Emphysematous cystitis in dogs and cats: A scoping review

To better characterize emphysematous cystitis and support evidence-based guideline development, a scoping review was performed to identify available evidence pertaining to risk factors, diagnosis, clinical management and outcome of emphysematous cystitis in dogs and cats. After deduplication and screening, 28 references were eligible for data extraction, describing disease in 101 (93%) dogs and 8 (7.1%) cats. The median age was 8.5 y (range 1-13 y) from the 42 animals for which age data were presented. Signs of lower urinary tract disease (excluding hematuria) were identified in only 23% of cases at presentation. One or more of gross hematuria, abdominal pain or lower urinary tract disease signs were present in 83/101 (82%) cases. Thirty-seven (37%) animals had gas accumulation in the bladder wall only, 24 (23%) in the bladder lumen only, 38 (38%) in both the bladder wall and lumen. Escherichia coli predominated, being identified in 68 (68%) cases and amoxicillin-clavulanic acid was the most common antimicrobial administered (12/45, 27%). Treatment regimens were highly variable and not always clearly described, but when reported (n = 18) ranged from 18 to 35 days (median 30d). Outcome was reported for 58 (53%) cases; 46(79%) recovered after initial treatment, one (1.7%) recovered after a single relapse, and 11 (19%) died or were euthanized. No controlled trials evaluated treatment regimens and observational studies had limited treatment information, highlighting evidence gaps for management of this disease.