1. 1 FELINE UR S T /O X URINARY FLUTD management – proven diet efficacy in general practice (clinical case studies)

2. 2 FELINE UR S T /O X Urinary Dissolution of struvite uroliths Reduction of struvite urolith recurrence Reduction of oxalate urolith recurrence Idiopathic cystitis INDICATIONS A clinical diet for the management of Feline Lower Urinary Tract Disease (FLUTD)

3. 3 FELINE UR S T /O X Urinary – Key Benefits PROMOTES THE PRODUCTION OF URINE UNDER-SATURATED for struvite and METASTABLE for calcium oxalate (S T /O X urinary security) PRODUCES A URINE COMPOSITION to promote DISSOLUTION of struvite uroliths MODERATE LEVELS OF FAT AND CALORIES to help maintain ideal body weight (obesity being a risk factor for FLUTD)

4. 4 FELINE UR S T /O X Urinary HORUS 9 years old GANESH 4 years old CANDY 4 years old FLORY 4 years old GARY 4 years old CHIPIE 6 years old SAMMY 2 years old BIBOUILLE 7 years old BALOO 2 years old BALZAC 5 years old STICK 2 years old PAYOU 1 year old PROVEN EFFICACY IN CLINICAL PRACTICE Diet used for successful management Diagnosis Idiopathic/ Haemorrhagic cystitis Struvite crystals and/or stones Calcium oxalate crystals (or stones after surgical removal) Dry and WetDry onlyWet only

5. 5 FELINE Idiopatic Cystitis Feline UR S T /O X Urinary beneficial for cats with idiopathic or haemorrhagic cystitis

6. 6 FELINE UR S T /O X Urinary Helps to promote effective urine dilution reducing concentrations of minerals and irritants in the urine Wet and dry diets both formulated to increase water intake Helps reduce inflammation Source of omega-3 fatty acids Moderate levels of fat and calories to help maintain ideal body weight (obesity being a risk factor for FLUTD) Ensures cat’s enjoyment, thus long-term patient acceptance and client compliance highly palatable formulas in multiple varieties Helps support the bladder mucosal barrier Natural source of glycosaminoglycans

7. 7 CASE STUDY 1: PATIENT: HORUS 9 years old MN DSH cat, living in a flat Ultrasound images of Horus’s bladder Photos and case courtesy of Dr Christelle Maurey, Lecturer, Department of Medicine, Alfort National School f Veterinary Medicine, Maisons- Alfort, France HISTORY: 3 episodes of lower urinary tract disease, 2 of which resulted in obstruction requiring urethral catheterisation (most recently 2 weeks before consultation) Cat previously treated with fluoxetine (Reconcile™) for anxiety but the treatment has been stopped Cat being fed Royal Canin Urinary S/O™ dry formula ad libitum and wet maintenance food morning and evening CLINICAL EXAMINATION: NAD TESTS: Haematology and biochemistry - NAD Urinalysis - SG 1.045, microscopic haematuria. Sediment positive for struvite crystals. Culture negative Radiology - NAD Ultrasound - Moderate quantity of echogenic material in the bladder compatible with cellular debris or crystals DIAGNOSIS: Idiopathic Cystitis Idiopatic cystitis in a neutered male cat

8. 8 CASE STUDY 1: PATIENT: HORUS 9 years old MN DSH cat, living in a flat Ultrasound images of Horus’s bladder Photos and case courtesy of Dr Christelle Maurey, Lecturer, Department of Medicine, Alfort National School f Veterinary Medicine, Maisons- Alfort, France HISTORY: 3 episodes of lower urinary tract disease, 2 of which resulted in obstruction requiring urethral catheterisation (most recently 2 weeks before consultation) Cat previously treated with fluoxetine (Reconcile™) for anxiety but the treatment has been stopped Cat being fed Royal Canin Urinary S/O™ dry formula ad libitum and wet maintenance food morning and evening CLINICAL EXAMINATION: NAD TESTS: Haematology and biochemistry - NAD Urinalysis - SG 1.045, microscopic haematuria. Sediment positive for struvite crystals. Culture negative Radiology - NAD Ultrasound - Moderate quantity of echogenic material in the bladder compatible with cellular debris or crystals DIAGNOSIS: Idiopathic Cystitis MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary wet (one can/ day) and dry food (ad libitum) Well accepted FOLLOW UP: At 1 month follow up, no further urinary problems were reported. Ultrasound unchanged from pre treatment (echogenic material still present in the bladder) At 4 month follow up, ultrasound examination revealed echogenic material almost disappeared Ultrasound scan of Horus after 4 months Idiopatic cystitis in a neutered male cat

