What is a Perineal Urethrostomy?

A Ginger Cat Walking Out of a Covered Litter Box

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A urinary blockage is a life-threatening emergency regardless of the species. Male cats, though, are most commonly seen with this issue in veterinary medicine. If your cat has struggled with a urinary blockage, or multiple blockages, your vet may recommend a procedure called a perineal urethrostomy.

What is a Perineal Urethrostomy?

Male cats, in particular, have a urethra that becomes incredibly narrow as it gets closer to the outside of the body. This is why they are the most common type of patient for a urinary blockage.

Cats can be prone to something called Feline Lower Urinary Tract Disorder (FLUTD) and this can involve urinary tract infections, urinary crystal formation, and inflammation of the bladder. If your cat has FLUTD, urinary crystals and blood clots are at risk of getting stuck where the urethra narrows.

A perineal urethrostomy, sometimes simply called a PU surgery, is a surgical procedure in which your cat's urethra is shortened by removing this narrow portion. Doing this means they are less likely to get a blockage in the future.

When Would a Perineal Urethrostomy be Recommended?

Not all male cats that have a urinary blockage will require a PU surgery. If your cat only suffers from one blockage, recovers, and never blocks again they probably will do just fine without one. However, if your cat has a urinary blockage cleared by your vet and then promptly re-blocks, or if they struggle with chronic blockages, they may be a candidate for a PU surgery.

Since this is a procedure that requires general anesthesia there are other considerations to be taken into account before scheduling your cat for surgery. Their age, blood work results, and heart function will all be looked at by your veterinarian. Your cat's risk factor for general anesthesia will be weighed against the benefits of the surgery.

Can My Regular Vet Perform a Perineal Urethrostomy?

Unfortunately, PU surgeries are not as routinely performed as spays and neuters. If this surgery is recommended for your cat you may want to look into having it performed by a board-certified veterinary surgeon as they will have much more experience performing this surgery.

Of course, with higher credentials comes higher expense and the total cost may be more than if your regular vet performed it. You may also have some difficulty finding a board-certified surgeon 'local' to you. These veterinary specialists usually work out of large, referral hospitals.

Having your regular veterinarian perform the procedure may mean you can stay closer to home and it won't be as expensive. You and your vet will have to decide what would be more practical for you and your cat.

Perineal Urethrostomy Aftercare

It is not uncommon for a cat to stay in the hospital the first night after surgery. Your vet will want to make sure that your cat is able to produce urine and urinate. Once home you will want to confine your cat to a small room where you can closely monitor their litter box habits.

You will want to use a low-dust and clay-free litter until your cat is fully recovered from surgery. There are commercially made, paper-based cat litters that are the best substrate to use after a PU surgery. You will also want to keep your cat as quiet and calm as possible, including trying to prevent them from jumping on and off high surfaces.

Your cat will need to wear an e-collar to prevent them from licking at their incision. Unfortunately, surgery suits that some people use for spay recoveries may not be practical for this kind of procedure as they may not fully cover your cat's incision.

If your cat experiences any redness, swelling, oozing, or pain at their incision site, if they seem to be having trouble urinating, or if they don't seem to be acting like themselves a few days after coming home from the hospital, have them seen by your veterinarian.

If your cat is being treated for FLUTD or any other related urinary disorder, it is important to continue that treatment post-surgery. Even though a PU surgery drastically reduces the chances of a cat having a urinary blockage, it does not completely remove it.

A perineal urethrostomy surgery isn't a common procedure at most general practice veterinary hospitals. If you think your cat would benefit from this procedure talk to your veterinarian. They can answer any questions you have about the procedure as well as assuage any concern you may have about putting your cat under general anesthesia.