Second Possible UTI in Less Than Two Weeks, HELP!!

I am really worried. My almost 10 yo neutered male was diagnosed with a UTI about two weeks ago. He was given the Convenia antibiotic injection. While the frequency to the litter box decreased and his urine output increased over the next two-three days he was having urethra spasms for over a week and the medicine given (Prozasin) didn't help.

He had a urine recheck this past and my vet isn't in til Monday but the vet tech said today his results were normal.

Tonight, he began frequently visiting the box again, producing urine but only a very small amount each time. He is not crying when he uses the box. He is frequently licking his private parts. The previous urinalysis used to detect the first UTI showed zero crystals, none at all so unless I don't understand how bladder/kidney stones work I don't think it's that.

He has not had a UTI for years. I am just extremely suspicious that he could now have 2 witching such a short time frame. This past week his urine output has been of normal size so I don't think it's that the original UTI didn't clear up.

His diet hasn't changed. I added an omega 3 supplement for cats about a month ago. He got a new litter box a little over a month ago. I had initially also tried a wheat based litter, but he didn't like it and I suspect that may have been the cause of his first UTI although now I'm not so sure. He was switched back to a clay based litter after the diagnosis of the first UTI which is what he has used his whole life.

So I have a few questions if anyone could please help me. Is it possible this is the same UTI that wasn't fully treated? If it is a separate new UTI, what could be causing it? As far as stress goes nothing in his environment has changed at all and he's been on his same diet (Merrick limited ingredient turkey, he has IBD) for more than a year with no issues. He is drinking water and I will even occasionally add water to his wet food (he gets no dry food). If this is not a UTI, what could it be? Stones even if there are no crystals?

I am hoping to be able to wait until Monday to take him to the regular vet but will of course take him to emergency if I suspect he has become blocked. For now though he is peeing just a very small amount.

Please, any thoughts are appreciated. I am so worried.

Struvite crystals can pop up whenever the urine is alkaline, i.e. above 7.0 pH.  With a wet food diet, that usually will not happen until the pH reaches 7.5 or higher.  When the urine is acidic as it is in cats eating their natural diet of mostly meat, moderate fat, and very low (less than 10%) carbphydrates, the urine produced averages 6.0 to 6.5 pH most of the time, and struvite crystals DISSOLVE in acidic urine.  If he does form crystals, they do not form stones right away but they irritate the bladder and urethra like microscopic pieces of glass and that can cause the frequent urination and straining.

Secondly, there are bacterial infections cats can get in their urine that are NOT sensitive to Convenia.  In fact, Convenia is NOT the first drug of choice for bladder infections, but vets use it because it is very broad spectrum AND "convenient," (thus the name) i.e. the owner does not have to give antibiotics by pill form.  The vet is really supposed to do a urine culture & sensitivity BEFORE treating with an antibiotic.  I do know of one case where the urine was cultured and contained some bacteria that was NOT sensitive to Convenia but WAS sensitive to Clavamox, a much more common drug that only has to be given twice a day.  

You might also check the Merrick receipt to see if it has changed.  Merrick was purchased by Purina in 2015 and although they were supposed to continue on doing exactly what they were doing, it is always possible there was some change, such as adding some of the new fillers like peas, potatoes, sweet potatoes, etc. that might make the carb count higher.  If you want to be on the safe side by keeping up with the urine pH, you can by pH testing strips on eBay very cheaply and test whatever drops he leaves behind on his fur before he washes himself --

If he is getting cystitis again, I would ask your vet to try Clavamox instead of using Convenia again to see if that might work.  It did work for my friend after a culture showed what the organism was.  Good luck, and stay on top of it. 

Thank you so much for responding. The curious part of all of this is his he was fine a few days after the Convenia as far as in and out of the box and urine output. He was normal for over a week until last night. He went in and out of the box about 5 times over the course of about 90 minutes producing only small amounts. Then, he didn't use the box again at all until early afternoon today, and he went normally and produced his normal amount of urine. Would a UTI have symptoms that come and go like this? When the vet calls me tomorrow I will definitely mention the Clavamox. Thank you again!

That sounds more like spasms to me rather than a recurrence of any infection, because that wouldn't come and go, it would come and stay.  If he continues peeing normally, at least most of the time, then probably the Convenia did kill whateverwas causing the infection.  Convenia actually stays in the system for 65 days, and it's advisable to give a probiotic when a cat is treated with it because it tends to kill all the GOOD bacteria in the gut as well and can cause digestive disturbances. They say it acts as an antibiotic for two weeks only, but you do need to replace the good bacteria for longer than that to get their system right again.  You should not repeat a Convenia treatment in less than 65 days from the first one, so if your cat does get a second UTI soon, go with Clavamox unless he has a penicillin allergy.

