PERINEAL URETHROSTOMY (PU) – $875
What Is A Perineal Urethrostomy?
A perineal urethrostomy (PU) is a surgical reconstruction of the tube your cat urinates through called the urethra. The purpose is to create a larger opening through which your cat can urinate. This is a salvage procedure performed when urinary obstructions either cannot be corrected by catheterization or repetitive blockages have occurred. The word perineal refers to the location of the new hole between the penis and the anus and the term urethrostomy is the process of surgically making the new hole.
This surgery helps to decrease the chance of repeat urinary blockages. A urinary blockage is a life threatening situation for your pet. It is important to repeat that this surgery significantly decreases the chance of repeat blockages, but does not guarantee a future blockage will not occur. Post op preventative care is very important to the success of this surgery.
Male cats are much more prone to urinary blockages than female cats. The female urethra is much shorter and wider than the male urethra . The male urethra is narrow and becomes even narrower as it extends the length of the penis, so even a small plug can cause a life threatening blockage.
Identifying the Need for Perineal Urethrostomy (PU) Surgery
Mucus, crystals, and urinary bladder stones in your pet’s urine can easily clump together to form a plug in the urethra. Sometimes a blockage in the urethra can be relieved by using a catheter to push the plug back into the urinary bladder. If this cannot be successfully done, then a perineal urethrostomy must be performed in order to save your cat’s life. If catheterization has been needed on multiple occasions to remove a plug, your vet may suggest PU surgery as a preventative strategy. In any case where a plug is caused by a stone and the stone is pushed back into the urinary bladder, a different surgery, called a cystotomy must be performed to remove the stone from the urinary bladder. That way the stone will not roll back into the urethra causing another blockage.
We will need a copy of your vet’s medical notes and x-rays before getting you on our schedule. So please have your vet e-mail or fax those notes and x-rays to us.
An x-ray must be provided to be sure no stones are in the urinary bladder before performing a PU. We do not offer x-rays at Helping Hands, so they must be provided by your regular veterinarian.
After Perineal Urethrostomy (PU) Surgery
Immediately after a PU surgery, the most important responsibility you will have is keeping the E collar on your cat so it cannot get to it’s incision. The tissue involved in the surgery is very thin and delicate, so if your cat licks or gets to the incision in any way, there may not be any tissue left to repair. You absolutely must keep the E collar on at all times until your veterinarian tells you it is safe to remove it, usually after 2 weeks.
To help your pet eat with the collar on you can use a small plate raised up on a can so that the collar can fit around it, or you can hand feed them, or just be creative, but do not take the E collar off!
Immediately after the surgery it is normal for your pet to have bloody urine for few days and your pet may have accidents as they are getting used to their new way of life. This will be temporary. We recommend you keep your pet in a room with tile or linoleum flooring during their recovery so any accidents can be cleaned up easily. If blood or urine stains their back legs or belly, you can use a wet washcloth to clean them, but avoid direct contact with the incision. Do not wipe the incision area directly.
Your cat will require a special litter for his recovery. Clay litter will stick to his incision causing trauma and delayed healing. You can use shredded newspaper or if your cat prefers a pelleted litter, you can purchase pelleted paper litter named Yesterday’s News from most pet stores. Be prepared and have appropriate paper litter ready for your cat when he gets home. You can return to clay litter after he is all healed up.
Two weeks after surgery you are required to follow up with your regular veterinarian. There are several important reasons that we mandate this appointment.
First, your veterinarian must test your pet’s urine in order to verify that any urinary infection has completely cleared up. Occasionally a stronger antibiotic may be needed or the antibiotic your pet is taking may need to be refilled for a longer course. Please do not let your veterinarian skip this important step. The blockage most likely started from a low grade urinary tract infection, and if the urine stays infected, a new blockage can occur higher up beyond the new hole we have made. It is important to stress, PU surgery does not cure urinary blockages. Pets can still block if larger mucus plugs or stones reform.
Second, You cannot remove the E-collar without the approval of a veterinarian. Your veterinarian has to check your pet’s incision to verify that it has fully and properly healed.
Finally, you and your veterinarian will need to develop a preventative plan in order to help your pet’s body prevent more of these urinary bladder problems and infections. Whether your pet needs a PU, a cystotomy, or both, surgery is only one step in the overall process of resolving urinary tract issues. Infections are likely to recur if you do not take preventative measures. Preventative measures may include dietary changes, medications and/ or regular monitoring of urine. This is why it is so important to follow up with your regular veterinarian and follow their recommendations strictly. Again, PU surgery is a temporary cure for urinary blockages. You must work closely with your veterinarian to prevent future blockages.
There are additional things you can do at home to help. Keep the litter pan clean several times a day. Just like you probably don’t like to sit on a toilet that isn’t flushed, cats don’t like to climb in litter pans that are not scooped so they will hold their urine too long. Also, free access to fresh water and feeding canned food will keep cats better hydrated so they flush their systems naturally.
It is important to remember that your pet will not be able to tell you that they have a urinary infection, but they may show you. Some behaviors to look for as an early warning sign may be, your pet drinking more often or having to fill up their water bowl more often than usual. You may see your cat in the litter pan more often. Or you may find your pet having accidents in the house. Often, these are not actually accidents. Pet’s are smart and will put urine where you will see it or step in it as a sign they need help or maybe they just can’t hold it long enough. If you see any of these behaviors, please don’t wait. Have your veterinarian check their urine right away.
Even as the most dedicated pet owner, you may not realize your pet has a urinary tract infection because it goes against their nature to complain. You may not be aware of any problem lurking until it is so bad that they start urinating in the house where you’ll see it, urinating blood, or not urinating at all.
We cannot stress enough to you how important a preventative care plan is when you are dealing with urinary tract issues in your pet. Despite all your best efforts, sometimes urinary tract infections still occur.
Scheduling Surgery for a Perineal Urethrostomy (PU) at Helping Hands
As previously mentioned, the Perineal Urethrostomy surgery is defined as a salvage procedure to allow for your pet to urinate. Since an enlarged prostate gland can potentially impair urination and the new surgically created exit that allows for urination will be located along the scrotum in males, neutering your cat is mandatory ($35).
Bloodwork ($90) is required for your pet. The bloodwork we perform at Helping Hands shows us basic organ function values (kidney and liver) to help make the safest choices for anesthesia. The bloodwork we perform at Helping Hands is not diagnostic. It is always recommended that you discuss surgery and sedation with your primary veterinarian that has followed your pet’s health if you have any concerns. It is important to remember there is always risk when sedating any living animal.
E-Collars ($15) Many animals chew or lick open their incisions after surgery. We REQUIRE that every pet having this procedure have an e-collar to help prevent this. If your pet opens their incision, you will be charged for closing the wound. It is also STRONGLY advised that your pet stay calm and crated if possible during recovery to reduce the risk of the incision site opening, especially if the mass is in a “high motion” area. Patients requiring surgery close to the eyes or ears will require an e-collar to prevent the rubbing of the face with paws.
We are an outpatient facility which means the pets go home the same day. While a lot of our clients take their pets home after surgery, we always recommend you talk to your veterinarian to see if they recommend overnight monitoring be performed with them or an emergency hospital. We always encourage owners to consider a transfer for post-op care after surgery.
If so, you can return to your full service veterinarian or a 24-hour facility for continued care at your expense. We are here to get your pet through the surgery and back into the hands of your full service veterinarian.
Additional Resources for Further Information on Perineal Urethrostomy Surgery: