Reframing litterbox issues as "house soiling" rather than "inappropriate elimination" helps caregivers better understand their cat's needs and seek appropriate care, according to Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFC.

Rethinking feline house soiling: What you should know

Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFCP, details 3 key takeaways from her session “Litterbox Lessons: Keeping Cats in the Litterbox,” which she presented at the Fetch dvm360 Conference in Nashville, Tennessee.

First, she stresses the importance of offering caregivers empathy and support, helping them move away from blame-based narratives surrounding cats, like "spiteful" or "inappropriate" behavior, and instead viewing the issue as "house soiling"—a sign that the patient may be struggling.

Second, a full medical and behavioral workup is key. This includes not only a urinalysis and physical exam but also consideration of pain and other emotional or behavioral factors.

Stress management is also crucial, according to Kucera. Creating safe spaces, reducing household stressors, and addressing multi-cat tension can significantly improve outcomes for both the patient and client.

Below is the interview transcript, which has been lightly edited for improved clarity:

Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFCP: 

We should do our best to provide caregivers with hope and support and validate their feelings. And I understand that that's not addressing the medical issue just yet, but as a VTS and behaviorist who commonly deals with caregivers who have been unfortunately struggling with this for really long periods of time, the emotional burden can be really challenging and unfortunately, there is quite a few labels to describe cats, like “spiteful,” or even we call it “inappropriate elimination”—that's already problematic. There's nothing inappropriate about it. The animal is trying to essentially communicate, “I'm struggling with severe stress and/or medical and/or behavioral issues” versus what I call it, “house soiling.”

But when caregivers hear things like “my cat's spiteful,” “inappropriate elimination”—labels aren't really helpful to describe the behavior or its cause, so we can't help, but also it causes caregivers to create—even though they love their cats—to create narratives around like “my cat should know better, they're jealous,” like all of these kind of dangerous narratives where they may not reach out to someone like me or even to your veterinary clinic to get an appropriate medical workup. 

So, I think a big thing would be to provide caregivers with hope and support. Understand, “oh, this is so frustrating.” Like, address that, but then also share with them, “I understand how frustrating this can be. I know sometimes it feels like your cats are spiteful, but that's a human thing. I love humans, but that's a human thing.” And then kind of touch on, similar to when your child—I use a lot of analogies— is throwing up because they're not feeling well, your cat is expressing they're not feeling well. So just that will make such a big difference.

 And then the second thing, I think understanding the full context. So, it's important to obtain more information just like we would with any medical condition. So of course, we want to explore medical possibilities, which, yes, starting with the cystocentesis and a good exam is great, but let's say this cat is repeatedly having these cystitis workups or urinary issues, we should definitely be recommending radiographs and further diagnostics. But also kind of think outside of the urinalysis.

I had a cat once house soiling due to fleas. The discomfort that the fleas caused that animal—understandably—increased their stress and caused that house soiling.

I see pain contribute to more than 60% of my cases, whether it's osteoarthritis pain, GI pain, so of course, bladder pain. So again, we really want to explore those medical possibilities but also consider behavioral and emotional factors.

 And then the third, I think it's really important to manage and reduce stressors. We all know that a cat's stress organ is their bladder, so identifying and avoiding triggers is a big thing. For example, if [clients are] like, “when friends come over, my cat hides for 5 hours and doesn't return to baseline by coming out and being themselves in 8 hours.” Hey, we're going to set up a safe space for that kitty before people come over with enrichment and make sure it's somewhere they choose to be, not just putting them in a room that causes stress, and we're going to prevent them from interacting with that stranger at all. 

Or if you notice—in many cases this is something I see—there is some multi-cat tension. There are some simple things we can do.

Sometimes that might be creating safe spaces and separating cats, depending on the severity of the tension. But increasing resources, meeting their needs. If outdoor cats are a trigger, sometimes I just have my clients as immediate management—“hey, tape up some sheets to your windows.” And also there's really great like window decals that allow the sun to come in, but things are a little fuzzy outside.

