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PU surgery on a cat?

Species: Cat
Breed: domestic long hair
Age: 1-2 years
Hi Dr. Marie ,
I hope you can help me with my cat, Jack. He is 1 ½ years old and is a domestic long hair. At the end of May, I noticed him peeing outside his liter box and straining to urinate. He only produced tiny amounts so I brought him to the emergency clinic and they said his bladder is enormous. They stuck a catheter in him and flushed his bladder. We picked him up and the vets gave us Metacam, Phenoxybenzamine, and Clavamox to give Jack. After a week, I brought him back in to see the vets and they again said his bladder was large and they gave us prescription food to try, royal cain. So we yet again, put another catheter in him and drained his bladder for another 1000 dollars. After, when we picked Jack up, they had us give Jack all the medications listed above previously and Bethanechol. They recommended feeding Jack prescription canned food for the rest of his life to prevent the formation of crystals. Then about a week later, he still wasn’t producing a lot, so my mom took Jack to get his bladder flushed out via another catheter. The vets said there was no grit or stones, but that it was just inflamed. Then, we went to the vets yet again about another week later and same problem. He got another catheter put in him and we picked his up June 15th. They prescribed Jack Metacam, Clavamox, Phenoxybenzamine, and Diazepam and I had been feeding him his prescription food. I have been monitoring his peeing and it has been about 10 days and he is producing large amounts with a strong pee stream. He has had a good appetite and seems to be back to himself. The vets are trying to push the Perineal Urethrostomy surgery, but if Jack is peeing and healthy I feel guilty subjecting him to surgery that may be unnecessary. The vets say he will most likely block again. From May 28th to June 15th he has had 4 catheters put in him, but now he is doing fine. The specialist I went to go see is trying to do the surgery on Jack this week. I am unsure. I want the best for my cat and do not want his getting unnecessary surgery, but I also want to take preventive measures and get his situation fixed. But on the other hand, he may already be fixed. What do you think? Right now jack is taking metacam .1 ml once every 3 days, 1 phenoxybenzamine and ¼ pill of diazepam once every 12 hrs. He has finished the clavamox, which he used for 10 days and the vets said he does not need a refill. I don’t want to wait until my cat is blocked to get him the surgery, but I also don’t want to make him get a surgery that doesn’t need to happen right away. Please help! I feel like my vets are all saying different things and trying to make a profit off of me rather than help my cat. Any insight is appreciated!
Thank you so much,

Online vet, Dr. Marie

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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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.