Perineal Urethrostomy in Cats

Learning that your pet needs surgery can be an overwhelming experience, especially if you are unsure of what the procedure entails. At Anicira, we work with pet parents to ensure that you are well informed before your pet’s surgery. Our veterinary team provides compassionate care before, during, and after the surgery to ensure that your pet is safe and comfortable.

What is urethral obstruction?

The urethra is the tube from which urine leaves the body. When the urethra becomes blocked, urine becomes trapped in the body which can quickly lead to a build-up of toxins causing animals to become very ill and if not resolved will cause death. This condition, called urethral obstruction, most commonly occurs in male cats.

Causes of urethral obstruction include urinary crystals, bladder stones, inflammation, and tumors. Oftentimes the obstruction occurs secondary to inflammation in the bladder referred to as feline idiopathic cystitis (FIC). This inflammation in the bladder is not caused by infection or trauma but can be related to periods of stress. The inflammation causes the composition of the urine to change and the urine can become thick with mucus or crystals/grit. This material then passes into the urethra and can cause urethral obstruction.

What causes blocked urethra in male cats?

Male cats are more likely to develop urethral obstructions because of their anatomy. The urethra of a female cat is slightly shorter and maintains a consistent diameter. Male cats have a slightly longer urethra that narrows as it enters the penis. The narrowing of the urethra makes it easier for obstructions to occur.

When is a PU surgery recommended?

PU surgery is recommended when a cat has recurrent urethral obstructions or an obstruction that cannot otherwise be removed. Without PU surgery, obstructions can recur even if the original blockage passes.

Pre-Surgical Instructions

Admission Time – Bring your pet to Anicira at 7 am.
Pre-surgical exam – Your pet must be in good health and show no signs of sickness such as coughing, sneezing, runny eyes, or diarrhea.
Medical records – Please bring proof of rabies vaccination if this has not already been provided. If your cat or dog has not been previously vaccinated or lacks proof of vaccination, we will administer a rabies vaccine on the day of surgery. If you have not already sent your medical records, please bring all relevant medical records.

Perineal Urethrostomy (PU) Surgery

Perineal urethrostomy is performed to prevent a urethral blockage so that your cat can pass urine and avoid the life-threatening emergency of urethral obstruction.

Before surgery, our veterinary team will perform a thorough examination to ensure that they are a good candidate for anesthesia. Before this surgery, we require current lab work to assess kidney function and overall health. Many times this has been done at another veterinarian, but if not, we can do this in conjunction with their surgical appointment.

The surgical team will prepare the surgical site by shaving then cleaning the area to remove bacteria and decrease the potential of infection.

Once your cat is prepared, the veterinarian will perform the PU surgery. During the surgery, the cat’s penis will be removed and the veterinarian will create a new urinary opening making the urethra shorter, straighter, and wider. This makes it much less likely that your cat will experience a urethral obstruction in the future.

How to care for your cat after PU surgery

Providing adequate care for your cat after his PU surgery is vital for his recovery.

Anesthesia takes 24 to 48 hours to wear off.

• Your cat will be groggy during this time period.
• Keep your cat confined in a secure, quiet, and comfortable space. We recommend a crate or a small room.
• Isolate him from other pets and children while recovering.

Make sure your cat wears his Elizabethan Collar (E Collar / Cone)

• Your cat’s surgical site will take 10 to 14 days to heal. During this period, they should wear an e collar at all times.
• Allowing your cat to lick their incision can lead to infection and scarring.

Offer food & water after surgery

• When your cat returns home, offer them food and water
• Anesthesia may cause nausea so your cat may not be interested in food
• If vomiting occurs, wait until the next day to give more food.
• Resume normal feeding the day after surgery. Your cat’s appetite should be back to normal within 24 hours.
• If your cat refuses to eat, you may try offering a bland diet such as white rice and boiled chicken breast while they regain a normal appetite.
• Please do not feed your cat junk food, table scraps, or milk

Give pain medication

• Your cat is being sent home with oral pain medication. Please follow the instructions on the label.
• If possible, please give the pain medication with food. If your cat has no appetite please ensure that they still take the pain medication.
• OTC pain relievers such as Tylenol and Advil are toxic to cats. Please do not give these to your cat.

Check surgical incision daily for the first week

• Your cat’s surgical site will be healing for 10-14 days.
• What you see on the day of surgery is what we consider normal
• There may be moderate bruising.

Discharge may be present for 2-3 days after surgery

• Gently clean any discharge from your cat’s hind legs but avoid touching the surgery site.
• Your cat must be wearing an e-collar at all times during their recovery. Therefore, grooming may be difficult.
• Do not disturb the blood clot or attempt to clean the surgical site.
• We recommend keeping your cat confined to a large crate or small room with plenty of bedding that can be easily laundered.

Limit your cat’s activity and keep them clean, dry, and warm for 10 days after surgery.

• Keep your cat away from all potential hazards (including stairs)
• Cats should be kept indoors so they can stay clean, dry, and warm.
• No running, jumping, playing, swimming, or other strenuous activity.
• Do not bathe your cat or have it groomed during the recovery period.

Monitor urination closely

• Make sure that your cat is passing urine at least once every 24 hours.
• Schedule an appointment for suture removal
• Your cat has sutures that need to be removed in 10-14 days
• Oftentimes, they need to be sedated for suture removal, so you may be asked to drop off your cat for a few hours.

Your veterinarian may recommend feeding a special urinary diet. Please follow all dietary recommendations from your veterinarian.

Urine culture and urinalysis should be performed 3 months after surgery

How effective is PU surgery?

Perineal urethrostomy is a common, safe, and highly effective procedure. It prevents the likelihood of developing a life-threatening urethral obstruction. However, it does not prevent episodes of feline idiopathic cystitis (FIC) so if this was the cause of the obstruction your cat may still have episodes of bladder inflammation and discomfort.

Rare, but serious surgical complications:

Subcutaneous (under the skin) leakage of urine

• If there is a tear in the urethra outside of the surgical field and urine leaks under the skin and not outside the body this can cause a life-threatening emergency.
• Signs of this are significant bruising around the surgical site and on the cat’s lower abdomen. Sometimes you may be able to feel a fluid build-up under the skin.
• This usually occurs within the first 1-5 days after surgery.
• Treatment is hospitalization with an indwelling urinary catheter for 5-7 days. This allows the urethra to heal around the catheter.

Stricture of the urethra

• Scar tissue that forms and restricts urine from leaving the body
• Typically occurs within 6 weeks following surgery
• Requires a second surgery

Atonic Bladder

• A muscular dysfunction that makes it difficult for your cat to urinate
  May cause leaking of urine

Bleeding

Incontinence

Bladder infection

Infection of the surgical site

Please contact Anicira, your primary care veterinarian, or an emergency clinic if any of the following occur:

• No urine passed for more than 24 hours
• Pale gums
• Severe pain, depression or weakness
• Vomiting or Diarrhea
• Labored breathing
• Decreased appetite for more than 24 hours
• Lethargy lasting more than 24 hours
• Abdominal pain and swelling