So, do your best to manage and reduce stress. Those would be my 3 takeaways.

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Internalized, harmful narratives about feline behavior can prevent caregivers from seeking appropriate care, according to Tabitha Kucera, RVT, VTS (Behavior), CCBC, KPA-CTP, FFC.

Image Credit: © ryanking999 - stock.adobe.com

At the 2025 Fetch dvm360 Conference in Nashville, Tennessee, on May 31, 2025, William Rausch, DVM, DACVIM (Cardiology), presented “Torsemide: When, How and Why I Use It in Canine Heart Failure.” Rausch highlighted that loop diuretics remain the cornerstone of congestive heart failure (CHF) therapy but noted evolving evidence suggesting torsemide may outperform the long-standing “workhorse” furosemide in certain clinical scenarios.

Rausch explained that torsemide’s pharmacokinetic profile may offer advantages over furosemide. In dogs, torsemide has a half-life of approximately 12 hours compared with 5 to 6 hours for furosemide, allowing for sustained diuresis with fewer daily doses. He stated, “Torsemide just might be that next step, which is...a super exciting thing…. Lasix has always been such an assumption, and it’s been a workhorse, and it’s been wonderful. But I think there may be more benefit to be had with torsemide.” He further emphasized that torsemide is “about 10 to 20 times as powerful” on a milligram-to-milligram basis and noted, “I’ve never treated a dog with more than twice-a-day torsemide, ever. And many of my patients are on [once-daily].”¹

To substantiate these claims, Rausch reviewed the TEST study, a prospective, randomized, blinded, positive-control clinical trial conducted in Europe. Enrolling 366 dogs with stable CHF secondary to degenerative mitral valve disease, the trial compared twice-daily furosemide to once-daily torsemide while maintaining all other cardiac medications (eg, ACE inhibitors, pimobendan, spironolactone) unchanged. Investigators defined clinical success using a composite scoring system that included thoracic radiographs, physical examination findings, and owner-reported signs (cough, appetite, activity). A second end point was the risk of death, euthanasia due to CHF progression, or the need to escalate diuretic dosing. At 3 months, 60% of torsemide-treated dogs vs 55% of furosemide-treated dogs “remained stable,” demonstrating noninferiority of torsemide.

More strikingly, Rausch highlighted, “over the course of those 3 months, about 22% [of dogs on furosemide] died or had severe worsening heart failure. In the torsemide group, 11%. So, a 50% reduction in your risk of dying or having worsening heart failure.” Despite torsemide’s greater potency, mortality due to renal failure was similar between groups (2% furosemide vs 4% torsemide; not statistically significant).

 He said that higher rates of polyuria/polydipsia and mild, nonserious increases in blood urea nitrogen or creatinine were seen with torsemide, but that in over 90% of cases, no dose adjustment was required.

Rausch then summarized a US-based, noninferiority trial beginning at first CHF diagnosis rather than stable disease. Dogs presenting in CHF were randomized to receive either once-daily torsemide or twice-daily furosemide, along with other indicated cardiac therapies. At 3 months, torsemide again demonstrated noninferiority in maintaining clinical stability; 23% of furosemide-treated dogs experienced death or CHF-related decompensation vs 13.7% of torsemide-treated dogs, replicating the approximately 50% risk reduction observed in TEST. Both trials reported higher rates of polyuria/polydipsia and transient, nonserious renal parameter elevations with torsemide.

From a clinical standpoint, Rausch advocated converting furosemide to torsemide using a sliding-scale potency ratio, approximately 1:10 at lower furosemide doses and up to 1:15 to 1:20 at higher doses. He recommended obtaining baseline renal panels, rechecking bloodwork at 48 to 72 hours, and scheduling follow-up exams and labs at 1 month, mirroring trial surveillance frequency.

