To cystoscopy or not to cystoscopy

This might be a long post, but I'll give the whole story. Skip to the 2nd paragragh if you don't want the background.

It all started about a week before Thanksgiving. Polly had peed outside the litterbox. At the time, I didn't know who had done it. Then a couple days later, I caught her in the act. It was a Sunday, so I took her to the emergency clinic. They were unable to get a urine sample, so they gave her amoxil drops. A few days after the antibiotics were finished, I took a urine sample to my regular vet. There were crystals in her urine and the pH was high (9.0) She put Polly on Hill's prescription diet s/d and on clavamox. They also took a sterile culture to send for bacteria testing. There were no bacteria. After Polly had been on s/d for about 3 weeks, we did another urine sample. The crystals were gone, but there was blood in her urine. She got x-rays. She went to the vet school at a local University. She had bloodwork, another urine sample, and an ultrasound done. Nothing on the bloodwork, nothing on the ultrasound, and blood in the urine.

My vet thinks that Polly likely has idiopathic cystitis, however, the only way to diagnose it for sure is to do a biopsy. Before that however, they would do a cystoscopy to check for anything that didn't show up on ultrasound or x-ray.

So now, I'm trying to decide whether or not to do the cystoscopy. The options are 1) go ahead and have the cystoscopy ($1200-$1500) and 2) treat her for cystitis and if she doesn't seem to respond, then do the cystoscopy later.

Right now, I'm leaning toward 2. I don't mind spending the money, but in order to diagnose her with cystitis, she'd have to have 2 surgeries, the cystoscopy and then a biopsy later. The biopsy would be an open surgery, so there'd be recovery time like any other open surgery. I'm not sure that putting her through a minimum of two surgeries is the best thing for Polly. Also, the vet resident that saw Polly doesn't think that any non-cystitis problem (if she doesn't have cystitis) would be masked by the cystitis treatment. That was one of my concerns.

I know no one can make this decision for me, but I thought maybe you guys could give me some opinions to chew on or things I haven't thought of to think about.

Heh minus the crystals it sounds almost exactly like what I went through a couple years ago (me not the cat). Cystitis should be treatable with antibiotics but some strains are resistant to certain antibiotics. My aunt went through this with her male kitten who had crystals. After surgery he was tested and still had a UTI but no crystals. It took a while and more antibiotics for it to completely go away.

From the human experience I had with cystitis, though I don't know if this transfers to cats: It was a matter of switching from Cipro to a penecillin based antibiotic. The particular strain was resistant to everything else. It took a year of awful pain for them to make that diagnosis. Also, none of their tests showed I had an infection but I did. So I have my doubts on reliability. If some strains dont' show for humans then I'm sure there are some that don't show for cats.

So maybe there is an alternative antibiotic? Clavamox is certainly the drug of choice... I have no idea other than to continue treatment. I sort of don't think the cystoscopy is necessary unless you think he is in an horrible pain and there is nothing else that will make a diagnosis.

I guess you can think about - what will the cystoscopy prove? What course of action would be taken afterwards? Can that course of action be taken safely without difinitive diagnosis? In other words...is it necessary..

EDIT: Do you think when you took her in for tests that she had been holding her urine for a while? I'm just curious because when I first brought my girl Autumn home we were in a car accident and she had to wait in the car for 2 hours while we sorted it out. When we got home I barely put the litter box down and without any litter she jumped in and peed, full of blood. I was alarmed and brought her to the vet the next day. They said like dogs, when they hold their urine, they will have blood in it. I don't think this is the case here but I thought I'd throw that out as well.

Well, her urine was checked 3 different times and had blood in it each time.

My impression of cysitis is that it is chronic. Polly will be on medication and special diet for the rest of her life (if, indeed, she has cystitis).

The cystoscopy might catch anatomic abnormalities or masses or polyps that didn't show up on ultrasound or x-ray. The cystoscopy could see (but not usually) changes in the bladder wall consistent with cystitis. I think they chances are pretty slim that the cystoscopy will find anything. I think it is pretty likely that Polly has cystitis.

If the cystoscopy finds nothing (which seems likely) then the next step would be a biopsy. That would be an open surgery.