9. 9 CASE STUDY 2: PATIENT: GANESH 4 year old FN DSH cat, living in apartment Ultrasound images of Ganesh’s bladder Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: 1 month history of urinating in the bath with frequent traces of blood Fed grocery dry food CLINICAL EXAMINATION: No abnormalities detected Owners asked to change diet to wet food pending results of tests TESTS: Blood - NAD Urinalysis - SG 1.050, red blood cells and numerous struvite crystals, culture negative Radiology - NAD Ultrasound - NAD DIAGNOSIS: Idiopathic FLUTD FLUTD in a female cat

10. 10 CASE STUDY 2: PATIENT: GANESH 4 year old FN DSH cat, living in apartment Ultrasound images of Ganesh’s bladder Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: 1 month history of urinating in the bath with frequent traces of blood Fed grocery dry food CLINICAL EXAMINATION: No abnormalities detected Owners asked to change diet to wet food pending results of tests TESTS: Blood - NAD Urinalysis - SG 1.050, red blood cells and numerous struvite crystals, culture negative Radiology - NAD Ultrasound - NAD DIAGNOSIS: Idiopathic FLUTD MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary wet and dry food FOLLOW UP: 2 months - No urinary problems. Owners had fed wet food only and Ganesh was tiring of eating this so had lost some weight. Urine SG 1.016, pH 8.0, numerous red blood cells (possibly caused by cystocentesis) and occasional struvite crystals. Radiology and ultrasound NAD. Advised to add in dry form of the diet along with wet 4 months - Clinical signs had returned- urination in the bath with blood traces. Urinalysis SG 1.050, no blood but struvite crystals found. Radiology NAD but ultrasound revealed a thin bladder wall with hyperechoic particles floating in the urine DISCUSSION AND CONCLUSION: Once Ganesh had been returned to wet food only, clinical signs totally resolved In this case, clinical signs appear to be related to consumption of dry food regardless of composition- possibly because Ganesh was not drinking enough Ultrasound image of Ganesh’s bladder at 4 months FLUTD in a female cat

11. 11 CASE STUDY 3: PATIENT: CANDY 4 year old FN DSH cat Radiograph and ultrasound scan of Candy on Day 0 Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: Dysuria, stranguria, periuria (inappropriate urination), haematuria for 3 days CLINICAL EXAMINATION: Caudal abdominal discomfort- otherwise NAD TESTS: Haematology and biochemistry: NAD Urinalysis: SG 1.030, pH 6, positive peroxidase activity (blood). Sediment positive for blood but no crystals. Culture negative Radiology; Small round slightly radio opaque areas in the bladder (few mm diameter). Kidneys normal Ultrasound: Bladder wall increased thickness and moderately irregular suggesting widespread inflammation, bladder contents had hyperechogenic elements in suspension distal to bladder neck DIAGNOSIS: Cystitis Haemorrhagic cystitis in a female cat

12. 12 CASE STUDY 3: PATIENT: CANDY 4 year old FN DSH cat Radiograph and ultrasound scan of Candy on Day 0 Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: Dysuria, stranguria, periuria (inappropriate urination), haematuria for 3 days CLINICAL EXAMINATION: Caudal abdominal discomfort- otherwise NAD TESTS: Haematology and biochemistry: NAD Urinalysis: SG 1.030, pH 6, positive peroxidase activity (blood). Sediment positive for blood but no crystals. Culture negative Radiology; Small round slightly radio opaque areas in the bladder (few mm diameter). Kidneys normal Ultrasound: Bladder wall increased thickness and moderately irregular suggesting widespread inflammation, bladder contents had hyperechogenic elements in suspension distal to bladder neck DIAGNOSIS: Cystitis Ultrasound images of Ganesh’s bladder MANAGEMENT: NSAIDs (meloxicam 0.1 mg/ kg/ day) for pain relief PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary dry food FOLLOW UP: Clinical signs disappeared within 3 days At 1 month follow up imaging was repeated: Radiographs and ultrasound no longer showed radiodense or hyperechogenic images Compatible with initial presence of struvite crystals which had dissolved under the influence of the diet Follow up urinalysis and bloods revealed no abnormalities at 2 and 4 months. Ultrasound image of Ganesh’s bladder at 4 months Haemorrhagic cystitis in a female cat