Owner compliance and practical considerations

On owner compliance, Rausch stated, “There was better compliance in the torsemide group than the furosemide group. And these are people in a clinical trial…you’d think they’d be 100% compliant, right? It’s just like real life.”

 He also stressed selecting clients who would reliably return for monitoring: “I choose my clients pretty carefully who I’m doing this on. I wouldn’t just do this for any client…I want you to come back in a week for blood work with our technicians—they’re going to do that.”

Rausch communicated to the attendees that torsemide offers at least equivalent efficacy to furosemide in canine CHF, with the added benefits of halved morbidity and mortality over 3 months and improved owner compliance due to once-daily dosing. Rausch suggested that these findings support earlier adoption of torsemide, particularly for patients struggling with high-frequency dosing or recurrent decompensations. Further long-term studies may clarify whether torsemide’s short-term advantages translate into prolonged survival and enhanced quality of life.

Rausch W. Torsemide – when, how and why I use it in canine CHF. Presented at: Fetch Nashville. May 31, 2025. Nashville, Tennessee.

Chetboul V, Pouchelon JL, Menard J, et al. Short-term efficacy and safety of torasemide and furosemide in 366 dogs with degenerative mitral valve disease: the TEST study. 

. 2017;31(6):1629-1642. doi:10.1111/jvim.14841

Besche B, Blondel T, Guillot E, Garelli-Paar C, Oyama MA. Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: the CARPODIEM study. 

. 2020;34(5):1746-1758. doi:10.1111/jvim.15864

Articles

William Rausch, DVM, DACVIM (Cardiology), explains that torsemide offers at least equivalent efficacy to furosemide in canine CHF while significantly reducing short-term mortality/worsening events by approximately 50%.

Torsemide for canine CHF: Emerging evidence and clinical benefits

Approximately 20% of all spayed female dogs and up to 30% of large-breed dogs will develop urinary incontinence.

 Although any dog can develop incontinence, the condition most commonly affects large-breed female dogs who are middle-aged or older.

Typically, incontinence presents as an intermittent or continuous dribbling of urine alongside episodes of normal urination, according to Mark J. Acierno, DVM, MBA, DACVIM (SAIM), professor at Midwestern University College of Veterinary Medicine and associate dean for the school’s Clinical Affairs in Glendale, Arizona. At the Fetch dvm360 Conference in Nashville, Tennessee, Acierno led a lecture on the topic.

Incontinence can be caused by bladder spasms, ectopic ureters, an inability of the bladder to dilate, damage to the nerves that control micturition, and urethral sphincter incompetence (USMI)—also called spay-related incontinence. Still, 85% of canine incontinence cases are caused by either ectopic ureters or urethral incompetence.

To diagnose incontinence in a dog, it is important to obtain a thorough history. According to Acierno, the discussion should also include questions about timing. “Knowing the timing is really, really important because a middle-aged female dog who's spayed, who's wetting its bed at night, is a very, very different situation than the puppy that is dribbling urine constantly, right?” said Acierno during his talk at Fetch.

 “So, the history is really, really important.”

“Is it only at night? And is it happening 

 the bed? Because if it's happening next to bed, then the dog woke up, [went] next to the bed, peed on the floor, and went back to sleep, right?” Acierno continued, emphasizing questions that should be considered when discussing the patient’s history. He explained that the scenario would indicate something different if the patient were urinating directly 

 the bed. Considering the timing of events surrounding urination can help clinicians differentiate incontinence from other conditions such as nocturia, pollakiuria, or polyuria.

Part of the diagnostic process when evaluating a canine patient for incontinence includes obtaining a detailed examination of the genitalia. Veterinarians should look for anatomic abnormalities. According to Acierno, patients with incontinence will have wet or stained fur. Scalding and dermatitis will also be present.

“If we don’t [see these], the [patient] is probably not incontinent. It's probably something else,” said Acierno.

He also recommends asking clients to prevent their dog from urinating before the appointment and wait until during the appointment, as observing how the patient urinates can offer valuable information. Things to look for include whether the strain is normal and whether the patient postures correctly after urinating.

