a very treatable condition, there is a LOT of nursing care that these patients benefit from - not just when they’re obstructed, but to help prevent future obstructions, too.

In this episode, we’ll discuss what causes urethral obstruction, how these patients present, and how we can provide them with the best possible care.

What is a urethral obstruction?

As the name suggests, a urethral obstruction is some sort of blockage in the urethra, causing an inability for urine to exit the bladder.

It’s a common condition, with a reported incidence of 1.5-9% of all cats.

For a long time, we thought urethral obstructions were caused by a physical obstruction - such as a stone, stricture, urethral plug, or neoplasia blocking the lower urinary tract. However, we now know that many cats are affected by idiopathic obstructions, suggesting that functional obstructions are more common than we initially thought.

Feline urethral obstruction is a very treatable emergency condition, with high survival rates above 90%. However, we also know it can be life-threatening, especially where that obstruction has been present for some time - with patients at risk of severe acute kidney injury, azotaemia, uraemia, hyperkalaemia and metabolic acidosis.


What patients are at risk?

Though we can see urethral obstruction in cats and dogs, we see it far more frequently in cats - and male cats are more likely to develop an obstruction than females, owing to their longer, narrower urethra.

On top of gender, studies have documented that indoor-only cats, overweight or obese cats, and cats exclusively fed a dry diet have a higher incidence of urethral obstruction.

Other specific risk factors are associated with developing diseases like feline idiopathic cystitis (FIC), which commonly causes functional urethral obstruction. Now, because FIC is a complex condition in itself, I’m going to discuss that separately in next week’s episode - but essentially, chronic stress (think multicat households with conflict) or acute stressors can also be considered risk factors for FIC and, therefore risk factors for urethral obstruction.

What signs do we see in these patients?

The most common early signs of a urethral obstruction are similar to signs of cystitis. They include stranguria (straining), dysuria (difficulty urinating), pollakiuria (frequent passage of small urine volumes) and haematuria. Clients may report that their cat is in and out of the litter tray and only passing tiny volumes of urine, and they may report that they appear constipated. Other signs of urinary tract obstruction include hiding, vocalising in the litter tray, and licking around the back end.

If the obstruction has been present for some time, the patient will likely have systemic signs of acute kidney injury, including anorexia, vomiting, lethargy and even collapse.

On physical examination, these patients classically have an overdistended, turgid bladder that is unable to be expressed (side note - be VERY careful when palpating the bladder in these patients!)

The penis is often inflamed and erythematous from self-trauma, and sometimes, a urethral plug is seen at the tip of the penis.

Depending on the severity of the patient’s dehydration, signs of dehydration may include skin tenting, tacky or dry mucous membranes, and even sunken eyes.

On top of being painful, patients may be either tachycardic (usually due to pain and stress) or bradycardic (due to shock or hyperkalaemia). In severe cases, cats may present collapsed with hypothermia and obtunded mentation, and these patients require immediate stabilisation.

And how will we stabilise them?

Stabilising the emergency bladder cat is a vast area where nurses make a difference. We’re often triaging these patients, having initial discussions with worried clients, and then administering emergency treatment on the vet’s behalf - so what will we do?

The first step is to get verbal consent from the client for a triage exam and emergency treatment if needed. 

Next, triage your patient, collect a blood pressure reading, place an ECG for cardiovascular monitoring (if you have access to one) and run an emergency blood panel to check renal function, electrolytes and acid-base status.

After this, we’ll likely place an IV catheter and, if necessary, administer a small fluid bolus under veterinary direction. We tend to administer a buffered isotonic crystalloid solution, like lactated Ringer’s solution, as this will correct hypovolaemia, help reduce acidaemia, and doesn’t contain enough potassium to make the patient’s hyperkalaemia worse.

Once that IV is in, we want to get some analgesia on board for these patients, too, since we know urethral obstruction is often very painful.

In some cases, decompressive cystocentesis can be considered. This relieves some pressure from the bladder until the patient is stable enough for anaesthesia and catheterisation. There is a risk of iatrogenic bladder rupture and uroabdomen in these patients. However, some studies support the safety of this procedure - this should be carefully considered on a risk-to-benefit basis before it is performed.

And lastly, if your patient is hyperkalaemic, we’re going to need to manage this since it carries severe cardiovascular consequences.

And how will we manage their obstruction?

