In cats with feline idiopathic cystitis (FIC) is environmental modification superior than medical management in preventing reoccurrence?
Clinical bottom line
Category of research question
The number and type of study designs reviewed
16 papers were critically reviewed; 14 randomised trials and two case studies
Strength of evidence
Critical appraisal of the selected papers meeting the inclusion criteria collectively provide weak evidence in terms of their experimental design and implementation
There is weak evidence that any medication or environmental modification is successful in reducing the reoccurrence of FIC when compared to a placebo. Short-term use of amitriptyline can contribute to an increase in occurrence of FIC
In view of the strength of evidence and the outcomes from the studies the following conclusion is made; in cats with feline idiopathic cystitis there is weak evidence that environmental modification or medication are effective at preventing reoccurrence. Further research is required into the cause of FIC before comparisons on treatment options can be made, however, with the exception of short-term use of amitriptyline, environmental modification and systemic treatment of clinical signs did not contribute to an increase in occurrence of FIC
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
Bradley, A.M. & Lappin, M.R. (2013). Intravesical glycosaminoglycans for obstructive feline idiopathic cystitis: A pilot study. Journal of Feline Medicine and Surgery. 16(6): 504–6. DOI: https://doi.org/10.1177/1098612X13510918
Buffington, C.T., Westropp, J.L., Chew. D.J. & Bolus, R.R. (2006). Clinical Evaluation of Multimodal Environmental Modification (MEMO) in the management of cats with idiopathic cystitis. Journal of Feline Medicine and Surgery. 8(4): 261–8. DOI:https://doi.org/10.1016/j.jfms.2006.02.002
Chew, D.J., Buffington, C.A., Kendall, M.S., DiBartola, S.P. & Woodworth, B.E. (1998). Amitriptyline treatment for severe recurrent idiopathic cystitis in cats. Journal of the American Veterinary Medical Association. 213(9): 1282–6.
Delille, M., Fröhlich, L., Muller, R.S., Hartmann, K. & Dorsch, R. (2016). Efficacy of intravesical pentosan polysulphate Sodium in Cats With Obstructive Feline Idiopathic Cystitis. Journal of Feline Medicine and Surgery. 18(6): 492–500. DOI: https://doi.org/10.1177/1098612X15588934
Dorsch, R., Zellner, F., Schulz, B., Sauter-Louis, C. & Hartmann, K. (2016). Evaluation of Meloxicam for the Treatment of Obstructive Feline Idiopathic Cystitis. Journal of Feline and Medicine and Surgery. 18(11): 925–933. DOI: https://doi.org/10.1177/1098612X15621603
Gunn-Moore, D.A. & Shenoy, C.M. (2004). Oral Glucosamine and the Management of Feline Idiopathic Cystitis. Journal of Feline and Medicine and Surgery. 6(4): 219–25. DOI: https://doi.org/10.1016/j.jfms.2003.09.007
Gunn-Moore, D.A. & Cameron, M.E. (2004). A Pilot Study Using Synthetic Feline Facial Pheromone for the Management of Feline Idiopathic Cystitis. Journal of Feline and Medicine and Surgery. 6(3): 133–8. DOI: https://doi.org/10.1016/j.jfms.2004.01.006
Kraijer, M., Fink-Gremmels, J. & Nickel, R.F. (2003). The Short-Term Clinical Efficacy of Amitriptyline in the Management of Idiopathic Feline Lower Urinary Tract Disease: A Controlled Clinical Study. Journal of Feline and Medicine and Surgery. 5(3): 191–6. DOI: https://doi.org/10.1016/S1098-612X(03)00004-4
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Osbourne, C.A., Kruger, J. M., Lulich, J.P., Johnston, G.R., Polzin, D.J., Ulrich, L.K. & Sanna, J. (1996). Prednisolone therapy of idiopathic feline lower urinary tract disease: A double-blind clinical study. The Veterinary Clinics of North America Small Animal Practice. 26(3): 563–9. DOI: https://doi.org/10.1016/S0195-5616(96)50085-9
Reineke, E.L., Thomas, E.K., Syring, R.S., Savini, J. & Drobatz, K.J. (2017). The effect of prazosin on outcome in feline urethral obstruction. Journal of Veterinary Emergency and Critical Care. 27(4): 387-96. DOI: https://doi.org/10.1111/vec.12611
Seawright, A., Casey, R., Kiddie, J., Murray, J., Gruffydd-Jones, T., Harvey, A., Hibbert, A. & Owen, L. (2008). A case of recurrent feline idiopathic cystitis: The control of clinical signs with behaviour therapy. Journal of Veterinary Behaviour. 3(1): 32–38. DOI: https://doi.org/10.1016/j.jveb.2007.09.008
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Wallius, B.M. & Tidholm, A.E. (2009). Use of Pentosan Polysulphate in Cats With Idiopathic, Non-Obstructive Lower Urinary Tract Disease: A Double-Blind, Randomised, Placebo-Controlled Trial. Journal of Feline Medicine and Surgery. 11(6): 409–12. DOI: https://doi.org/10.1016/j.jfms.2008.09.003
Zezza, L., Reusch, C.E. & Gerber, B. (2012). Intravesical Application of Lidocaine and Sodium Bicarbonate in the Treatment of Obstructive Idiopathic Lower Urinary Tract Disease in Cats. Journal of Veterinary Internal Medicine. 26(3): 526–31. DOI: https://doi.org/10.1111/j.1939-1676.2012.00911.x
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