He did have a lot of trouble with the spasms with the initial UTI. They lasted for nearly 2 weeks. I could tell because there were tiny bits of pee along with the large normal clump. Would spasming still be normal? This seems like an awful long time for the spasms to be continuing. The Prozasin didn't work, and he prescribed the human equivalent of Valium which I elected not to give him as I thought the side effects outweighed the benefits. He gets a probiotic daily to help with his IBD, so I've got that covered. I'm just concerned as to if the urinalysis and blood work all come back normal what could be causing the issue.

Ty3535 said:

I am really worried. My almost 10 yo neutered male was diagnosed with a UTI about two weeks ago. He was given the Convenia antibiotic injection. While the frequency to the litter box decreased and his urine output increased over the next two-three days he was having urethra spasms for over a week and the medicine given (Prozasin) didn't help.

He had a urine recheck this past and my vet isn't in til Monday but the vet tech said today his results were normal.

Tonight, he began frequently visiting the box again, producing urine but only a very small amount each time. He is not crying when he uses the box. He is frequently licking his private parts. The previous urinalysis used to detect the first UTI showed zero crystals, none at all so unless I don't understand how bladder/kidney stones work I don't think it's that.

He has not had a UTI for years. I am just extremely suspicious that he could now have 2 witching such a short time frame. This past week his urine output has been of normal size so I don't think it's that the original UTI didn't clear up.

His diet hasn't changed. I added an omega 3 supplement for cats about a month ago. He got a new litter box a little over a month ago. I had initially also tried a wheat based litter, but he didn't like it and I suspect that may have been the cause of his first UTI although now I'm not so sure. He was switched back to a clay based litter after the diagnosis of the first UTI which is what he has used his whole life.

So I have a few questions if anyone could please help me. Is it possible this is the same UTI that wasn't fully treated? If it is a separate new UTI, what could be causing it? As far as stress goes nothing in his environment has changed at all and he's been on his same diet (Merrick limited ingredient turkey, he has IBD) for more than a year with no issues. He is drinking water and I will even occasionally add water to his wet food (he gets no dry food). If this is not a UTI, what could it be? Stones even if there are no crystals?

I am hoping to be able to wait until Monday to take him to the regular vet but will of course take him to emergency if I suspect he has become blocked. For now though he is peeing just a very small amount.

Please, any thoughts are appreciated. I am so worried.

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I am a human doctor, not a vet and any advice that I give about cats should be checked by a vet.  Having written this, I have to say that urinary tract infections arise from somewhere in the urinary tract, and nowhere else.  That is the infection involves the kidney, the two ureters (the tubes connecting the kidneys to the bladder), the bladder and the urethra (the tube coming out of the bladder to the penis in males, or to the exterior in females). 

You wrote:  "... I had initially also tried a wheat based litter, but he didn't like it and I suspect that may have been the cause of his first UTI although now I'm not so sure. He was switched back to a clay based litter after the diagnosis of the first UTI which is what he has used his whole life. "

No, there is no way, in my opinion, that cat litter can contribute to a urinary tract infection. 

Cat urinary tract infections are different from human UTIs, they are often associated with an actual stone or crystal formation and are frequently associated with being fed dry food.  They are called UTI, but there may not be any true bacterial infection, (although viral infections do occur).   I do not practice feline medicine and you should ask your veterinarian if you want to know more about this illness in cats.

To try and answer your other questions:  

Recurrent episodes of UTIs are not uncommon and the first episode always be followed by others, as could be happening here.  On the other hand he maybe having urinary crystals, with irritation of the bladder neck or penis causing his spasms.  See below in my last paragraph.   I doubt, however, that the original infection has persisted until now and I am sure that the first episode was correctly treated.  I understand that stress can contribute to episodes in cats - but this does not mean that all episodes have to be associated with stress.

Yes, it is likely that your cat is suffering from crystals in the urine, even though they cannot be seen in the urine test.   Something is causing irritation of the bladder neck and urethra, but it is unlikely to be an urinary infection as the test was reported clear for bacterial infection.   It is also possible that he is in danger of having a bladder neck or urethral blockage and I think that you are very  wise to have arranged to see your vet as soon as possible.

With all best wishes,

Geoffrey