We’re going to sedate or anaesthetise our patient to deobstruct them and place a urinary catheter. Usually, we use a combination of ketamine and a benzodiazepine, such as midazolam, alongside opioid analgesia. Propofol or alfaxalone can be used for induction before the patient is anaesthetised and maintained on oxygen and inhalational anaesthesia.

Once they’re sedated, we need to do some imaging.

All cats with urethral obstruction should be evaluated with abdominal radiography to rule out urolithiasis as a cause. Make sure that your X-ray includes the entire urinary system, including the kidneys, ureter, and urinary bladder, as well as the entire length of the urethra—it’s common for cats to have uroliths in multiple areas across the urinary tract.

Once you’ve diagnosed your patient (and assuming they do not have a ruptured bladder, which would require an emergency trip to theatre), it’s time to place your catheter.

What other care do these patients benefit from?

Once you’ve relieved your patient’s obstruction, it’s time to recover them and think about ongoing care. They should always have a closed collection system attached to their urinary catheter since this will help keep the patient clean, minimise ascending infection, and allow us to measure urine output. 

An Elizabethan collar should also be placed to prevent interference or self-removal of the catheter.

After the patient recovers, the rest of our care aims to maintain fluid and electrolyte balance, provide analgesia, urethral muscle relaxants, supportive treatment, minimise stress, and provide general nursing care.

Let’s look at fluids

We know post-obstructive diuresis is expected in patients after their obstruction is relieved. So keep measuring fluid output and match this with the fluids you’re administering. We often need to add potassium supplementation to the patient’s fluids, too, depending on their blood results.

And what supportive treatment will we give?

These patients often benefit from prazosin, a urethral muscle relaxant. This drug can cause hypotension, so measure your patient’s blood pressure when using it.

Alongside muscle relaxants, other drugs commonly used include opioid analgesia (we tend to avoid NSAIDs until we’re happy there is no lasting renal dysfunction or acute kidney injury) and gabapentin (to provide additional analgesia and anxiolysis).

What about antibiotics?

These patients often do not need antibiotics, and these drugs are often overused in urethral obstruction patients. 

Firstly, most patients do not get an obstruction due to a urinary tract infection.

Secondly, we also know that antibiotics do not prevent a catheter-associated infection in the hospital. Instead, they can contribute to developing a resistant hospital-acquired UTI, so they should only be used in line with culture and sensitivity results in a patient with appropriate clinical signs.

And when do we remove that catheter?

There is no one correct answer for the duration a catheter should stay in. We don’t want to remove it too soon and risk reconstruction. Still, we also know that the longer a urinary catheter remains in situ, the longer the risk of infection and the more irritation and inflammation we see in the lower urinary tract.

Really, we need to base our decision to remove the patient’s catheter on their clinical signs and general status rather than how long that catheter has been in. We want to ensure our patient is not azotaemic, their post-obstructive diuresis has resolved, and their urine looks grossly normal.

How will we nurse these patients?

In the hospital, our focus is on maintaining comfort, minimising stress, appropriately caring for that patient’s urinary catheter, and providing general nursing care—focusing particularly on pain, nutrition, hydration, IV catheter and urinary catheter care, and grooming.

But our care for these patients does not end when their hospitalisation does—and there is a lot we can do to support these patients at home. We need to work with the pet’s family to adjust the home environment, making sure it meets their cat’s needs, they have sufficient resources and an enriched environment, and if they’re in a multi-cat household, there are minimal opportunities for inter-cat conflict.

These are all great uses of our nursing skills, and they allow our clients to see just how vital the nurse or technician is in their pet’s care.



So, that’s an overview of managing cats with urethral obstructions! We know these patients can be challenging to manage, especially when they’ve obstructed multiple times, are in a stressful environment, or have been blocked for some time, presenting as a hyperkalaemic AKI emergency. 

However, with swift triage and stabilisation, careful catheterisation, and appropriate post-operative nursing care, the outcome is very good for nearly all of these patients.

Did you enjoy this episode? If so, I’d love to hear what you thought - screenshot it and tag me on Instagram (@vetinternalmedicinenursing) so I can give you a shout-out and share it with a colleague who’d find it helpful!

Thanks for learning with me this week, and I’ll see you next time!

References and Further Reading

Laura Jones
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18 | How to successfully care for cats with ureteral obstructions