13. 13 CASE STUDY 4: PATIENT: FLORY 12 year old MN DSH cat Ultrasound picture of Flory’s bladder showing bladder wall thickening Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: Dysuria, haematuria, pollakiuria CLINICAL EXAMINATION: Caudal abdominal palpation painful with small bladder Otherwise NAD TESTS: Blood: NAD Urinalysis: SG 1.045, pH 7.0- 8.0, No crystals or bacteria Ultrasound: Abnormally thickened bladder wall (0.5cm), no calculi DIAGNOSIS: Idiopathic cystitis Ideopathic cystitis in a male cat

14. 14 CASE STUDY 4: PATIENT: FLORY 12 year old MN DSH cat Ultrasound picture of Flory’s bladder showing bladder wall thickening Photos and case courtesy of Drs Ducluzaux and Pereira, veterinary clinic, route de Romans 53, 26120 Chabeuil, France HISTORY: Dysuria, haematuria, pollakiuria CLINICAL EXAMINATION: Caudal abdominal palpation painful with small bladder Otherwise NAD TESTS: Blood: NAD Urinalysis: SG 1.045, pH 7.0- 8.0, No crystals or bacteria Ultrasound: Abnormally thickened bladder wall (0.5cm), no calculi DIAGNOSIS: Idiopathic cystitis MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary dry food 3 day course of anti- inflammatories (Metacam) Increasing the number of water sources available FOLLOW UP: 1 month: Asymptomatic. Ultrasound NAD (no bladder thickening). Urinalysis NAD 3 months: Asymptomatic. Ultrasound NAD. Urinalysis: SG 1.032, pH 6.5 Ultrasound of Flory’s bladder at 1 month showing no bladder wall thickening Ideopathic cystitis in a male cat

15. 15 FELINE Struvite Feline UR S T /O X Urinary beneficial for cats with struvite

16. 16 FELINE UR S T /O X Urinary Promotes the production of urine under-saturated for struvite Produces a urine composition to promote dissolution of struvite uroliths Helps to prevent both struvite and oxalate stones-Reduced urine mineral concentrations and urinary RSS (RelativeSupersaturation and APR (Activity Product Ratio) values Helps to promote effective urine dilution reducing concentrations of minerals and irritants in the urine- Wet and dry diets both formulated to increase water intake Moderate levels of fat and calories to help maintain ideal body weight (obesity being a risk factor for FLUTD) Ensures cat’s enjoyment, thus long- term patient acceptance and client compliance- highly palatable formulas in multiple varieties

17. 17 CASE STUDY 5: PATIENT: BIBOUILLE 7 year old FN DSH cat, living in an apartment Radiograph and ultrasound images of Bibouille showing cystolith Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: 2 year history of dysuria, intermittent haematuria and urinary soiling Recently starting leaking urine in her sleep Urolithiasis had been diagnosed 1 year previously but surgery was declined by the owner Fed commercial dry diet CLINICAL EXAMINATION: Poor general health- thin with dull, ruffled coat Small hard bladder with grinding sensation on palpation resulting in pain and immediate urination Urine pink and malodorous TESTS: Blood - mild dehydration (haematocrit 50%, total protein 70 g/l) and renal insufficiency urea 0.9 g/l, creatinine 24mg/ l Urinalysis - SG 1.020, pH 8,5, large numbers of struvite crystals, culture positive for E. Coli (1000 colonies/ ml) Radiology - 15mm bladder stone Ultrasound - Hypertrophy of bladder mucosa together with hyperechoic bladder mass with shadow cone (urolith) DIAGNOSIS: Struvite urolithiasis and urinary tract infection Struvite urolithiasis in a female cat

