Bladder Struvite Urolithiasis in a Kitten

Abstract

Background: Bladder urolithiasis, a complex and multifactorial condition, is a disease of the lower urinary tract and is related to crystal solidification, known as urolith, caused by urine supersaturation in the bladder. Its incidence is greater in 2- and 7-year-old, with few reports of affected felines aged less than 1 year. Doppler ultrasonography, visualized in color, is an important test that aids in bladder urolithiasis diagnosis. This study reports a rare occurrence of bladder urolithiasis in a 2-month-old feline, emphasizing ultrasound diagnosis.

Case: A 2-month-old unneutered female feline presented with hematuria, pollakiuria, and dysuria for 1 day. The patient was the result of a consanguineous cross between a Siamese cat and her mixed-breed son. The animal’s diet consisted of commercial dry puppy food on demand and limited water intake. On palpation, abdominal pain was noted. During examination, drops of reddish urine and small uroliths were expelled from her vulva. The patient underwent an abdominal ultrasonography that revealed an inflammatory process in the bladder and intraluminal urinary lithiasis. Cystitis was treated with antibiotics, nonsteroidal anti-inflammatory drugs, and opioids over 3 days along with general guidance on diet and environmental management. On the day of her final drug administration, she experienced strangury and expelled more uroliths through her vulva. Consequently, the patient was referred for a cystotomy. The patient experienced three episodes of cardiac arrest during the procedure, which was controlled by the anesthetist, and one more in the immediate postoperative period after which the patient died. Qualitative analysis of the stones removed during surgery and those expelled previously indicated the presence of struvite.

Discussion: The diagnosis of urolithiasis was based on the animal’s history, physical examination, blood count, and color Doppler ultrasonography. The animal was 2-month-old, which is an age group rarely affected by this disease. The patient, a partially Siamese kitten, a breed predisposed to the formation of urate stones, presented with struvite urolithiasis, which was in agreement with the predispositions dictated by its age group and sex. The blood count revealed mild anemia and leukocytosis caused by neutrophilia and monocytosis, indicating possible inflammation and infection associated with urolithiasis. Doppler ultrasonography was chosen because of its low cost, no radiation exposure, and grater sensitive than radiographic examination. Although the patient’s clinical condition led to low bladder filling and increased complexity in observation, the surface of the urolith stood out on the ultrasound image as hyperechoic in the bladder lumen, generating intense posterior acoustic shadowing. Thus, the use of ultrasonography played a crucial role in the diagnosis of bladder urolithiasis, confirmation of the presence of urolith with the Doppler mode, and the inflammatory process due to bladder wall thickening. The treatment of struvite uroliths consists of medical dissolution by a therapeutic diet. In this case, the patient developed strangury 4 days after initiating treatment with medicated food; therefore, the choice of surgical treatment was considered. Given the rarity of these events in young felines, this report highlights the need and relevance of early diagnosis, implementation of specific therapeutic strategies, and fortifies ultrasonography as a sensitive and specific diagnostic technique, despite challenging symptoms in pediatric patients.

Keywords: cistotomia, diagnóstico, ultrassonografia.

Título: Urolitíase vesical de estruvita em uma gatinha

Descritores: cistotomy, diagnosis, ultrasonography.