Feline LUTD Management: Disease-Specific Guidelines for Veterinarians – iCatCare 2025

Introduction 
Lower urinary tract signs (LUTS) in cats—such as dysuria, haematuria, pollakiuria, stranguria, and periuria—are common and potentially serious presentations. The 2025 iCatCare Guidelines provide a structured approach to managing LUTD, including Feline Idiopathic Cystitis (FIC), urolithiasis, urinary tract infection (UTI), and urethral obstruction (UO^)1. Given overlapping clinical signs, a disease-specific management strategy is essential for improving patient outcomes and owner compliance. 

1. Feline Idiopathic Cystitis (FIC) 
Management 

• Multimodal Environmental Modification (MEMO): Increase litter box number (one more than number of cats), ensure cleanliness, reduce stressors, and provide vertical and horizontal enrichment². 

• Hydration & diet: Aim for total water intake ≥ 25–30 mL/kg/day (food moisture + water) to reduce recurrence risk. Encourage wet-food diets (≥70% moisture) and multiple water sources¹. 

• Analgesics/adjuncts: Buprenorphine 0.01–0.02 mg/kg IV/SC/SL Q8–12h for acute episodes¹ 

• Monitoring: Track recurrence of LUT signs and reassess MEMO compliance; studies report ~70–75% reduction in recurrence with consistent environmental management¹. 

2. Urolithiasis 
Management by Stone Type 

• Struvite stones: Consider medical dissolution using diet and optimize hydration³. 

• Calcium oxalate stones: Surgical removal is usually necessary; post-operative prevention focuses on diet and hydration⁴. 

Supportive Care 

• Encourage hydration to maintain dilute urine (USG < 1.030 where possible)⁵ 

• Pain management: Opioids or NSAIDs if renal function permits¹. 

Follow-Up 

• Recheck urinalysis and imaging every 6–12 months. 

• Ensure ongoing access to fresh water and monitor diet compliance. 

3. Urinary Tract Infection (UTI) 
Management 

• Confirm diagnosis via urine culture and sensitivity (cystocentesis sample preferred^)1. 

• Subclinical bacteriuria: Usually not treated; consider only in diabetics, suspected pyelonephritis, or pre-urinary surgery^1,6. 

• Clinical UTI: Treat based on culture & sensitivity; provide analgesia (NSAID or opioid). 

• Empirical therapy: Amoxicillin or trimethoprim-sulfonamide; avoid cefovecin or fluoroquinolones unless resistant or severe cases^1,6. 

• Treatment duration^1,6: 

• Simple UTI: 3–5 days 

• Complicated/recurrent: 7–14 days 

• Pyelonephritis: longer as needed 

• Resistance: Enterococcus spp. resistant to beta-lactams, cephalosporins, TMP-SMX, fluoroquinolones¹. 

• Adjunct/supportive care: 

• Increase hydration and voiding frequency 

• Reduce stress; provide environmental enrichment 

• Analgesia if mobility issues limit urination⁷ 

Monitoring 

• Re-culture after therapy in recurrent or complicated cases. 

• Address underlying comorbidities to prevent recurrence. 

4. Urethral Obstruction (UO) 
Emergency Management 

• Stabilization: Evaluate for hyperkalaemia and cardiovascular compromise. 

• Calcium gluconate 10%: 0.5–1 mL/kg IV over 2–3 min if ECG abnormalities (peaked T-waves, bradycardia) are present¹. 

• Fluid therapy: Initial IV rate 10–20 mL/kg/hr until obstruction relieved; maintenance ~50 mL/kg/day (~2 mL/kg/hr). 

• Decompression: Catheterization preferred; cystocentesis if catheterization delayed or unsafe¹. 

• Analgesia: Buprenorphine for 5–7 days post-obstruction. 

Post-Obstruction & Monitoring 

• Monitor urine output hourly; post-obstructive diuresis often > 2 mL/kg/hr.^6 

• Adjust fluid therapy accordingly. 

• Check serum electrolytes and PCV/TS every 8–12 hours until stable¹. 

Prevention of Recurrence 

• Identify underlying cause (FIC, urolithiasis, UTI). 

• Implement MEMO, hydration, and urinary diet plans post-discharge. 

Key Takeaway 
Effective management of feline lower urinary tract diseases requires a disease-specific approach, combining emergency stabilization, targeted pharmacologic therapy, supportive care, and environmental management. Feline idiopathic cystitis, urolithiasis, urinary tract infections, and urethral obstruction each demand tailored interventions based on clinical presentation, underlying cause, and comorbidities. 

Key principles include: 

• Prioritizing life-threatening emergencies (e.g., hyperkalaemia in urethral obstruction). 

• Using culture-guided antimicrobial therapy for UTIs and avoiding unnecessary or empiric use of critically important antibiotics. 

• Promoting hydration, stress reduction, and environmental enrichment across all LUTD types. 

• Educating owners on recurrence prevention, dietary modification, and early recognition of signs. 

By integrating these evidence-based strategies, veterinarians can improve clinical outcomes, reduce recurrence, and enhance quality of life for feline patients with LUTD. 

References  

1. Taylor S, Boysen S, Buffington T, Chalhoub S, Defauw P, Delgado MM, Gunn-Moore D, Korman R. 2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats. Journal of feline medicine and surgery. 2025 Feb;27(2):1098612X241309176. 

2. Kurum H, Yalcin E. Effects of multimodal environmental modification in crystal-related feline lower urinary tract diseases. Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 2023 Jul 17;75:665-72.  

3. Westropp JL, Delgado M, Buffington CT. Chronic lower urinary tract signs in cats: current understanding of pathophysiology and management. Veterinary Clinics: Small Animal Practice. 2019 Mar 1;49(2):187-209. 

4. Buote NJ, Hayes G, Bisignano J, Rosselli D. Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score. Journal of Feline Medicine and Surgery. 2022 Oct;24(10):1032-8. 

5. Heseltine J. Diagnosing and Managing Feline Lower Urinary Tract. Texas A&M University College of Veterinary Medicine & Biomedical Sciences. 2019;45:1307-10. 

6. Weese JS, Blondeau J, Boothe D, Guardabassi LG, Gumley N, Papich M. ISCAID guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. The Veterinary Journal. 2019;241:8-25. 

7. Al-Anany AM, Hooey PB, Cook JD, Burrows LL, Martyniuk J, Hynes AP, German GJ. Phage therapy in the management of urinary tract infections: a comprehensive systematic review. Phage. 2023 Sep 1;4(3):112-27.