18. 18 CASE STUDY 5: PATIENT: BIBOUILLE 7 year old FN DSH cat, living in an apartment Radiograph and ultrasound images of Bibouille showing cystolith Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: 2 year history of dysuria, intermittent haematuria and urinary soiling Recently starting leaking urine in her sleep Urolithiasis had been diagnosed 1 year previously but surgery was declined by the owner Fed commercial dry diet CLINICAL EXAMINATION: Poor general health- thin with dull, ruffled coat Small hard bladder with grinding sensation on palpation resulting in pain and immediate urination Urine pink and malodorous TESTS: Blood - mild dehydration (haematocrit 50%, total protein 70 g/l) and renal insufficiency urea 0.9 g/l, creatinine 24mg/ l Urinalysis - SG 1.020, pH 8,5, large numbers of struvite crystals, culture positive for E. Coli (1000 colonies/ ml) Radiology - 15mm bladder stone Ultrasound - Hypertrophy of bladder mucosa together with hyperechoic bladder mass with shadow cone (urolith) DIAGNOSIS: Struvite urolithiasis and urinary tract infection MANAGEMENT: Antibiotics for urinary tract infection (Marbofloxacin 10mg/day for 10 days) PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary wet (mainly) and dry food FOLLOW UP: 4 days after antibiotics finished, urine sample positive for blood but negative for crystals, urine SG 1.035, culture negative 1 month - No further symptoms, radiology and ultrasound NAD (stone disappeared), Urinalysis: SG 1.046, pH7, large numbers of struvite crystals, very small quantity of blood, numerous epithelial cells 2 months - No symptoms, cat refusing wet food so now being fed entirely Feline UR St/ Ox dry. Urinalysis; pH7.0, SG 1.050, sediment revealed numerous calcium oxalate crystals, Radiology and ultrasound NAD 4 months - No symptoms, gained 0.7kg in weight (now weighing 4.5kg and in better general health), Urinalysis: large quantities of struvite crystals, SG 1.050, renal parameters (urea and creatinine) now normal. Radiology and ultrasound NAD Ultrasound scan of Bibouille bladder D0 + 4 months Microscopic examination of Bibouille’s urina Struvite urolithiasis in a female cat

19. 19 CASE STUDY 6: PATIENT: GARY 4 year old neutered MN DSH cat, living in a flat Initial Ultrasound image of Gary’s bladder Photos and case courtesy of Dr Christelle Maurey, Lecturer, Department of Medicine, Alfort National School f Veterinary Medicine, Maisons- Alfort, France HISTORY: 3 episodes of lower urinary tract disease, one of which involved obstruction with the presence of struvite crystals and required urinary catheterisation to relieve the blockage. A special diet was prescribed but not given by the owner Currently fed Whiskas dry diet CLINICAL EXAMINATION: Discomfort on palpation of the bladder, pollakiuria and stranguria TESTS: Blood - NAD Urinalysis - SG 1.035, microscopic haematuria and large number of struvite crystals, culture negative Radiology - NAD Ultrasound - 2 small bladder stones and echogenic material adhering to the bladder wall DIAGNOSIS: Struvite urolithiasis Struvite stones in a neutered male cat

20. 20 CASE STUDY 6: PATIENT: GARY 4 year old neutered MN DSH cat, living in a flat Initial Ultrasound image of Gary’s bladder Photos and case courtesy of Dr Christelle Maurey, Lecturer, Department of Medicine, Alfort National School f Veterinary Medicine, Maisons- Alfort, France HISTORY: 3 episodes of lower urinary tract disease, one of which involved obstruction with the presence of struvite crystals and required urinary catheterisation to relieve the blockage. A special diet was prescribed but not given by the owner Currently fed Whiskas dry diet CLINICAL EXAMINATION: Discomfort on palpation of the bladder, pollakiuria and stranguria TESTS: Blood - NAD Urinalysis - SG 1.035, microscopic haematuria and large number of struvite crystals, culture negative Radiology - NAD Ultrasound - 2 small bladder stones and echogenic material adhering to the bladder wall DIAGNOSIS: Struvite urolithiasis MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary dry food Well accepted (Gary refuses to eat wet food) FOLLOW UP: 2 months - No urinary problems, Ultrasound showed stones and echogenic material had disappeared Ultrasound image of Gary’s bladder after 2 months treatment Struvite stones in a neutered male cat

21. 21 CASE STUDY 7: PATIENT: CHIPIE 6 year old FN DSH cat, living in apartment Ultrasound pictures of Chipie’s bladder showing bladder wall thickening and microcalculi in suspension in the urine Photos and case courtesy of Dr Amélie Nègre, Clinique Vétérinaire des Remparts, Pontoise, France HISTORY: 5 day history of abnormal urination (increased frequency, inappropriate urination, pink- tinged urine) CLINICAL EXAMINATION: Cat anxious but slightly overweight, caudal abdomen slightly sensitive to palpation TESTS: Blood - NAD Urinalysis - SG 1.055, pH 6.0, sediment revealed red blood cells and struvite. Culture negative Radiology - NAD (no calculi observed) Ultrasound - Irregular bladder wall, substantial quantity of microcalculi (snowstorm effect on manipulation of the bladder) but no calculi DIAGNOSIS: Non- obstructive cystitis associated with struvite microcalculi Cystitis associated with struvite microcalculi in a female cat

