Perineal Urethrostomy, commonly abbreviated PU, is the surgical treatment of choice for male cats that have recurrent episodes of urethral obstruction.
Cats as a species are highly susceptible to environmental stress and particular cats will develop a condition known as “feline idiopathic cystitis” or FIC. FIC results in inflammation of the urinary tract and produces symptoms similar to a urinary tract infection. Unfortunately, male cats have a narrowed urethra when compared to female cats so this inflammatory response can actually lead to urethral obstruction, and prevent them from urinating. The bladder will become hard and distended as urine is unable to escape. When cats are obstructed or “blocked” they display signs of straining to urinate, frequent visits to the litter box, vocalizing in pain, and will act lethargic or hide. Urinary obstruction is considered a medical emergency and if obstruction is prolonged serious kidney damage, cardiac arrhythmias, and death can result. Because of this we recommend immediate treatment by a veterinarian whenever these signs are noted. Typically the obstruction is resolved by passing a urinary catheter under sedation or anesthesia, but the recovery period can be days in a hospital while the inflammation resolves.
Male cats can also become obstructed for less common causes such as bladder stones or stricture of the urethra from trauma.
Recurrent episodes of urinary obstruction can be frustrating for owners as veterinary costs quickly add up for emergency visits. In some instances owners elect to euthanize their pets because they cannot handle the emotional and financial toll that repeated life-threatening episodes of urinary obstruction causes.
Fortunately, PU is a surgical option readily available at the DVSC that is highly successful at preventing recurring obstruction long-term. The PU procedure involves removal of the narrowed portion of the feline urethra. This procedure results in an enlarged urethra opening, which greatly reduces the risk for urinary obstruction. It is important to note this procedure does not reduce the risk of FIC, or other causes of obstruction, just that when it does occur the chance of obstruction is much less. FIC can then be managed on a non-emergency basis by your family veterinarian. If obstruction is the result of bladder stones then medical therapy is required to prevent stone re-formation.
In some cases a PU is performed on an emergency basis when a cat is obstructed and a urinary catheter fails to relieve the obstruction.
Following the PU procedure cats are usually remain in the hospital for a few days and then are discharged home. Cats continue to urinate normally afterwards. Complications can occur from this procedure, although most are minor. The most significant post-operative complication is that of stricture, or scaring down, of the new urethral opening. This rarely happens, but if it does surgical revision may be necessary. Rarely, cats may become more susceptible to urinary tract infections (UTI) as a result of this procedure. UTIs are usually easily recognized and resolve with simple antibiotic therapy.
The PU procedure has been investigated in many veterinary university studies all showing excellent results for long-term, disease-free outcome. Surveyed owners in these studies have reported high satisfaction for the procedure even when urinary tract infections occur, as their cats no longer have the risk of life-threatening urethral obstruction.
Author: Dr. Eric Hans