Help with diagnosis (blood clot in urine)

Hello, We could really use some advice because our vets aren't sure how to proceed treating our cat. We have a 16-year-old male sphynx cat. He's not neutered. Now he seems to have a recurring problem we don't know how to address. It happened several times in the past 3 weeks. Before this, it happened on the 5th of January 2021. And it was treated with antibiotics like an isolated event. Here goes: He goes to pee and can't- like he has some blockage. A couple of droplets happen, and then from all the straining, he defecates (his poop thin at the end, outside of this event, his poop is regular), and after he defecates, his attempts to pee result in bloody droplets (pinkish to red). This usually lasts 2-4 hours, where he tries to urinate every couple of minutes. The last two times, he also passed a blood clot or two through his penis (we made a video to show the blood clot to the vets if needed). During these events he licks his crotch, one time he was also meowing while straining. Then he goes to sleep and the next day everything goes back to normal. Peeing like usual, being friendly, eating, drinking water, licking himself. Like nothing happened. And then two weeks later, it happens again. At the vets, They did blood and urinary tests (attached at the end) and they did several ultrasounds. He has deformed kidneys and they said his kidneys are probably deformed with age but functioning normally. They also noticed a thickened bladder wall. And there were some crystals showing on the ultrasound, but the vet assured us the amount wasn't alarming. No stones. They also followed his blood pressure for 10 days and it's slightly elevated but not enough to start medication. They suggested switching to renal food and we did, two weeks ago. We also switched his water to low mineral. On the last visit (two days ago), they started to question whether it was the prostate. They tried to see his prostate on the ultrasound but couldn't, so we're shooting blind. They advise neutering him. Which we are uneasy to accept since we still didn't get the proper and certain diagnosis. He has no other medical issues. And he's not on medication. He had surgery on his teeth, twice, total anesthesia. The last one was when he was 14. We are also adding his lab results to this post. Blood result and urine. Please help us if you can. We love our boy and we want to help him and prolong his life. Thank you kindly, Nina

Hello - I haven't seen these clots but I wondered whether feline cystitis might be involved?  This is inflammation of the bladder, usually in connection with sone kind of stress (that tends to make sense with a knowledge of cat behaviour, but can be difficult to decipher for humans - the things that stress cats out aren't just the things you'd expect).  Cystitis can present as blood in pee or straining to pass urine and while in the past it used to be attributed to bacterial disease, now behavioural stress, pain (eg arthritis / being an old cat) are thought to be more likely the causes.

Other causes of blood in urine may include actual bleeding eg from a tumour or from the kidneys.  A good question for your vet about any ongoing case, would be:  what have the tests that have been done so far ruled out?  Do we know whether the blood joined the urine before the bladder, in bladder or after the bladder?  What causes could still be involved?   Which is most likely?  How should we rule this one out?  And to take it from there.

Hello Liz, thank you for your opinion! Based on urine color, and the clots, the vet believes that the blood joined the urine after the bladder which is why they believe it might be an enlarged prostate. I'm personally not convinced since there was no evidence of this on the ultra sound and from what I read online, enlarged prostate in cats is a very rare condition. They didn't find any evidence of a tumor on the ultra sound. His kidneys do look deformed but they believe its due to age since his blood tests were fine. Cystitis does sound plausible, is there anyway to confirm it? Thank you for you time! Nina

Hello - I'm obliged to explain to you that I dont have an opinion or diagnosis regarding your cat.  The things that I am telling you are facts that apply to cats, in general, with blood in their urine.  Your vet is in a much better position to talk to you about your own cat than I am - and as cystitis is incredibly common, any uk vet will have already considered it.  A good question, then, is 'could this be cystitis? / how have you ruled cystitis out?'   You can read more about the symptoms to see if they fit, by typing 'feline cystitis' into the search bar of the blog or checking the International Cat Care website.  Your vet may know something that makes them suspect prostatitis (rare, but not unheard of in intact males), or a tumour or clotting disorder, for example.  If a second pinion is needed, your vet should be in a position to get one for you.  Once a diagnosis has been established, they can talk the situation through with regards to treatment.

With apologies Nina, that I avoided answering your question there.  The truth is that idiopathic cystitis is often diagnosed by ruling out other possibilities, so it could be that your vet is working toward a diagnosis.  It is certainly something to ask them about.

Yes, I'm aware. Thank you for your time! I think my plan forward is to make a list of suspected causes and rule out one by one.