Cats that have urinary obstruction require emergency treatment. Sedation or general anesthesia is needed in all but the sickest patients to allow placement of a catheter into the urethra to flush out the plug or force the stone into the bladder. The bladder is thoroughly flushed and drained through the catheter to remove any remaining sediment. The urinary catheter is then typically left in place for a few days until urethral swelling subsides. Once the catheter is removed, the cat is then evaluated to make sure it can urinate freely before it can be discharged from the hospital. Your veterinarian may also prescribe pain medication, a diet change to decrease crystal-forming tendency, or other drugs to make the cat more comfortable and to help it relax.
In cats with bladder stones that can be flushed into the bladder, a cystotomy(surgical opening of the bladder) is performed to remove the stones (Figure 2). Cystotomy is also performed in cats with congenital outpouchings of the bladder (“vesicourachal divericuli”).
If the obstruction recurs or cannot be relieved, a thorough work-up (including x-rays, cultures, and contrast studies of the bladder and urethra) should be performed before surgery is considered.
If your cat has multiple occurrences that cannot be unblocked or managed medically, and does not have any underlying conditions that could cause recurrence, your veterinarian may recommend a perineal urethrostomy (“PU”), or surgical widening of the urethra. (Figure 2) This procedure is intending to provide a permanent opening that allows crystals, mucus plugs, or small stones to pass out of the urethra; this minimizes the chance of re-obstruction.