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Plugged cat!  Urethral obstruction! Urethral calculus!  FLUTD... these words spoken at any animal hospital indicate an emergency feline bladder problem is on the way.  FLUTD is a general term that refers to Feline Lower Urinary Tract Disease.  Any time a cat seems to strain to urinate it should be considered a potential emergency.  As you can see in the diagram below the urethral diameter, as it leaves the bladder and continues toward the end of the cat's penis, becomes smaller and less distensible.  This means any hard concretion, such as tiny bladderstones or an accumulation of crystals, mucous and fibrin, has the potential to obstruct the urethra and block passage of urine.  In some cases of feline urethral obstruction there will be a partial blockage; and the greatly increased pressure in the bladder will force urine to the outside.  It won't be long, though, and the urethral obstruction will be complete... and the cat has about 36 hours to live if unassisted by a veterinarian.

Any  time a cat misses the litterbox and begins to urinate in other places around the house, a bladder infection should be suspected and the urine should be examined.  Pain or discomfort in the cat's bladder when it urinates is perceived by the cat as the fault of the litterbox!  The cat thinks the pain is coming from the litterbox and seeks out a more safe and secure area in which to eliminate such as the owner's bed, a laundry basket, behind or on couches, in a tub or sink, or in dark corners of closets.  Bladder infections provide a perfect environment in the cat's bladder for magnesium ammonium phosphate ions in solution to begin to form crystals. These microscopic crystals attach to each other or bacterial organisms and begin to precipitate into larger concretions.  If the crystals stay small enough, they will pass out in the urine. If they continue to grow they will form bladder stones or even the more rare occurrence of kidney stones.  Bladderstones irritate the lining of the bladder and provide an excellent breeding ground for bacteria.  In female cats, the urethra leading from the bladder to the outside world is relatively distensible, shorter, and of larger diameter than the urethra of the male cat.  Therefore female cats rarely become obstructed.  Male cats, neutered or unneutered, have a relatively long and quite narrow urethral diameter; the male cat is highly prone to struvite (magnesium ammonium phosphate) material congesting and obstructing the distal end of the urethra.  This is often called FLUTD...Feline Lower Urinary Tract Disease. Research has proven that neutering tom cats has no influence on subsequent urethral blockage.  Take a look at a case of bladderstones in a cat and a very distended, obstructed bladder on this page.  Or click on the image here...

Every veterinarian has been presented with the challenge of treating an obstructed cat.  These patients are presented in various states of distress and pain as well as in different stages of criticality.  The earlier the obstructed cat is presented the better they tolerate the anesthetic needed to insert a catheter to empty the bladder and relieve the pressure.  If a cat has been obstructed for 24 hours, there is high potential for kidney damage... and the longer the obstruction goes on the worse effects on kidney tissue.  Death is inevitable if the cat is not relieved of the obstruction

The veterinarian on some occasions will pass a needle through the abdominal wall, called a cystocentesis procedure, and aspirate urine from the bladder to alleviate the internal bladder pressure.  Once some urine is removed, the patient is administered gas (inhalent) anesthesia so that the  penis can be grasped, the urethra extended, and the distal end of the urethra in the penis catheterized.  This can be very difficult to do if the plug is very hard or tightly impacted in the end of the penis.  On occasion, back flushing with a sterile solution is required in order to clear the calculus (plug) and to allow insertion the catheter.

CATHETERIZING THE MALE CAT'S BLADDER (Click on an image to see a full view)
The anesthetized cat is prepared for catheterization	The penis is grasped and the catheter is introduced	Urine is seen dripping from the end of the catheter	A syringe is used to extract urine from the bladder
The immediate pressure problem is eliminated and the bladder resumes a normal size	The catheter is removed to allow flushing of all obstructing material	A special catheter is sutured in place for 3 to 4 days	X-ray of a mildly distended feline bladder... a severely distended bladder could be twice this size!

DIET AND URETHRAL BLOCKAGE

Veterinarians today have the advantage of suggesting a number of good, proven diets that will greatly decrease the probability of urethral blockage in cats.  Twenty-five years ago, when veterinarians didn't have knowledge of the nutritional component of this disorder, many cats would suffer from repeated episodes of urethral blockage.  Some cats eventually required surgery to remove the penis and widen the urethra so that when the crystalline plugs did reoccur they would be less likely to obstruct the cat.  This surgery, called a PERINEAL URETHROSTOMY, is still performed for difficult-to-control cases, but fortunately much less often than a few years ago.  

Dietary management of feline urethral blockage and FLUTD is highly effective.  A number of pet food companies produce these low magnesium diets so that the consumer and the cat have choices of types and flavors of food.  The low magnesium diets prevent concentrations of the magnesium ion in the urinary tract from reaching levels that predispose to magnesium ammonium phosphate crystal formation.  There are other types of crystals that can form, though, and sometimes these unusual crystals can cause trouble.  The large majority of urinary tract crystals, though, can be prevented with modern, low magnesium diets.

OTHER FACTORS

Bacteria...
Any cat that has experienced urethral blockage should have urine samples checked periodically.  In some cases of obstruction there is a bacterial infection going on at the same time so keeping the urinary tract free of any infection will be helpful.  

Water Intake...
Cats are not prolific water drinkers, possibly due to their ancestral origins as desert animals.  In normal cats is isn't unlikely to see urine concentrations twice as high as a dog's.  With the low water intake there is slow turnover of urine through the bladder... in other words, the cat's bladder doesn't get flushed with new urine very often.  Once an infection is present, slow turnover of urine and prolonged retention of urine in the bladder allow for rapid growth of bacteria.  Plus, if conditions are right for crystal formation, slow flushing of the bladder will predispose the cat to accumulations of struvite or other crystals and obstruction or bladder stones often occur.

Environment or stress...
When cats are taken out of their accustomed environment and find themselves in situations that are stressful due to loss of privacy or because of interaction with potentially adversarial animals (read that as a "new dog in the family"), they often stop drinking and use the litterbox less.  Long retention of highly concentrated urine invites infection and crystal formation and can cause FLUTD.  Switching to new kitty litter can be upsetting to a cat.  Remodeling a home or moving to a new home often stresses a cat and can lead to urinary tract difficulties and behavior changes in the cat's elimination patterns.

Weather...
In northern latitudes of the USA many veterinarians have observed an unexplainable but consistent pattern.  During winter months, it seems that there is an increase in urethral blockages in male cats immediately after a severe, dry, cold wave.  A sharp temperature drop to extremely cold, clear weather often foretells of an emergency call or two that goes something like "Doctor, my cat is sitting in the litterbox, digging frantically, and yelling as if in pain".