22. 22 CASE STUDY 7: PATIENT: CHIPIE 6 year old FN DSH cat, living in apartment Ultrasound pictures of Chipie’s bladder showing bladder wall thickening and microcalculi in suspension in the urine Photos and case courtesy of Dr Amélie Nègre, Clinique Vétérinaire des Remparts, Pontoise, France HISTORY: 5 day history of abnormal urination (increased frequency, inappropriate urination, pink- tinged urine) CLINICAL EXAMINATION: Cat anxious but slightly overweight, caudal abdomen slightly sensitive to palpation TESTS: Blood - NAD Urinalysis - SG 1.055, pH 6.0, sediment revealed red blood cells and struvite. Culture negative Radiology - NAD (no calculi observed) Ultrasound - Irregular bladder wall, substantial quantity of microcalculi (snowstorm effect on manipulation of the bladder) but no calculi DIAGNOSIS: Non- obstructive cystitis associated with struvite microcalculi MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary wet dry food 6 days course of anti- inflammatories (Metacam) FOLLOW UP: 1 month - Asymptomatic. Diet enjoyed. 800 gram weight gain. Ultrasound NAD (no bladder thickening and no suspended particles in the urine). Urinalysis SG 1.050, pH 7. No struvite crystals or blood. Feeding quantity reduced to 50g/ day 2 months - Asymptomatic. Reduced feeding quantity had led to 450gram weight loss. Urinalysis and ultrasound unchanged compared to 1 month Ultrasound of Chipie’s bladder at 1 month showing no bladder wall thickening and no sediment Cystitis associated with struvite microcalculi in a female cat

23. 23 CASE STUDY 8: PATIENT: SAMMY 2 year old MN DSH cat Urine sample showing sediment and microscopic view of urine sample showing numerous struvite crystals Photos and case courtesy of Dr Philippe PINARD, Clinique Vétérinaire, 6 rue de l'Eglise, 92210 St CLOUD France HISTORY: 2 day history of vomiting, pollakiuria, stranguria, dysuria, inappropriate urination and urinary soiling CLINICAL EXAMINATION: Cat anxious but in good body conditions (BCS 6/9), small pliable bladder, marked faecal impaction TESTS: Blood - mild hyperglycaemia associated with anxiety Urinalysis - SG 1.065, pH 7.0, sediment revealed very numerous struvite crystals and some red blood cells, culture negative Radiology - spastic faecal impaction. NAD after enema to remove faecal material (no calculi observed) Ultrasound - Substantial quantity of sediment (snowstorm effect on manipulation of the bladder) DIAGNOSIS: Non- obstructive cystitis associated with struvite crystals Non-obstructive cystitis associated with struvite crystals in male cat

24. 24 CASE STUDY 8: PATIENT: SAMMY 2 year old MN DSH cat Urine sample showing sediment and microscopic view of urine sample showing numerous struvite crystals Photos and case courtesy of Dr Philippe PINARD, Clinique Vétérinaire, 6 rue de l'Eglise, 92210 St CLOUD France HISTORY: 2 day history of vomiting, pollakiuria, stranguria, dysuria, inappropriate urination and urinary soiling CLINICAL EXAMINATION: Cat anxious but in good body conditions (BCS 6/9), small pliable bladder, marked faecal impaction TESTS: Blood - mild hyperglycaemia associated with anxiety Urinalysis - SG 1.065, pH 7.0, sediment revealed very numerous struvite crystals and some red blood cells, culture negative Radiology - spastic faecal impaction. NAD after enema to remove faecal material (no calculi observed) Ultrasound - Substantial quantity of sediment (snowstorm effect on manipulation of the bladder) DIAGNOSIS: Non- obstructive cystitis associated with struvite crystals MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary dry food Due to body condition score, the owners was advised to feed the low end of the recommended feeding quantities (65g/ day) 10 day course of antispasmodics to help relieve symptoms FOLLOW UP: 1 month - Ultrasound showed significant reduction in sediment. Other than a 2 day recurrence of mild clinical signs a few days after discontinuing the antispasmodics, Sammy had been symptom- free. He had gained 300 grams in weight and his ration was reduced to 50g/ day (with added cooked courgettes to help him accept the reduced ration) 2 months - Asymptomatic. Reduced feeding quantity had led to 190gram weight loss. Urinalysis: SG 1.50, significant reduction in crystals, Ultrasound showed some sediment but markedly reduced. Microscopic examination of Sammy’s urine showing marked reduction of crystals Non-obstructive cystitis associated with struvite crystals in male cat

