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Perineal Urethrostomy

Perineal Urethrostomy

Perineal urethrostomy is a surgical procedure performed in male cats to amputate the end of the penis which contains the narrowest portion of the urethra (the tube which transports urine from the bladder to the outside). 

This procedure is usually performed on patients who suffer from either repeated urinary obstructions, or who have a urinary obstruction which can not be cleared. 

Male cats are much more likely to develop an obstruction compared to female cats as their urethra is longer and narrows towards the end.  It is this point which can become blocked with either mucous, blood clots or stones. 

Most cats who present to us with this condition will have a history of urinary tract disease.  Feline Lower Urinary Tract Disease (FLUTD) is a common condition in cats, and risk factors for this condition include:

  • Male neutered cats
  • Indoor cats
  • Overweight cats
  • Multi-cat households

Cats who are naturally anxious will also be more prone to developing FLUTD as stress plays a very large role in the development of feline cystitis. 

In most instances there are important changes that can be instigated at home to reduce the risk of your cat developing FLUTD. 

  • Have at least 1 litter tray per cat available, with 1 additional ‘spare’ tray
  • Make sure plenty of water is available in a form which your cat will drink from - some cats will only drink from water fountains, a dripping tap, or water glasses
  • If your cat won’t drink water, add wet food into their diet to increase water intake
  • Encourage exercise and activity, especially in indoor cats
  • Consider use of a pheromone diffuser to help reduce anxiety

Patients who present with an acute urinary obstruction will need stabilisation prior to surgery.  A urethral obstruction is a medical emergency, as if left untreated it can lead to irreversible kidney disease, dangerously high potassium levels and is very painful.  Cats will often be seen to strain to urinate, or may pass small frequent drops of urine or blood. 

Cats will be started on intravenous fluid therapy, and any increase in kidney enzymes will be treated prior to surgery.  A urinary catheter will be placed under general anaesthesia to try and unblock the urethral obstruction.  This may need to stay in place for 24-48hours before the patient is stable enough to undergo surgery.

Surgery is performed to excise the end portion of the urethra.  The wider portion of the urethra further up is then sutured to the skin to create a wider opening. 

Following surgery, cats will remain in the hospital for at least 24hours to ensure they are urinating freely.  It is common for cats to pass blood tinged urine in the first few days following surgery.   It is essential that cats are not allowed to lick the surgical site until it is fully healed, and so they will be fitted with a buster collar which they must wear for the first 2 weeks following surgery, or until your vet advises that it can be removed.   

Following surgery most patients have a very good prognosis.  This procedure reduces the risk of urinary obstruction in the future, however it doesn’t stop cats from developing FLUTD and it can increase the risk of future urinary tract infections due to the wider diameter of the urethra.    

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