Stuck with incomplete diagnosis for a cat (struvites confirmed, infection cannot be confirmed). What are my options?

Question

The full ranty version of this is on reddit, if you want a very detailed explanation.

So, I have 5 cats, and 1 of them started peeing bloody urine. I contacted a vet and brought in the cat for ultrasound and the urine sample for urinalysis.

Relevant parts of the urinalysis:

• pH: 8.0
• Blood: trace ("trace", my butt. It was intense dark pink!)
• Leukocytes: up to 13 in the area
• red blood cells: up to 39 in the area
• Crystals: tripelphosphates units/singular
• Microflora: (nothing)

The ultrasound results I didn't get. Initially the ultrasound specialist gave me a printout but my vet practically tore it out of my hands before I could read it properly and later only sent a small screenshot with numbers: "Dist. 0.77 cm, Dist. 0.64 cm, Dist. 0.47 cm" and told me those were urolith sizes. Overall, the vet refused to explain anything to me and didn't answer my questions, just gave me a prescription including 6 weeks (!) of antibiotics. When I asked whether we needed urine culture first, the vet got passive-aggressive. Long story short, the only 2 labs in the city that do cat urine culture at all, the vet badmouthed a lot. The vet admitted, that she can't be sure, whether there's infection at all or not, but she still pushes the antibiotics, refuses to answer questions, and acts passive-aggressive. As a preemptive answer, no, I can not go to another vet. At least this one is just stubborn, not actively trying to get as much money out of me as humanly possible. The few good vets here are so rare and far between that I have basically no chances to just stumble upon them, and I have no one to ask for help.

The cat is currently near the end of a NSAID+flat muscle relaxant+antibiotic 2 week course (I only agreed to 2 weeks of antibiotics to put the vet in a more agreeable mood but it backfired because she "smelled blood in the water" and started pushing for 6 weeks again without letting me check or answering my questions).

So I guess my question is, what are my options? I really don't want to subject my cat, who's feeling overall fine btw, to 6 weeks of antibiotics without knowing whether there's an infection at all. Especially since the struvites won't just magically dissolve from the antibiotics. What would happen if I just... do nothing? How high are the chances that my cat would eventually bleed out or we get some other serious complications? And if I find a vet surgeon I could more or less trust, what's the worst that could happen if my cat goes into surgery and she does indeed have an infection along with the stones?

I suspect this post will probably gut all of my remaining karma here, but I'm just that desperate at this point. I've lost a cat to lack of resources once, I'm not sure my mental health will survive another one.

Edit: The country is Kazakhstan. And there are no legal regulations whatsoever about what vets can or cannot do.

Answer 1

Struvite uroliths are often sterile (not bacterial) in cats. This differs from dogs, where infection is more often the source of the problem. Any pet with stones may however be prone to secondary to infection, as the stones can serve as a nidus of infection.

Based on the alkaline (high) urine pH and struvite crystals seen on the urinalysis, there is a high chance any stones are also struvite. The other common form of urolith in cats is calcium oxalate, but these tend to form in acidic urine (low pH). I have occasionally removed stones that contained both struvite and oxalate components, but these cats generally seem to have a more neutral urine pH.

Large stones may require surgical removal. This may allow the quickest resolution as other options may take much much longer to resolve. I would consider a 7mm stone quite sizeable for a cat. The penile urethra in the male narrows to 1-2 mm, and in a female the urethra is approximately 3-5mm throughout; therefore they would be unlikely to be able to pass a stone of this size in either case.

Male cats are prone to urethral obstruction, which could develop in a life-threatening emergency if a stone passed into the urethra. He would then be unable to urinate. Therefore especially in a male cat we may be more inclined to go to surgery. Urethral obstruction while not impossible in a female cat is quite uncommon in comparison.

Struvite stones may be amenable to dissolution. Calcium oxalates will not. Dissolution is largely accomplished through diet, and possibly urinary acidifiers (methionine). A urinary diet (usually prescription) will be most effective, but there may be other options. In generally we are looking for a diet that is low in magnesium (and phosphorus), as this is what drives struvite stone formation. Canned food is generally better than dry, due to the high moisture content. Diet change can be effective but may take weeks to months (and those cases need to be kept on pain medication for a longer time).

Answer 2

Your current vet sounds very difficult; you have my sympathy.

I really don't want to subject my cat, who's feeling overall fine btw...

If your cat has hematuria from stones (as opposed to a bleeding tumor/other), it's pretty much a given that she does not feel fine. Hematuria occurs when there's bladder wall irritation, and the more irritation there is, the more blood there is, so "gross hematuria" (visible to the naked eye) is very uncomfortable for humans, and as cats are mammals like us, it's fairly reasonable to assume they are in pain, as we would be under those circumstances. Leucocytes (white blood cells, or WBCs) confirm the presence of irritation, as opposed to other causes of hematuria.

I'm not a vet, and can only guess what she was thinking about the antibiotics. They may have been prescribed to prevent infection rather than treat it. The lack of communication is just awful. Although the stones were made by her, they aren't supposed to be there; their presence increases the risk of infection as the epithelial lining of her bladder is 'wounded' and easier for bacteria to set up shop there, so to speak.

Aside from the great comments above, water, copious amounts of water, will help. If nothing else, it flushes out any possible bacteria, and it does help with the inflammation (dilute urine is less painful to irritated bladder epethelium than concentrated urine.) Getting a cat to drink more water isn't easy, so anything that helps to tempt her to drink (sometimes "running water" is preferred, from the faucet or a fountain) is always good with kidney and bladder stones.