2025 iCatCare Consensus Guidelines on Feline Lower Urinary Tract Diseases: A Must-Read for Veterinarians

These guidelines provide practical information for primary care practitioners to assist in the approach and management of cats presenting with lower urinary tract signs (LUTS). Remember that LUTS such as dysuria, haematuria, periuria, pollakiuria, and stranguria can result from various underlying conditions, necessitating thorough diagnostic investigation. The guidelines emphasize that these presenting signs are often indistinguishable between different underlying causes, creating a diagnostic challenge.

Key areas covered in the 2025 guidelines include:

· Understanding the terminology: The guidelines clarify the evolution of terms like ‘feline urologic syndrome’ and ‘feline lower urinary tract disease’ (FLUTD), emphasizing that ‘FLUTD’ is an umbrella term and not a diagnosis. The guidelines intentionally use the term ‘LUT diseases’ (plural) to encompass the multiple underlying causes of LUTS.

· Diagnostic approach: A structured approach to diagnosis is outlined, including history-taking, physical examination, laboratory testing (particularly urinalysis), and imaging. The importance of cystocentesis for urine sampling is highlighted.

· Feline idiopathic cystitis (FIC): As the most common cause of LUTS, FIC is discussed in detail, including its complex pathogenesis involving systems beyond the urinary tract. The guidelines stress that FIC should be considered a systemic disorder. Diagnosis of FIC remains one of exclusion, taking into account history, clinical signs, risk factors, and the exclusion of other causes. Multimodal environmental modification (MEMo) is emphasized as the standard of practice for managing FIC. The guidelines also address the limitations of the term ‘cystitis’ and suggest that alternative names like ‘bladder pain syndrome’ might be preferred in the future.

· Urolithiasis: This important cause of LUTS and urethral obstruction is thoroughly reviewed, covering investigation and management strategies. The most common types of uroliths (calcium oxalate and struvite) and their changing prevalence are discussed.

· Urinary tract infections (UTIs) and subclinical bacteriuria: The guidelines provide updated information on the prevalence of UTIs in cats, noting that they are uncommon in otherwise healthy adult cats. The management of subclinical bacteriuria is also addressed, with a general recommendation against routine treatment.

· Urethral obstruction (UO): This life-threatening condition, almost exclusively occurring in male cats, receives significant attention. The guidelines cover pathophysiology, triage, diagnosis, and comprehensive management, including stabilization, pain management (prioritized), and techniques for urethral catheterization. The pros and cons of decompressive cystocentesis are summarized. Post-obstructive diuresis and its management are also discussed.

· Other lower urinary tract diseases: The guidelines briefly touch upon other less common causes of LUTS.

· Environmental and behavioral considerations: Recognizing the significant role of stress in LUTD, particularly FIC, the guidelines emphasize the importance of addressing the cat's environment. Caregiver education and communication are highlighted as vital for successful outcomes. Practical advice on litter tray management, secure resting opportunities, water and food resources, and addressing multi-cat tension is provided.

Key Takeaways for Veterinarians:

· LUT signs are not diagnoses. A thorough diagnostic approach is crucial to identify the underlying cause.

· FIC is a complex, systemic condition that requires a multimodal management approach, with MEMo as the cornerstone.

· Pain management is a priority in cats with both non-obstructive LUTD, especially FIC, and urethral obstruction.

· Environmental factors and stress play a significant role in the development and recurrence of LUTD. Addressing these is essential for effective management.

· Effective communication with caregivers is paramount for adherence to recommendations and improved outcomes.

These 2025 iCatCare consensus guidelines offer an invaluable resource for veterinary practitioners managing feline lower urinary tract diseases. By providing a clear diagnostic framework and emphasizing the multifactorial nature of these conditions, particularly FIC, these guidelines aim to improve the care and well-being of affected cats. Veterinarians are strongly encouraged to consult the full guidelines for detailed recommendations and further information. The guidelines also highlight available resources for caregivers to complement veterinary advice.