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Perineal Urethrostomy (PU)

By: Dr. Cathy Reese

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Perineal urethrostomy is the procedure that is done to make a new opening in the urethra in the perineal area (the area between the scrotum and the anus). The procedure is most commonly done in male cats that suffer from Feline Lower Urinary Tract Disease (FLUTD) and to bypass an obstruction of the urethra in the penis. It is also indicated if there is trauma to the penis or lower urethra.

Most FLUTD cats are 2-6 years old neutered males, sedentary and overweight. The cause of FLUTD is unknown, but FLUTD cats are predisposed to urethral obstruction. And an animal that has suffered trauma to the urethra, either from a laceration caused by a broken pelvic bone, direct injury to the penis, or from traumatic catheterization of the urethra, may require a perineal urethrostomy.

Diagnosis

Your veterinarian will ask you many questions to develop a complete history of the progression of the problem. These questions will include:

  • How is your pet's appetite?
  • Is your pet active?
  • What is your pet's demeanor?
  • Has he been urinating normally
  • Has there been any straining to urinate?
  • Has there been any blood in the urine?
  • How long has the problem been going on?

    Your veterinarian will also examine your pet completely, including checking for a fever and listening to his heart and lungs. He/she will palpate (feel) you pet's abdomen to check for an enlarged bladder, fluid in the abdomen or pain in the abdomen. Animals that cannot urinate due to an obstructed urethra can become very ill and may require emergency treatment.

    Tests

  • Blood and urine tests are submitted to look for electrolyte abnormalities, signs of kidney failure or urinary tract infection. These tests will also identify abnormalities in kidney or liver function, which is important to know if your pet needs general anesthesia and surgery.

  • Radiographs (x-rays) may be taken of the abdomen to look for stones in the bladder or urethra which may be causing an obstruction.

  • An abdominal ultrasound is also helpful in identifying stones or other abnormalities in the bladder or rest of the urinary tract.

    Treatment

  • If the urethra is obstructed and your pet cannot urinate, he may become very ill and require emergency stabilization. This can include intravenous fluids and emergency urethral catheterization.

  • Many cats must be tranquilized or anesthetized in order to place a urinary catheter. If the obstruction cannot be relieved and the cat cannot be catheterized, a peritoneal dialysis catheter can be placed into the abdomen or a tube cystostomy can be placed into the bladder to allow removal of the urine and/or stabilization of the electrolyte abnormalities.

  • Once the patient is stable, the perineal urethrostomy can be performed. During a perineal urethrostomy, the penis is removed and the wider diameter pelvic urethra is opened and sutured to the surrounding skin, creating a new permanent opening in the urethra, just below the anus.

    Home Care

  • Closely follow your veterinarian's instructions on post-operative care in order to get the best results.

  • The patient should wear an Elizabethan collar to avoid licking the new urethral opening as it heals. Trauma to the new opening could cause it to scar and close over, necessitating further surgery.

  • The stitches should be removed after the cat has been tranquilized, since removing stitches in such a sensitive area is mildly uncomfortable. In addition, if the cat should move suddenly during removal of the stitches, the new urethral opening could be damaged.

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