Understanding the current evidence base for the commonly recommended management strategies for recurrent feline idiopathic cystitis: a systematic review.

Objectives: This systematic review aims to describe and understand the evidence available for commonly recommended management strategies for feline idiopathic cystitis (FIC) to provide guidance for clinicians in their treatment of this condition. A subsequent objective was to identify gaps in the literature and areas where future research may be directed.

Methods: A computerised search of three electronic databases (Discover, Scopus and PubMed) was performed. Results were imported into a single EndNote library and duplicates were removed. Remaining records underwent a two-stage screening process with the aim to identify peer-reviewed primary literature on therapeutic strategies for FIC. Studies were categorised according to one of seven management strategies: environmental modification, dietary manipulation, anti-inflammatory drugs, amitriptyline, glycosaminoglycans, prazosin, and intravesical lidocaine.

Results: Twenty-two studies were included in the final review, with one study providing evidence in two categories. Two studies assessed environmental manipulation, with results showing encouraging evidence for multimodal environmental modification but little evidence to support the use of feline facial pheromone. Five papers examined dietary manipulation, with good evidence for the use of therapeutic urinary diets, and for increasing the moisture content of a cat's diet. Anti-inflammatory drugs were the focus of four studies, with none providing evidence to support their use. Four papers indicated that the evidence to support glycosaminoglycans is lacking. The antispasmodic drug prazosin was purported to be useful in one retrospective paper, while three papers comparing it to a placebo showed no evidence for its use. Three studies assessed amitriptyline, with two indicating that short-term use is not supported, and one long-term study suggesting it may be useful in some refractory cases. One study on intravesical instillation of lidocaine concluded that it was not a useful treatment strategy.

Conclusions: Multimodal environmental modification to reduce stress/conflict and therapeutic urinary foods (particularly if combined with an increase in moisture content of the diet) currently have the strongest evidence to support their use in managing FIC, and should, together, be considered the primary treatment approach. The evidence for other modalities, is currently insufficient to support their use. The overall lack of high quality studies emphasises the need for clinicians to be critical in their evaluation of the published literature on the management of this perplexing condition.