After observing the patient urinate and measuring the output, a complete and thorough diagnostic workup should be conducted. This should include a complete blood count, serum chemistry, and urine analysis with aerobic culture.

 Conducting a blood count, Acierno explained, will help in ruling out systemic illnesses while urine analysis can help determine if cystitis is causing the incontinence. Additional triggers of incontinence include urinary tract infections, which can themselves result from ectopic ureters and anatomic abnormalities.

When it comes to imaging, although radiographs can be helpful, ultrasounds are preferred—this method has a higher sensitivity rate in detecting uroliths, tumors, and, in certain cases, visualizing ureters. According to Acierno, radiographs miss approximately 27% of uroliths. Meanwhile, ultrasounds will yield only approximately 6% false negatives.

When looking at an ultrasound, Acierno shared he also looks to see if the bladder is mostly empty. “If it doesn't, then we have a different set of problems, right?” he said.

Although this step is commonly missed, conducting a neurological examination is a crucial part of the incontinence exam, according to Acierno. Spinal cord disorders above the fifth lumbar vertebra, ie, upper motor neuron lesions, can cause the bladder to empty involuntarily and reflexively, accompanied by increased resistance of the external urethral sphincter. Patients with these disorders may exhibit paresis, paralysis, hyperreflexia, decreased proprioception, and decreased pain perception.

For lower motor neuron lesions, or lesions of the sacral spinal cord, there is inhibition of bladder sensation from traveling up the spinal cord. Moreover, sacral lesions can affect the pudendal nerve, leading to loss of external sphincter resistance.

 Dogs with these lesions typically dribble urine and present with an easily expressed and overdistended bladder. Voiding will also be rare in these patients as they have lost bladder sensation.

As part of the neurological exam, patients may be taken for a walk. “You can get a dog, take it for a walk, and watch it walk, and do we see gait abnormalities?” said Acierno. “Another thing I'll do [is] look at the top of the nail, and if they're scuffed, it means they’re dragging [their] feet, which could be indicative of [lumbosacral] LS disease, right?"

According to Acierno, gently squeezing the distal portion of the penis or edge of the vulva and watching for a reflex contraction of the anus can also be used to assess afferent and efferent function of the pudendal nerve.

As incontinence presents ongoing challenges for veterinary professionals and caregivers, performing a thorough incontinence exam on patients is crucial for accurate diagnosis. To begin, the thorough history of the patient must be discussed with the client, with special focus on the timing of events surrounding urination. Veterinarians should also perform a physical examination and watch for any anatomic abnormalities or clear signs of incontinence, followed by laboratory work and, in some cases, imaging. Lastly, the neurological examination plays a crucial part in the exam and must not be overlooked.

Weir M, Hunter T, Ward E. Urinary incontinence (urethral incontinence) in dogs. VCA Animal Hospitals. Accessed June 5, 2025. 

https://vcahospitals.com/know-your-pet/urethral-incontinence-in-dogs

Acierno M. How do we turn off this spigot? Managing canine incontinence. Presented at: Fetch dvm360 Conference; May 31, 2025; Nashville, TN. 

Mark J. Acierno, DVM, MBA, DACVIM (SAIM), professor at Midwestern University College of Veterinary Medicine, offers a detailed run-through of the incontinence exam

Diagnosing canine incontinence

A new digital cytology tool that uses artificial intelligence (AI) to analyze lymph node and skin and subcutaneous masses in nonhuman species is now available for use with the Vetscan Imagyst, a diagnostic platform by Zoetis. The new tool, AI Masses, has the ability to detect potentially neoplastic cells accurately within minutes, according to Zoetis.

Leveraging deep learning algorithms, AI Masses identifies and classifies common skin and subcutaneous masses and lymph node lesions. Clinical pathologists review these insights through Digital Cytology and Add-on Expert Review functions within hours. By providing real-time insights at the point of care, the testing application helps veterinary teams with informed decisions, allowing them to better care for pet owners and veterinary patients.

