Pandora Syndrome – Beyond the Bladder and LUT Signs

What is Pandora Syndrome ? Is this terminology more helpful than FUS or FLUTD or IC ? Results of studies over the past 20 years indicate that idiopathic/interstitial cystitis in cats is the result of complex interactions between the bladder, nervous system, adrenal glands, husbandry practices, and the environment in which the cat lives. A recent review emphasizes that many cats with a diagnosis of FIC have lower urinary tractpredominant clinical signs that are part of a larger systemic disorder referred to as “Pandora Syndrome” 1 . Clinical problems outside the lower urinary tract are common in those with a diagnosis of FIC and include signs related to the GI tract, respiratory system, skin, central nervous system, cardiovascular system and the immune system. It has been traditional to refer to cats that have obvious LUT signs as those having “feline urological syndrome”, “feline lower urinary tract disease”, or “feline interstitial cystitis” but this method of naming the disease focuses on the organ with the predominant clinical sign rather than a thorough evaluation of the entire cat and all of its organ systems. A diagnosis of Pandora Syndrome would apply to those cats that exhibit clinical signs in other organ systems (in addition to the LUT), waxing and waning of clinical signs associated with stressful events that presumably activate the stress response system, and undergo resolution of severity of clinical signs following effective environmental enrichment.