Cat Peeing Blood for Over a Year, No one can tell me WHY

I noticed blood in my male kitten's urine a week after I adopted him in May 2020- he was 12 weeks old and is a domestic short-hair that was rescued from Mexico. I took him immediately to an emergency vet and since then it's been a whirlwind of different Vets, Specialists, Urinalysis, Urine Cultures, Bloodwork, Ultrasound imaging of bladder and kidneys, antibiotics, and in January of this year, surgery. Since the urine cultures kept coming back without any presence of bacteria, and crystals/UTI were ruled out by our regular Vet, we took him to be seen by a urology specialist. The specialists there determined that "congenital abnormal uric could be the reason for recurrent hematuria and that surgical excision of the ventral-apical bladder wall where the uric is located is recommended. We had the surgery in late January, (sent some of the bladder lining to be tested for Cancerous cells which came back negative) and then....nothing changed. Still blood in his urine. In March, a recheck ultrasound of the bladder was performed and the specialist believed that there was still some remaining "intramural vesico-urachal diverticulum" and they recommended having ANOTHER surgery to remove the remaining matter, but also said they were not certain that his hematuria is caused only by this remaining intramural vesico-urachal diverticulum: MY CAT HAS BEEN BLEEDING FOR A YEAR! It breaks my heart. He eats (Wet food only) and drinks (cat fountains all over the house) normally. He doesn't strain or make noise when urinating. He just urinates blood. I know cat's are good at hiding pain, I am worried he is in pain and there is no relief in sight. Has anyone experienced or heard of a Cat presenting with blood in their urine continuously for this long of a time period? I am going to move forward with whatever the urology specialists recommend since they are the experts, but I am reaching out to see if anyone has any advice.

What an ordeal for you and the patient yet also (as a vet) what an in interesting case.  Feline cystitis (inflammation of the bladder wall) can be down to stress and may contribute to bloody urine over a long time period, but one wouldn't expect that to be continuous.  If there was a clotting problem, it might exacerbate things (I assume that there isn't - you clearly have some top specialists looking at this case who would have thought of that, and often these cats would start bleeding from other places or deteriorating in time).  There are conditions I think, where cats might bleed spontaneously from their kidney - I don't know much about these but again, the specialists you mention would know more about this than me! I agree that cats hide pain extremely well;  sometimes trying something like a non-steroidal pain killer to see if it makes any general, unexpected difference to the patient's behaviour may be a helpful way to tell, but obviously this should be done through your vet (it doesn't seem likely that you'd try it yourself at home, but some common non-steroidals are extremely poisonous to cats). I am glad that you are able to have such well-qualified people overseeing this case - it must be hard facing the idea of surgery again - and would be interested to find out how you get on.  

I have just reread and see that you mention Mexico.  I am not sure where you are at the moment but that's half-way from the world from the UK!  I realise that this may be less relevant if, for example, you are in the states, but I wonder if there is a tropical diseases / parasitology expert who could shed any light on the situation?

Hi Dr. Buchanan, Thank you so much for the thoughtful reply. Funny you mention spontaneous bleeding from the kidney, as that is one of the things the specialist mentioned could be causing the bleeding: "I think the only way to find out is to perform another surgery, where all the abnormal intramural vesico-urachal diverticulum is removed and at the same timeobserve the urine jets coming from each ureter. Renal hematuria is diagnosed when urine tinged blood is seen coming from the UVJs." Throughout the course of all of this, our vet has prescribed Buprenorphine and Prazosin, but other than being a bit more lethargic, I didn't notice anything difference in his behavior. I am located in the States, so parasitology and tropical disease can most likely be ruled out! Anyways, thank you so much for responding. I am feeling pretty helpless and the thought of submitting my babe to another surgery (when we don't even know if it will help) is so stressful!!!!!  

Best of luck - please do keep us informed as to what happens next!

I was looking for an emoji button just now, but I don't have one so I will say it in words - wishing you lots of peace and good outcomes!

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