“Our research shows that up to 75% of pet owners find abnormal results highly stressful. AI Masses is yet another point-of-care capability to deliver results in clinic, further [exemplifying] Zoetis’ purpose to advance care for animals [and] shortening anxious wait times to allow for faster care decisions that help provide the best possible outcome,” Richard Goldstein, DVM, DACVIM (SAIM), DECVIM-CA, global chief medical officer at Zoetis said in an earlier statement.

AI Masses is the seventh testing application for Vetscan Imagyst. Other testing applications for the platform are Digital Cytology, AI Urine Sediment, AI Fecal, AI Equine Fecal, AI Dermatology, and AI Blood Smear.

Vetscan Imagyst works with most practice information management systems. It does not require a dedicated computer, but a high-speed connection in the clinic best supports the technology.

“By empowering veterinary teams with valuable insights into potentially cancerous cells, we are helping to reduce waiting times and alleviate stress for pet owners facing some of the most challenging moments with their beloved pets,” Abhay Nayak, president of global diagnostics at Zoetis, said in a news release.

 “With comprehensive digital cytology capabilities and flexible result delivery options, Vetscan Imagyst AI Masses allows veterinary practices to make timely, individualized treatment decisions.”

AI Masses was first exhibited at the 2025 Veterinary Meeting & Expo in Orlando, Florida.

 It is scheduled to be shown again at the 40th World Veterinary Association Congress held in Washington, DC, in conjunction with the American Veterinary Medical Association Convention, July 18 to 22, 2025.

Zoetis launches AI Masses, the new AI-powered cytologic capability for Vetscan Imagyst. News release. Zoetis. June 2, 2025. Accessed June 5, 2025. https://news.zoetis.com/press-releases/press-release-details/2025/Zoetis-Launches-AI-Masses-the-New-AI-Powered-Cytologic-Capability-for-Vetscan-Imagyst-2025-YhrB1kjmLg/default.aspx

Bautista-Alejandre A. New AI tool for in-clinic cancer screening is announced. 

. February 11, 2025. Accessed June 5, 2025. 

https://www.dvm360.com/view/new-ai-tool-for-in-clinic-cancer-screening-is-announced

AI Masses is the seventh testing application for Zoetis' Vetscan Imagyst platform.

AI cytology tool for masses is launched

Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM), discusses the benefit to all practice staff having the opportunity to earn CPR certification. 

Optimizing the full team to save lives 

Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM), program director for the RECOVER initiative and chief nursing officer for Veterinary Emergency Group, recently led certification courses in veterinary cardiopulmonary resuscitation (CPR) and instruction for basic and advanced life support at the North American Veterinary Community (NAVC) SkillShop in Orlando, Florida. In this video, Yagi discusses the benefit of all team members having the opportunity to learn basic life support techniques and earn CPR certification, and who should pursue an advanced life support course, during a 

The following is a transcript of the video:

Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM): 

There was mention about basic life support being important, not just to the licensed veterinary professionals like veterinarians, veterinary technicians and nurses, but also for front desk staff. If there are small teams that are going to require everyone [or] to be able to participate in CPR, to have enough hands to help the animal, then basic life support is something that anyone can learn, really, to do good chest compressions. And then, [on] the ventilation intubation side, depending on the state laws, it's a little bit different on who can actually be doing that. But giving everyone on the veterinary team the confidence and the ability to jump in and participate in CPR so that we can give the patients the best chance is something that we focus on as well.

: Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM), discusses the unique opportunity for veterinary professionals to learn this emergency rescue technique.

: Dana Varble, DVM, CAE, chief veterinary officer for NAVC, discusses the greater impact of veterinary CPR instruction.

How vet tech skills helps save a human life

: Elizabeth Reed, BSVT, LVT, CCRA, recounts the story of how her veterinary CPR skills helped save a stranger’s life during a roadside emergency.

