Expert: Ali - 4/10/2010

Question
Hello

Thank you in advance for your time and consideration. My cat began to use the litter box more frequently and started showing blood in his urine. I of course took him to the vet who then ran blood tests and gave a physical inspection.

Blood tests came back normal and my vet commented that my cat's bladder was not enlarged. She then prescribed Phenoxybenzamine which is an alpha blocker so I suppose it is for depression or anxiety.

He seemed to have returned to normalcy after a couple of days on the medicine but then one day later started peeing a much more noticeable amount of blood. We collected a sample in a tupperware and saran wrapped it to take to the vet. She claimed, however, that the only way to take a good sample is to inject a needle through the bladder and collect it straight from the source.

Is my vet try to upsell an unnecessary procedure? I don't understand how bacteria in the urethra could be considered a contaminant in the urine. Isn't whatever bacteria that is present in my cat's system, no matter where it resides, a potential suspect in the cause of the problem?

We are now doing a round of antibiotics to see if that helps. He is neutered, had issues with vomiting but no concise diagnosis, and he has all his vaccinations.

Let me know your thoughts.

-Tom Waters

Answer
Tom,

As far as I'm concerned when it comes to my own cats I prefer to start off with the least invasive techniques to collect urine (or other bodily fluid samples) first. In the event that you simply can't get kitty to urinate in a litter box filled with non-absorbant litter over the space of a few days (you can collect the pee from the litter pan with a syringe then empty the syringe into sterile urine sample cups provided by the vet) then my recommendation would be to speak with your vet about gently expressing the urine from your kitty's bladder by exerting gentle pressure on the bladder and having the kitty void into a sterile cup or clean bowl (some vets will show you how to do this properly while others will prefer to do it on their own). Ultimately I think that if you're able to collect a urine sample in a clean container at home and get it to the vet within a very short space of time for analysis I don't see the need to traumatize your kitty anymore than it's absolutely necessary to by subjecting him to very invasive procedures like collecting the urine sample through a needle that's inserted into the kitty's bladder via his abdomen. If you live a ways from your vet's clinic you may have to transport the sample in a cooler or refrigerate the urine sample for a few hours until you can get it to the clinic. Your vet can provide you with information about how to collect a sample that's as free from outside contaminants as possible, placing the sample into a sterile urine sample jar and keeping the sample in the best condition possible for later analysis. If you live within 10-15 minutes of the vet hospital, you are able to collect the urine sample within the hours that the clinic normally either sends urine to outside labs for analysis or analyzes them in house and you're able to get the sample to the vet quite quickly after you manage to get it then I see no reason why the vet wouldn't be able to test that sample to see if it offers any clues about the origins of the blood in your kitty's urine (whether that's crystals irritating the bladder or urinary tract, a urinary tract infection or some other issue).

If this vet is dead set against you trying to collect the urine sample as per her instructions at home to minimize the stress on your kitty then I must be honest with you - if this was my kitty I'd be seeking another opinion until I managed to find a vet that was willing to help me to help my cat through this whole situation with as little stress as possible. If your vet is so concerned about the way that the urine sample is collected she could simply admit your kitty to hospital first thing in the morning, provide kitty with a litter box filled with non-absorbant litter and wait for him to relieve himself....

The most recent time that my vet needed a urine sample from one of my cats wasn't so long ago and she simply allowed my kitty to settle into a hospital cage and offered her the chance to pee and provide the sample on her own. This sample did need to be sent off to an outside lab to be cultured for bacteria since there was a chance that our baby girl had a kidney infection that may have been contributing to the sudden development of her acute renal failure. One thing that our vet explained to us about collecting a urine sample by placing a needle into the kitty's bladder through the belly wall is that samples collected this way often have increased numbers of red blood cells simply because of the way the sample was collected. I guess the way that I look at this situation is that our vet was patient enough to allow our eldest cat to urinate in non-absorbant litter on her own time when our kitty had just been diagnosed with severe acute renal kidney failure which was life threatening at that point I see no reason why your vet can't simply exercise a bit of patience to make life easier for you and your cat and minimize the stress your kitty is under. This whole situation comes down to one important detail - while your veterinarian has spent years obtaining a formal post secondary education that allows her to practice medicine the reality is that YOU know your kitty best, you know what he's likely to tolerate in terms of stress and you know what you're willing to subject him to in terms of invasive procedures that aren't guaranteed to offer any significant benefit to your little man.

I can tell you this, if I was in your situation and we were talking about my cat I would be addressing this issue with my vet, voicing my opinion and asking that the vet not start off with the most invasive techniques to get the urine sample from my cat. If you're uncomfortable with the way things are playing out there's no rule that says you can't take your kitty's healthcare needs elsewhere. I don't agree with your vet when it comes to her contention that the only way to get a useable sample of urine from your kitty is to subject him to a very invasive procedure that I'm sure could prove to be painful, may require the use of sedation or anesthesia and may not add any concrete information that will allow her to make a formal diagnosis (sometimes diagnostic tests don't add any information to the differential, it depends what's going on with your kitty because I'm sure that there are situations when results from a urine test provide the missing piece of the puzzle that allows the vet to make a firm diagnosis and begin treating your kitty.) We're very fortunate to have found our family vet because she has a very calm, gentle way with her furry animal companions and their human caregivers. Our vet has taught me a valuable lesson over the years, sometimes less is more and I have complete faith in her approach because she's proven time and time again that she's extremely good at what she does - sometimes a hands off approach is the most humane thing that a vet can do for a pet and/or his/her human caregiver. Another way your vet could get a good sample without unnecessary pain and anesthesia would be to gently manually express your kitty's bladder into a clean or sterile container. Here are a few websites that deal with collecting urine samples from cats that I thought you might be interested in checking out:

~ http://www.katkor.com/english/indexe.html

~ http://tippedearclan.wordpress.com/tlc/cat-urine-sample/

~ http://www.cat-health-guide.org/cat-urine-health.html

~ http://www.cat-world.com.au/collecting-a-urine-sample-from-a-cat

If you have any further cat related questions or concerns I'd be more than happy to help you out in any way that I can so please don't hesitate to contact me again.