At this point, if she fails to respond to standard cystitis treatments, then we would know that we need to look for something else. It's always an option to have a cystoscopy done later.

Right now, Polly is doing great, acting totally normal and never missing her box. She was also examined completely and found to be totally healthy. Since she's healthy and doing well, that is why I say I'm not sure if I want to put her through the cystoscopy right now.

As far as whether it's necessary, of course I would prefer a definitive diagnosis, but I also don't want to put Polly through a lot to get it. If she responds to treatments for cystitis, then that would give us a pretty good (but not completely, totally definitive) idea that cystitis is the correct diagnosis.

Anybody else have any ideas, or experience with cystitis?

Idiopathic cystitis is bladder inflammation from an unknown cause. The cytoscopy would rule out any potential cause. Honestly, I wonder if having the crystals in the first place could have caused the inflammation. Since the urine was sterile, antibiotics may not help much. Has your vet given you any pain relief meds? Cystitis can be painful, which is usually why the pee outside the litterbox in the first place.

I think that the only reason to do the cytoscopy would be to rule out the presence of any small stones or growths that didn't show up on the x-ray or ultrasound. Stones that are small enough may pass on their own.

If it were my cat, I would treat the cystitis. In addition to anything your vet recommends, reduce the stress in your kitty's life, as stress often causes cystitis. I would not put her through the trauma of the cytoscopy unless she continues to get worse. My cat was diagonosed with cystitis last year after I brought home another cat and finally realized that she was peeing outside the litterbox on purpose. She didn't have any crystals, just some blood in the urine. We tried antibiotics but only did one round since the urine culture came back as sterile. We ended up putting her on amitryptiline (sp?), which is an antidepressant that acts as an anti-inflammatory for the bladder as well. After a few months, I weaned her off of it very slowly, and she is fine now (though still jealous of my other kitty).


Just to add, it can be chronic and it can reoccur. I think that Willow's cystitis was a result of adding a new cat and therefore more stress to the household. The vet visits after her initial diagnosis didn't help, though they were necessary. I think that stress reduction is key to helping the symptoms of cystitis disappear.

Thank you cloud shade. It sounds like your thinking is pretty similar to mine. Polly hasn't been given any pain meds, but my vet doesn't think she's in any discomfort after examining her thoroughly. It could get painful if left untreated, but she says we will have it taken care of before it gets to that point. I'm giving her lots of hugs and kisses.

I know cats are good at hiding pain, but she's been acting her normal, very active self. She also hasn't missed her box since the initial week.

So Willow is not on any more medication? Does she eat a special diet? My vet says Polly will probably stay on prescription diet for life.

My vet is on vacation this week, but when she gets back, I will try whatever medication she suggests trying first. She says the prescription diet is already helping (though not completely) because the crystals in her urine are gone. I think it's better to wait a week to start medicine anyway because I'm switching her from Hill's prescription s/d to c/d this week. One change at a time is probably better.

I just needed a little reassurance that I'm doing the right thing, and being a good kitty mommy.

Willow is not on any medications at all. She doesn't eat a special food, but she didn't have crystals either. My boyfriend's cat developed a blockage from crystals, so he is on a special diet for life.

My male foster has cystitis (one vet said crystals, but my vet said that is an old way of thinking), and the vets advice was wet food only, increase his fluid intake, and try and make things stress free (she did think he didnt like being in a multi cat household, but he sleeps on a bed with up to 4 other cats, and has been found cleaning the latest foster on a few occasions - however he is a scaredy cat and hides under the duvet when people come, I can't quite stop that!!)

I decided not to do the cystoscopy. The vet says to feed her as much wet food as she'll eat (c/d wet). I fed some to her this evening and she loved it. She also said Polly should drink a lot. I told her we already have a fountain. She is putting Polly on cosequin and amy-something or other....I can't remember the name right now. In a month, we'll do another urine sample to see how things are going.

The vet said that she thinks I'm making the right decision, and that she would do the same if Polly were her cat.

Booktigger, Polly had crystals in her urine before she started on prescription diet. The prescription diet got rid of the crystals, but she still had blood in her urine.