25. 25 CASE STUDY 9: PATIENT: STICK 2 year old MN DSH cat, lived in apartment and nervous to go out Left: Ultrasound picture of Stick’s bladder showing bladder wall thickening Right: Large mass of struvite crystals in Stick’s urine sediment Photos and case courtesy of Dr Amélie Nègre, Clinique Vétérinaire des Remparts, Pontoise, France HISTORY: 2 day history of dysuria, haematuria, inappropriate urination, licking genital region and vocalisation CLINICAL EXAMINATION: Caudal abdominal palpation painful but normal- sized bladder Otherwise NAD TESTS: Blood - NAD Urinalysis - SG 1.050, pH 7.0, blood (++++)- may be related to repeated cystocentesis, large quantity of sediment containing large quantities of struvite crystals and red blood cells Radiology - NAD (no calculi visible) Ultrasound - Abnormally thickened bladder wall (0.32cm), bladder contents not uniform- substantial quantity of sediment (snowstorm effect on manipulation of the bladder) but no individual stones DIAGNOSIS: Cystitis associated with struvite microcalculi Cystitis associated with struvite microcalculi in a male cat

26. 26 CASE STUDY 9: PATIENT: STICK 2 year old MN DSH cat, lived in apartment and nervous to go out Left: Ultrasound picture of Stick’s bladder showing bladder wall thickening Right: Large mass of struvite crystals in Stick’s urine sediment Photos and case courtesy of Dr Amélie Nègre, Clinique Vétérinaire des Remparts, Pontoise, France HISTORY: 2 day history of dysuria, haematuria, inappropriate urination, licking genital region and vocalisation CLINICAL EXAMINATION: Caudal abdominal palpation painful but normal- sized bladder Otherwise NAD TESTS: Blood - NAD Urinalysis - SG 1.050, pH 7.0, blood (++++)- may be related to repeated cystocentesis, large quantity of sediment containing large quantities of struvite crystals and red blood cells Radiology - NAD (no calculi visible) Ultrasound - Abnormally thickened bladder wall (0.32cm), bladder contents not uniform- substantial quantity of sediment (snowstorm effect on manipulation of the bladder) but no individual stones DIAGNOSIS: Cystitis associated with struvite microcalculi MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary wet food 5 day course of anti- inflammatories (Metacam) FOLLOW UP: 11 days - Telephone consultation- slight recurrence of dysuria and stranguria. Otherwise well. 3 days course of Metacam recommended 1 month- Asymptomatic. Urinalysis SG 1.055, pH 7, some struvite crystals but far fewer than before, Ultrasound: few hyperechoic elements in suspension but far fewer than before 2 months - Asymptomatic. Urinalysis SG 1.050, pH7, few cells but no crystals in sediment. Ultrasound NAD Ultrasound of Stick’s bladder at 2 months showing no bladder wall thickening and no hyperechoic sediment Cystitis associated with struvite microcalculi in a male cat

27. 27 CASE STUDY 10: PATIENT: PAYOU 1 year old MN DSH cat, lived in flat with no outside access Ultrasound picture of Payou’s bladder showing shadow cone Photos and case courtesy of Dr. Ducluzaux and Dr. Pereira, CLINIQUE VETERINAIRE 53, route de Romans 26120 – CHABEUIL France HISTORY: 1 day history of dysuria CLINICAL EXAMINATION: Abdominal palpation painful with full bladder Bladder easily emptied without catheterisation while cat sedated indicating no obstruction TESTS: Blood - NAD except hyperglycaemia probably related to stress as came down to normal on subsequent tests Urinalysis - SG 1.050, pH 7.0, glycosuria 2+, sediment contained large quantities of struvite crystals, red and white blood cells Radiology - NAD (full bladder but no calculi visible) Ultrasound - Anechoic content with intravesical crystals (hyperechoic sediment with a "shadow cone" effect). On the midsagittal section, the sediment/ stone measured 0.44 x 2.5 cm. DIAGNOSIS: Struvite uroliths FLUTD associated with struvite microcalculi in a male cat

