PU surgery on a cat?

Dr. Marie replied:

Oh, cases like this are so difficult! Dealing with cats with urinary tract issues is one of my least favorite things to do as a vet.

Please know that your vets are doing all of the same things that I would do. It is very unlikely that they are just trying to make money off of you.

I have had a number of similar frustrating cases where we do all of the right things and then the cat blocks up again. You mentioned that the second time this happened, Jack was put on Bethanechol. This is a drug that we use when the bladder is stretched out and loses some ability to contract. Cases like this are often even more difficult because it can take a good amount of time for the bladder to repair itself.

Your decision is really a tough one though. I won't be able to make the decision for you but I can give you some of my thoughts. I can understand your reluctance to do an expensive surgery like a PU. It does come with some risks and it is very pricey. On the other hand, if you are thinking at all of doing the surgery, it is much much better to do it now than wait until he blocks again.

The decision would be so much easier if we could tell whether or not Jack is likely to have this issue again. I don't know if anyone has actual statistics on this, but I can tell you that the majority of cats that I see for urinary tract blockages do indeed have multiple episodes of blocking. So, if we play the odds, it is probably a good idea to have surgery done.

The idea of the surgery is that the vet will open up the penis and create a new opening that is much larger. It would be very similar to a female cat's urinary opening. This way, Jack would never have to worry about having urethral spasming. Plus, if he does get small stones in the future he is likely to be able to urinate them out and not have them get stuck.

The main risk with doing a PU surgery is that the surgery site can possibly scar over which is not a good thing. However, if the surgeon who is doing this surgery is experienced in doing perineal urethrostomies then this risk is very small.

Once again, I can understand your reluctance to do surgery when Jack seems to be doing so well right now. But remember, he is also on a number of drugs still to help his bladder. There is no guarantee that he will continue to do well once the medicines have stopped. Also, even if he does come through this and is able to urinate well after stopping his medicines, there is a good chance that he will have one or more urinary issues like this in the future.

I would say that if your vets are advising you that surgery is a good option, they really do have Jack's best interests in mind.

I hope that helps with your decision, but let me know if you have more questions.

Dr. Marie.


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