RECOVER Initiative announces updates to CPR guidelines

: This 2024 article outlines recent changes to RECOVER’s CPR guidelines.

In a recent continuing education session at Fetch Nashville 2025, Mike Barletta, DVM, MS, PhD, DACVAA; Tasha McNerney, CVT, CVPP, VTS (Anesthesia & Analgesia); and Kristen Ward, BSN-RN, RVT, VTS discussed the clinical value of prolonging local anesthetic effects by incorporating low-dose adjuvants in their session titled “Top 7 Local Blocks for Everyday Practice.” Part of their discussion included the use of 3 primary adjuvants—dexmedetomidine, epidural morphine, and buprenorphine—each of which can be integrated into existing local anesthetic regimens to achieve prolonged analgesia and potentially reduce perioperative opioid requirements.

Barletta described adding dexmedetomidine at a concentration of 1 µg/mL of local anesthetic (eg, 5 µg in 5 mL of bupivacaine) as a reproducible method to prolong peripheral blocks from approximately 6 to 8 hours to 10 to 12 hours without clinically relevant bradycardia or hypotension. He explained that dexmedetomidine’s α₂-agonist properties synergize with sodium-channel blockade while inducing localized vasoconstriction, slowing vascular absorption. Barletta noted that “using these teeny, tiny volumes will still increase the duration of your block, but it does not cause any systemic effect,” implying that microdoses suffice to achieve meaningful extension without sedation or cardiovascular compromise. Ward advised labeling any batch-mixed vials (eg, a 50-mL bottle of bupivacaine plus 50 µg dexmedetomidine) and storing them according to the preservative’s expiration date to streamline workflow and ensure consistency.

In the context of neuraxial blocks, Barletta described a standard epidural mixture consisting of bupivacaine (0.5 mg/kg) combined with morphine (0.05 mg/kg). This combination reliably doubles epidural analgesia, he said, extending effects from approximately 6 to 12 hours with bupivacaine alone to 12 to 24 hours when morphine is included. Barletta noted, however, that clinicians must account for morphine‐induced urinary retention, so he would not use this strategy in patients undergoing bladder surgery.

Ward and Barletta also addressed buprenorphine as an adjunct for peripheral nerve and tissue infiltration blocks, noting that it’s important to pay close attention to managing the administration volume. They cited studies whose results showed that adding buprenorphine at 0.005 to 0.01 mg/kg to local anesthetics can double the block duration.

They explained that given buprenorphine's standard concentration of 0.3 mg/mL, achieving a target dose of 0.005 to 0.01 mg/kg as an additive to local anesthetics can sometimes require a larger volume than ideal for certain blocks. Their recommended strategy involves preparing a consistent mixture of buprenorphine and local anesthetic, and then tailoring the injected volume of this prepared mixture to the specific anatomical site. For example, if 0.4 mL of buprenorphine solution (providing 0.12 mg of buprenorphine) is mixed with 1 mL of local anesthetic, the total volume prepared is 1.4 mL. However, for a site with limited capacity, such as a maxillary dental block, the clinician might opt to administer only half of this prepared mixture. This technique allows for better control of the final injected volume while maintaining the intended proportion of buprenorphine to local anesthetic, they said.

Clinical implications and recommendations

The speakers said that integrating these adjuvants into multimodal analgesia protocols can result in lower systemic opioid administration, reduced inhalant requirements, and improved postoperative comfort. The incremental cost is minimal, and the patient benefits can be substantial, they said.

Barletta M, McNerney T, Ward K. Top 7 local blocks for everyday practice. Presented at: Fetch dvm360 conference; May 31, 2025; Nashville, Tennessee. 

Mike Barletta, DVM, MS, PhD, DACVAA; Tasha McNerney, CVT, CVPP, VTS (Anesthesia & Analgesia); and Kristen Ward, BSN-RN, RVT, VTS, shared their approach at Fetch Nashville 2025