Can Surgery Solve Urinary Obstruction?

My cat Mr. Fez developed a urinary obstruction over New Year's weekend. This is the third time he's had urinary problems since the end of...

My cat Mr. Fez developed a urinary obstruction over New Year’s weekend. This is the third time he’s had urinary problems since the end of August, but this is the first time he blocked. He does not like the prescription food either (Hills s/d and c/d).

The ER vet said he has a very narrow urethra and was somewhat difficult to catheterize. Ultrasound did show a slightly inflamed bladder wall and tons of sediment. Crystals were found in his urine (only occasional crystal fragments were found previously) and his pH was high at 8.0.

Both the ER vet and my regular vet brought up the option of perineal urethrostomy surgery due to his history. What are your thoughts on this surgery?

Wausau, WI

Urinary obstruction is one of the worst things that can happen to a cat. It occurs almost exclusively in males.

The syndrome most frequently develops as a complication of another syndrome called feline lower urinary tract disease (FLUTD) (also known as feline urologic syndrome, or FUS).

FLUTD is triggered by a chemical imbalance in cats. This imbalance leads to high urinary pH levels (typically 7.5 or higher) and crystals in the urine. These urinary changes are correlated with pain, inappropriate urination, and other symptoms that initially mimic bladder infections.

FLUTD can cause swelling of the bladder and the urethra (the tube leading from the bladder to the outside world). Although cats are amazing creatures, one thing can be said of them definitively: male cats are not well hung. Small penis size and a swollen urethra are a combination that can lead to a urethra that is swollen shut or blocked by grit, mucus, or a stone.

When this happens, urinary obstruction results. Initially, cats with urinary obstruction are uncomfortable as their bladders fill. When the bladder is too full to hold more urine, the kidneys shut down. This leads to sudden kidney failure. Untreated urinary obstruction is fatal.

In the short term, urinary obstruction can be treated by passing a catheter through the urethra into the bladder. However, most cats treated in this way will suffer relapse unless steps are taken to address the underlying FLUTD.

The easiest way to prevent urinary obstruction in predisposed cats is to offer a diet that is designed to prevent the problem. Hill’s c/d and s/d are two of the most common. If your cat won’t eat these, then be aware that many other companies, including Waltham, Iams, and Purina, make similar diets. If you have time on your hands and are willing to do the appropriate research, it is possible to prepare nutritionally balanced home-cooked diets that prevent urinary obstruction as well.

Dietary supplementation with vitamin C or a natural amino acid called methionine also may help to prevent urinary obstruction. Talk to your vet about this.

Perineal urethrostomy is a surgery involves removing the penis and creating a new opening through which severely affected cats urinate. The surgery usually (but not always) is effective at preventing relapses of urinary obstruction. I recommend it for cats who suffer repeated bouts of urinary obstruction despite dietary modification. However, it is a major surgery and it usually isn’t a good choice for first time urinary obstruction sufferers.

I think you’d be jumping the gun if Mr. Fez underwent this surgery at this time. I’d recommend that you work on dietary alternatives (besides c/d and s/d) first.

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