When a Bladder Tumor Becomes a Bleeder: The Cat That Crashed and How Endoscopic Intervention Saved the Day
Urothelial cell carcinoma of the bladder is a diagnosis most veterinary professionals associate with dogs and chronic lower urinary tract signs. In cats, it is far less common and often flies under the radar until it becomes impossible to ignore. This case highlights a dramatic and life threatening presentation of feline urothelial cell carcinoma that progressed from hematuria to hypovolemic shock, and it underscores how minimally invasive interventions can be both lifesaving and surprisingly durable.
For clinicians navigating late night emergencies and complex oncology cases, this report offers practical insights into stabilization, diagnostics, and palliative treatment when definitive therapy is not on the table.
Case Overview
A 7 year old female spayed domestic shorthair cat was presented with a 10 day history of worsening hematuria. What initially looked like a severe lower urinary tract issue quickly evolved into a critical care scenario. Abdominal ultrasound revealed a large echogenic non shadowing mass occupying the bladder lumen, along with multiple small broad based pedunculated lesions along the bladder wall. Over the next several days, the cat became progressively anemic, tachypneic, and lethargic, ultimately requiring a whole blood transfusion.
Despite initial stabilization, the following morning brought a sudden crash. The cat developed peracute bradycardia, bradypnea, and unresponsive mentation. A rapid transfusion of packed red blood cells resulted in swift improvement in cardiovascular and neurologic status, confirming ongoing hemorrhage as the driving cause.
Given the severity and persistence of bleeding, cystoscopy was pursued. Endoscopic evaluation revealed a large blood clot occupying approximately half of the bladder lumen, multiple proliferative masses arising from the bladder wall, and two pulsatile bleeding vessels associated with one of the lesions. Biopsies were obtained for histopathology, followed by electrocautery of the actively bleeding vessels. Sclerotherapy of the entire urinary bladder was also performed to further control hemorrhage. A second packed red blood cell transfusion was required the following day, but after that point, the bleeding stabilized. The cat was discharged 48 hours after cystoscopy.
Diagnosis and Medical Management
Histopathology confirmed urothelial cell carcinoma. Given the extent of disease and the clinical context, definitive surgical or radiation therapy was not pursued. Instead, meloxicam was prescribed as a palliative medical therapy. Over the ensuing weeks, the cat continued to improve clinically. No additional transfusions were needed, and complete resolution of anemia was documented 20 weeks after discharge.
Urothelial cell carcinoma is the most common malignant tumor of the feline bladder, yet reports of severe hemorrhage leading to hypovolemic shock in cats are scarce. This case challenges the assumption that feline bladder tumors typically present as slow, insidious diseases and reminds clinicians that catastrophic bleeding is possible. Equally important, it demonstrates that endoscopic interventions such as electrocautery and sclerotherapy can provide long term control of life threatening hemorrhage. For cats that are poor surgical candidates or when owners decline aggressive oncologic therapy, these techniques can serve as effective palliative options with meaningful quality of life benefits.
Clinical Takeaways for Practice
Persistent or progressive hematuria in cats warrants early imaging and consideration of neoplasia. Acute decompensation in these patients should raise immediate concern for ongoing hemorrhage and hypovolemic shock. Cystoscopy is not only a diagnostic tool but also a therapeutic one, allowing direct visualization and targeted control of bleeding. Even in the absence of definitive cancer treatment, thoughtful intervention can dramatically alter outcomes.
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