28. 28 CASE STUDY 10: PATIENT: PAYOU 1 year old MN DSH cat, lived in flat with no outside access Ultrasound picture of Payou’s bladder showing shadow cone Photos and case courtesy of Dr. Ducluzaux and Dr. Pereira, CLINIQUE VETERINAIRE 53, route de Romans 26120 – CHABEUIL France HISTORY: 1 day history of dysuria CLINICAL EXAMINATION: Abdominal palpation painful with full bladder Bladder easily emptied without catheterisation while cat sedated indicating no obstruction TESTS: Blood - NAD except hyperglycaemia probably related to stress as came down to normal on subsequent tests Urinalysis - SG 1.050, pH 7.0, glycosuria 2+, sediment contained large quantities of struvite crystals, red and white blood cells Radiology - NAD (full bladder but no calculi visible) Ultrasound - Anechoic content with intravesical crystals (hyperechoic sediment with a "shadow cone" effect). On the midsagittal section, the sediment/ stone measured 0.44 x 2.5 cm. DIAGNOSIS: Struvite uroliths MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary wet food 5 day course of anti- inflammatories (Meloxicam) Enrofloxacin prophylactic antibiotics Bladder flushed to remove crystals FOLLOW UP: 1 month - Asymptomatic. Urinalysis SG 1.036, pH 6, no crystals, Ultrasound: NAD (no urolith observed) 2 months - Asymptomatic. Urinalysis SG 1.050, pH 5, Ultrasound NAD Ultrasound of Payou’s bladder at 1 month showing no abnormalities and no calculi FLUTD associated with struvite microcalculi in a male cat

29. 29 FELINE Calcium Oxalate Feline UR S T /O X Urinary beneficial for cats with calcium oxalate

30. 30 FELINE UR S T /O X Urinary Promotes the production of urine metastable for calcium oxalate Helps to prevent both struvite and oxalate stones- Reduced urine mineral concentrations and urinary RSS (Relative Supersaturation and APR (Activity Product Ratio) values Helps to promote effective urine dilution reducing concentrations of minerals and irritants in the urine- Wet and dry diets both formulated to increase water intake Moderate levels of fat and calories to help maintain ideal body weight (obesity being a risk factor for FLUTD) Ensures cat’s enjoyment, thus long- term patient acceptance and client compliance- highly palatable formulas in multiple varieties

31. 31 CASE STUDY 11: PATIENT: BALOO 2 year old MN DSH cat, living in an apartment with another cat Initial Ultrasound image of Baloo’s bladder showing hyperechoic mass Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: 3 day history of dysuria and haematuria Fed grocery dry food and occasional canned food CLINICAL EXAMINATION: No abnormalities detected No initial urine sample collected because bladder was empty. Cat given initial 3 days treatment with antispasmodics and anti inflammatory TESTS: Blood - NAD Urinalysis - SG 1.032, pH6.0, red blood cells and calcium oxalate crystals, culture negative Radiology - NAD Ultrasound - Hyperechoic mass in bladder lumen with no shadow cone therefore considered likely to be a blood clot. Thickened bladder wall. DIAGNOSIS: Idiopathic FLUTD with calcium oxalate crystals Idiopathic FLUTD with calcium oxalate crystals in male cat

32. 32 CASE STUDY 11: PATIENT: BALOO 2 year old MN DSH cat, living in an apartment with another cat Initial Ultrasound image of Baloo’s bladder showing hyperechoic mass Photos and case courtesy of Dr Fradin- Fermé, Feline exclusive veterinary practitioner, Vincennes, France HISTORY: 3 day history of dysuria and haematuria Fed grocery dry food and occasional canned food CLINICAL EXAMINATION: No abnormalities detected No initial urine sample collected because bladder was empty. Cat given initial 3 days treatment with antispasmodics and anti inflammatory TESTS: Blood - NAD Urinalysis - SG 1.032, pH6.0, red blood cells and calcium oxalate crystals, culture negative Radiology - NAD Ultrasound - Hyperechoic mass in bladder lumen with no shadow cone therefore considered likely to be a blood clot. Thickened bladder wall. DIAGNOSIS: Idiopathic FLUTD with calcium oxalate crystals MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary wet and dry food FOLLOW UP: 2 months - Asymptomatic (clinical signs had resolved within 1 week of starting the food). Ultrasound showed normal bladder with thin, even wall and no mass. Urinalysis: SG 1.52, pH 7.0, few epithelial cells. Slight weight gain of 150g 4 months - Asymptomatic. Large weight gain of 590gras since first visit. Radiology and ultrasound NAD. Urinalysis SG 1.029, pH 7.0, sediment NAD Ultrasound of Payou’s bladder at 1 month showing no abnormalities and no calculi Baloo at 4 months post treatment Idiopathic FLUTD with calcium oxalate crystals in male cat

