Running out of ideas on what Dio might have

My buddy Dio, rescued neutered american shorthair of about 5 -6years old has been having UTI problems about 3 years ago. His symptoms start with feeling that he has to   go pee often, go everywhere but only releasing a few drops of urine (for some reason when this happens he goes everywhere, not just litter box) after a while he would start releasing blood out of his anus.   His favorite spots are the bathtub and the sink, although I do find myself buying new bed sheets and pillow covers pretty often.

 I saw the vet when this all started, and at first he said it might be that he wasn't drinking enough water, so he would give him fluid via injections  and the symptoms would wear off after 2 or 3 days.  But after like a month the problem would come back (he drinks water normally like any other cat). After the 4th or 5th visit to that vet (and several clinic stays so that they could check up on him) he referred me to a specialist cat surgeon, who suggested the problem might be that his penis was smaller than normal so when he pees, the penis is not able to come out all the way so some urine ends up inside of him and that was causing him to get the infections...  I ended up spending the 4k to basically remove his penis and open up his urethra so that he wouldn't get infected. 

He didn't get better at all. UTI's kept coming back.  The problem persisted even after the surgery. He just seems to get it once a month for a few days and then it wears off. I read online that giving him Apple Cider Vinegar helps with the problem, so I started giving him ACV whenever the symptoms started to appear. He hates it, he doesn't go anywhere near anything that smells like ACV ha, so my solution was to mix it up with some water in a syringe and forcing him to drink it. Most of the times he ends up vomiting it, but the symptoms tend to get better and  I feel like he calms down like 30 to 40 minutes after I give him the acv.

So to make long story short, this has been going for like 3 or 4 years. He starts feeling the need to urinate frequently although most of the times it is just a few drops (Yes, I find myself buying new bed sheets and pillow covers pretty often), and then some times those symptoms are accompanied by blood coming out of his anus.  Vet's don't seem to be able to figure out what is wrong with him either.

I also bought UroMAXX Urinary Tract, Kidney & Bladder Formula for Cats because of the reviews it had... but I have been giving it to him for 3 weeks and I am not sure it is doing anything. 

Anybody has had a similar case? I don't know what else to do, vets don't seem to be able to figure out what is wrong with him.

Thanks a lot! 

Is the vet actually finding bacteria in the urine or is it just the symptoms that go with a UTI.  There is a condition called Feline Idiopathic Cystitis http://bluepearlvet.com/feline-idiopathic-cystitis-fic/     They aren't certain or the cause.  It's basically a diagnosis of exclusion and they don't know the cause.   It is thought to at least be aggravated by stress.  Have you tried various things to relieve stress like the Feliway diffusers and regular play sessions  Sometimes kitties are put on a medication called amitriptyline or have a surgery where they scrape the lining of the bladder, those are last resorts though.

Thanks for the reply Denice! They rarely found anything on his urine... so he never had to take any antibiotics, except after surgery. I am thinking it was mostly symptoms and that is why they couldn't figure out his problem. Although they do make me buy him the royal cannin urinary tract special food.

I don't know what the feliway diffusers are, I have never tried them. I live on a 1,000 sq ft apt along with him and his brother Napoleon (hemmingway about his age)...   given that I don't know what else to try, maybe I should buy a couple diffuseness and see if that helps?

Here is their website http://www.feliway.com/us/Feliway/Feliway-Diffuser   You can find them at pet stores as well as online, I am sure Amazon carries them as well as the pet supply websites.  They are a bit on the pricey side.  To cover a 1000 sq ft you would probably need two, one on each end of your home.  They mimick the pheromones  that the glands on the sides of their face produce.  They give a feeling of security, that is why kitties often 'mark' things and us by rubbing with the side of their face.

Thanks a lot! I will give it a try, I read it takes 7 or 8 days for it to have an effect so I will let you know.

I usually leave the balcony window opened as they like to go out and lay in balcony by the sun... it will still be ok with the diffusers right? 

I had exactly the same problems with my boy Bonaparte a few years ago, when he was peeing blood all over the floor, but it took no time at all to diagnose him with a blockage in his urethra, which was removed at first with flushing out his system under anaesthetic, and then antibiotics to cure any infection. The problem did recur and this time they discovered with ultrasound that the problem went right back to his bladder, which had a build-up of calcium stones in it. Once again he had surgery, and recovered well. 5 years on, he is still fine, but has to have a urinary food that dissolves the stones (I use Royal Canin but there are several) and I keep him on a low-calcium mineral water.

However, there are many forms of urinary blockage and the most usual one is crystal formation. Crystals too can be of different types, and the treatment is different. Are you sure your vet did not test him for crystals before doing radical surgery of penis removal? That is usually the last resort if crystal dissolution by medical means does not work.

I would ask the vet (maybe a different one?) to do ultra-sound or Xray to see if there are crystals or gravel in the bladder or the urethra and then consider the type and the treatment. To go straight to surgery seems extra-ordinary.

They did look for crystals but he didn't have any.

With his having had the PU surgery for anatomical reasons, long running history and persistent clean urine samples I really think this is Feline Idiopathic Cystitis.

thanks a lot! I have been reading online about Feline Idiopathic Cystitis. Apparently it mostly shows on cats who use an indoor litter box exclusively, are fed a dry food diet, don’t get adequate exercise, are overweight, and who are stressed by their environment.. Dio is not overweight but the rest may apply.

Since I have already tried everything else, I am going to try with the feliway pheromones, adding an extra litter box (I have 2 kitties and 2 litter boxes in my 1,000 sq ft apt), and switching them to wet food. Seeing that the royal canin food is not really making any difference, I may just try giving them regular good quality wet food. Any brand you guys can recommend? maybe there is one that helps with stress levels?