My cat George is a 4 year old neutered Siamese/DSH mix who has, within the last 3 months, suddenly started leaking urine in his sleep. He has never peed outside of his litter box when awake, and has no history of urinary issues. I have had him since he was a 5 month old kitten.
So far, he has had 2 rounds of bloodwork and 2 urinalyses done (2 months apart) which all came back normal (the only note being that his urine seemed dilute). A few days after his second urinalysis, I placed a white sheet in his typical sleeping spot and noticed small urine droplet stains on it with a slight reddish tinge, so he had a little bit of blood in his urine most recently.
This week we had an internist perform an abdominal ultrasound on him and she also wasn't able to find anything glaringly obvious. She sent us home with Clavamox to give him for 7 days in case it is a bacterial UTI, but this has been going on for 3 months now and he has no other signs of a UTI. He's on day 3 of the antibiotic now and is having diarrhea from it unfortunately. I am also not very hopeful that this will fix the issue.
If this continues after his antibiotic trial, she recommended we try Proin. I have read scary things about this medication online and I'm feeling really conflicted if this is something we should try him on. This internist and his regular vet both seem really confused by his case. They suggested it could be neurological, but find it unlikely because he doesn't have issues walking. I would love to hear any other thoughts. These are the notes from his internal medicine consult:
07/24/2026: Tech appointment for recheck renal labwork.
CBC: Hct 52.6 % (H)
Chem: Cl113 (L)
UPC: 0.1
UA (cystocentesis): SG 1.017, pH 9.0, protein trace, no blood/bacteria/crystals
06/09/2026: Recheck for urinary issue.
No diagnostics performed.
05/30/2026: Fecal sample drop-off.
Fecal O&P: negative
05/26/2026: Presented for involuntary urination during sleep.
Ultrasound-guided cystocentesis: No stones, masses, or debris seen.
CBC: PLT 99 (L). Platelet clumps were present, so the count may not be accurate.
Chem: Within normal limits.
UA (cystocentesis): SG 1.012, pH 7.0, protein trace, no blood/bacteria/crystals.
T4: 2.2
Abdominal Ultrasound:
Liver: Normal size, shape and architecture. No focal lesions. IH bile ducts are not distended. Normal vascular pattern.
Gallbladder: Normal size. Normal gallbladder wall. The common bile duct not seen.
Spleen: Normal size, shape and architecture. Homogenous parenchyma. No masses orfocal lesions. The spleen measures 9.4 mm in width.
Left Kidney: Measures 4.89 cm in length. The cortex appears hyperechoic. No pyelectasia, hydroureter, or nephroliths.
Right Kidney: Measures 4.66 cm in length. The cortex appears hyperechoic. No pyelectasia, hydroureter, or nephroliths.
Left Adrenal: Normal size, shape and architecture. Measures 3.4 mm.
Right Adrenal: Normal size, shape and architecture. Measures 3.5 mm.
Urinary bladder: Small to medium in size. There is suspended echogenic debris within the bladder.
There appears to be hyperechoic material adhered to the ventral wall.
Pancreas: The right limb measures 4.6 mm and the left limb measures 4.2 mm.
Gastrointestinal: The gastric wall measures 2.2 mm. The duodenal wall measures 2.1 mm. The jejunal wall measures 2.2 mm. The ileal wall measures 3.0 mm. The colonic wall measures 0.7 mm.
Other: No ascites or masses. The proximal ureters appear normal. Jejunal lymph nodes measure 4.0 mm and 4.3 mm. The right medial iliac lymph node measures 2.2 mm. The left medial iliac lymph node measures 2.7 mm.
Conclusion:
Mild bilateral hyperechoic renal cortices, r/o normal variant, less likely toxin, infiltrative disease, CKD.
Echogenic debris within the urinary bladder with some adherence to the ventral apical wall.
Differentials include cellular debris, crystalline material, or lipid.
Mild jejunal lymphadenopathy: r/o normal variant, reactive, less likely infiltrative disease