33. 33 CASE STUDY 12: PATIENT: BALZAC 5 year old MN DSH cat Radiograph and Ultrasound image of Balzac’s bladder showing calculus Photos and case courtesy of Dr Aurélie Baril, clinical research assistant, CHUVA, ENVA, avenue du général de Gaulle, 94700 Maisons-Alfort, France HISTORY: 3 year history of recurrent pollakiuria, stranguria, haematuria and urinary soiling Clinical signs usually resolve after management with NSAID meloxicam and spasmolytic phloroglucinol Most recent episode had not responded to management with alpha S1- casein (for stress), homoeopathic treatment and Royal Canin Urinary S/O diet CLINICAL EXAMINATION: No abnormalities detected TESTS: Blood - NAD Urinalysis - SG 1.032, pH6.0, sediment revealed red blood cells but no crystals, culture negative Radiology - Radio opaque object about 4mm long in bladder consistent with calculus Ultrasound - Calculus observed, bladder wall thickened (6mm) Cystotomy - Calculus removed and analysis by infrared spectrometry diagnosed 60% calcium oxalate dihydrate and 40% calcium oxalate monohydrate. DIAGNOSIS: Calcium oxalate urolithiasis Calcium oxalate uroliths in a male cat

34. 34 CASE STUDY 12: PATIENT: BALZAC 5 year old MN DSH cat Radiograph and Ultrasound image of Balzac’s bladder showing calculus Photos and case courtesy of Dr Aurélie Baril, clinical research assistant, CHUVA, ENVA, avenue du général de Gaulle, 94700 Maisons-Alfort, France HISTORY: 3 year history of recurrent pollakiuria, stranguria, haematuria and urinary soiling Clinical signs usually resolve after management with NSAID meloxicam and spasmolytic phloroglucinol Most recent episode had not responded to management with alpha S1- casein (for stress), homoeopathic treatment and Royal Canin Urinary S/O diet CLINICAL EXAMINATION: No abnormalities detected TESTS: Blood - NAD Urinalysis - SG 1.032, pH6.0, sediment revealed red blood cells but no crystals, culture negative Radiology - Radio opaque object about 4mm long in bladder consistent with calculus Ultrasound - Calculus observed, bladder wall thickened (6mm) Cystotomy - Calculus removed and analysis by infrared spectrometry diagnosed 60% calcium oxalate dihydrate and 40% calcium oxalate monohydrate. DIAGNOSIS: Calcium oxalate urolithiasis Initial Ultrasound image of Baloo’s bladder showing hyperechoic mass MANAGEMENT: PURINA PRO PLAN VETERINARY DIETS Feline UR S T /O X Urinary dry food Meloxicam for 3 days post operatively Advice given on increasing number of water sources in the home, changing litter trays daily, minimising environmental changes FOLLOW UP: 2 weeks post operatively - Cat eating food well. Some mild pollakiuria and haematuria. Managed with 5 days course of urinary muscle relaxants (alfuzosin and dantrolene) 1 month - Asymptomatic. Urinalysis: SG 1.050, pH7.5, Protein++++, blood ++++. No sediment. Radiography NAD. Ultrasound: fine suspended particles in bladder lumen but no calculi or sediment 2 months - As 1 month Ultrasound image of Balzac’s bladder at 2 months showing a normal healthy bladder Calcium oxalate uroliths in a male cat

35. 35 FELINE UR S T /O X Urinary Summary Highly effective in managing idiopathic cystitis and FLUTD associated with struvite and calcium oxalate crystals and dissolving struvite uroliths Owners noted high palatability of both wet and dry formulas

36. 36 FELINE UR S T /O X URINARY THANK YOU