Perineal Urethrostomy in Cats

What Is Perineal Urethrostomy in Cats?

If you have a male cat who can’t urinate because of an obstruction (blockage) of his urethra—the tube that carries urine from his bladder out through his penis—your veterinarian may recommend a surgery called a perineal urethrostomy.

A perineal urethrostomy (PU) in cats involves making a new exit for the urethra, shortening the pathway that urine must travel to leave the body, and removing the part of the urethra that is the narrowest.

Most male cats won’t need a PU during their lifetime, but this procedure is the most recommended long-term surgical treatment for cats who have repeated blockage of their urethra.

Anatomy of a Cat's Urethra

A male cat’s urethra starts at the bladder and then travels backward toward the tail. Their urethra travels through the penis under their scrotum, creating a pathway from the bladder to the outside of the body. A male cat’s urethra is longer and narrower than a female cat’s, making male cats more likely to experience a blockage.

When a surgeon performs a perineal urethrostomy in cats, they make a cut in the feline’s perineum (space between anus and scrotum). The penis will be removed and the urethra will be sutured (stitched) to the skin, allowing urine to flow directly out of the body. If your cat is not already neutered, he will likely be neutered at the same time.

Why Would a Cat Need a Perineal Urethrostomy?

The most common reason a cat needs a perineal urethrostomy is repeated blockage of his urethra. A perineal urethrostomy in cats would also be recommended if a cat has a blockage of his urethra that can’t be fixed by passing a urinary catheter through his penis into his bladder. If his urethra becomes blocked and he can’t urinate, the condition quickly becomes life-threatening.

Conditions that can cause blockage of the urethra include:

• Urinary stones (urolithiasis)

• FLUTD (feline lower urinary tract disease)

• Traumatic injury to the penis

• Masses/cancer blocking the urethra (rare)

Risks of Perineal Urethrostomy in Cats

Anesthetic procedures always come with several risks. Risks of nearly every surgery include:

• Adverse reaction to anesthesia

• Bleeding

• Infection

• The incision breaking open

• Swelling

One risk specific to perineal urethrostomy in cats is urine leakage under the skin. This could happen if there is trauma to the urethra when the catheter is placed or if there are leaks around the surgery site. The urethra can also become blocked again after surgery, though a urinary catheter is usually left in place for about a day after surgery to keep urine flowing.

The most common complications of perineal urethrostomy in cats include recurring urinary tract infection (about 23% of the time) and urine scalding (about 5% of the time). Excessive scar tissue can lead to a stricture, which may cause blockage to recur. If there is a recurrence and it can’t be fixed with a urinary catheter, your veterinarian may recommend humane euthanasia.

Benefits of Perineal Urethrostomy in Cats

Cats undergoing a PU will generally have a good long-term outlook. Perineal urethrostomy in cats reduces recurrence of urinary blockage, and most will continue to use the litter box as expected.

Effectiveness of Perineal Urethrostomy in Cats

From 30 to 60% of cats are disease-free long-term after a PU, which means free from recurrence of blockage and free from complications such as a recurrent UTI, according to this study. Some 88% of pet parents feel their cats have a good quality of life after surgery.

Cost of Perineal Urethrostomy in Cats

Expect to pay between $3,000 and $4,500 for a perineal urethrostomy in cats. Costs will vary based on your geographic location and the type of clinic you’re visiting.

A perineal urethrostomy will usually be partially reimbursed by your pet insurance if you have a plan that covers accidents and illness. However, FLUTD or development of bladder stones could be considered a pre-existing condition if your cat had symptoms before buying insurance or during the waiting period.

Preparation for Perineal Urethrostomy in Cats

Perineal urethrostomy in cats may be preplanned in cases with recurrent blockages or stones. However, it’s also common for pets to already be hospitalized because of a urinary blockage before surgery.

If your cat is at home before surgery, your veterinarian will give you instructions on how to prepare your cat for it. Usually this will include free access to water and no eating after a certain time the night before.

At the hospital, your cat will have his back end shaved under his tail. He’ll usually have a urinary catheter in place before the surgery, which is replaced with a new sterile catheter during the procedure.

Your cat will also be on intravenous (IV) fluids. If your cat was previously blocked and sick from the blockage, before undergoing surgery he will usually be kept on IV fluids and with a urinary catheter in until he’s feeling better and his electrolytes have improved.

Post-Op Care and Recovery for Perineal Urethrostomy in Cats

You’ll want to have comfortable beds and easy access to water and litter boxes when your cat returns home, which will usually be a day or two after the surgery. Your cat may remain in the hospital longer if he has post-surgery complications.

Your cat must keep a recovery cone on during the post-operative healing period, usually for at least two weeks. If he is allowed to lick his stitches, he could damage the surgical area or cause an infection.

It’s common to see pets drip urine, try to pee more frequently than normal, and have blood in their urine for up to five days after surgery. If your cat is straining to urinate and nothing is coming out over several hours or if he’s vocalizing while straining, vomiting, or sluggish, seek immediate veterinary attention.

Your veterinarian may also recommend a lifelong prescription urinary diet to lower the likelihood of FLUTD recurrence.

Typical recovery time for this procedure is two to three weeks. Often, there are stitches placed that will need to be removed after the recovery period.

Alternatives to Perineal Urethrostomy in Cats

Currently, there aren’t any effective alternatives to a perineal urethrostomy in cats.