PERINEAL URETHROSTOMY

It is common for male cats to develop an obstruction in the urethra which is the tube that drains urine from the bladder through the penis. There are various causes fro the blockage and are often inflammatory material, crystals, mucus or kidney stones which have passed into the bladder (known as calculi). It is difficult to determine the exact reason for the formation of inflammatory material and stones, however it is possible that diet and viral infections have an influence on it. Cancer, scarring as a result of previous injury and trauma are other possible causes. The urethral size does not decrease after neutering in cats like it does in some other species.

Cats are mostly affected between the ages of 1 to 10. Cases can be mild to severe. Cats often show signs in the beginning stages of discomfort and urinary inflammation, it can be urination on a frequent basis, difficulty urinating, blood in the urine, pain during urination and urinating in inappropriate place, namely, outside of the litter box.

Cases are often resolved within 5-7 days. However, many cats face a recurrence within 6-12 months, Symptoms can become harsh and life threatening in cases where the obstruction does not allow urine to exit the body. In this cases, the cat may attempt to urinate in its litter tray, but will be unable to produce the urine. The pain and discomfort can cause the cat to cry, hide and become restless, eventually you can expect them to become lethargic and lose their appetite. If the urethra is completely obstructed, the cat can die in 3-6 days time. You will be able to feel a large, painful bladder found in the back part of the belly, however, this is not the case if the bladder has ruptured.

An evaluation for risk factors of lower urinary tract problems, was performed. Risk was found to be increased in instances where cats are kept inside, fed dry food, specific behaviors such as nervous/aggressive/fearful, being in a household with other cats and stress. There are reportedly more cases of urinary obstructions in Winter months. Male cats are more susceptible to bladder inflammation which results in a mucous plug (also knows as Feline Urologic Syndrome [FUS]). Congenital Outpouchings in the bladder “vesicourachal diverticuli” can increase the likelihood of a bladder infection, but can also be caused by chronic inflammation.

Usually, if cats have signs of inflammation in the urinary tract, blood tests will be done to evaluate the presence of infection or systemic illness. A urine sample may also be evaluated for evidence of crystals, it may be sent in for culture. However, bacterial infections are uncommon in cats’ bladders. If infections are recurrent, the presence of calculi (stones) and other materials in the bladder or kidneys, will be determined through the process of an x-ray. During the x-ray, contrast material my be injected into the bladder to accurately determine if an anatomic cause is affecting the cat’s urine.

If a cat is suffering from a urinary obstruction, emergency treatment is often necessary. Patients are usually sedated or go under general anesthesia (the sickest patients are an exception) in order to place the catheter in the urethra. This is used to either force the obstruction into the bladder or to flush it out completely. A thorough flushing and drainage of the bladder will take place through the catheter which will ensure any remaining sediment is removed. The catheter is then usually left in place until the swelling of the urethra subsides. After removal of the catheter, an evaluation will take place to ensure proper urination before the patient is discharged. Pain medication may be prescribed by your veterinarian as well as a diet change and other medication to try and ensure comfort and prevent future formation of crystals.

A cystomy ( opening of the bladder surgically) is performed on cats that have stones which can be flushed into the bladder. If cats have congenital bladder outpouchings (vesicourachal divericuli), cystomy can also be performed.

In the case where the obstruction is recurring or has no potential for relief, a complete and thorough work-up should be completed before considering surgery. This will include x-rays, contrast studies of both the urethra and the bladder as well as cultures.

A perineal urethrostomy (PU) may be recommended by your veterinarian if the cat suffers multiple recurrences of the blockages which cannot be managed or unblocked medically and if there are no underlying conditions which result in this issue. This procedure involves widening the urethra surgically. Essentially, the surgery will allow crystals, small stones and mucus plugs to pass through thr urethra without causing an obstruction.

Using paper or pelleted litter is recommended for a few days post-surgery. A urinary catheter may be required for 2-3 days after an operation for cats who have urine leakage under the skin or severe swelling. Self-trauma to the surgical site should be prevented by wearing an E-collar for 10-14 days after surgery. The cat may or may not need sutures removed 10-14 days after surgery, this is dependent on whether your veterinarian used absorbable sutures or not.

Swelling or bleeding may occur after surgery. Without proper care to the surgical site, stricture (narrowing and scarring) may occur. This may result in complete blockage or recurrence of symptoms. A bacterial urinary tract infection occurs in 25% of patients within the first year after this procedure. Stone formation and bladder inflammation is not prevented by a perineal urethrostomy.