Perineal Urethrostomy

My experience with a feline perineal urethrostomy (cat pu)

As some of you guys know from my facebook page, my cat Shadow has been having some issues.  He had a UTI that did not get cleared up with a round of antibiotics, and got progressively worse to the point that he blocked.  We had such a difficult time putting a catheter in him that the vet recommended a perineal urethrostomy should he ever reblock.  I tried to research PUs on the web and had a hard time finding personalized accounts; thus, I am going to chronicle our experience with this procedure here, should anyone else need to know what to expect.

1.19.15 – Shadow jumped up on the loveseat, meowed at me, and peed.  This is very uncharacteristic behavior of him.  I kind of “huh’d” and followed him into the bathroom where he then proceeded to try to pee in the bathtub.  I then recognized this behavior as the onset of a urinary tract infection and rushed him to the vet.  Back in 2010, Storm had a UTI that nearly killed him.  Since then I have become very aware of the signs, and Shadow was exhibiting classic UTI behavior.  Male cats in particular are at danger of having their urethra blocked by urinary crystals or mucus plugs, and this can kill them very quickly as their kidneys go into failure.  Blockages are emergencies.

Dr. H felt his bladder and said it was small, which meant he was still peeing and was not blocked.  She prescribed him a 10 day course of Clavamox, which is what I am used to giving Storm for his UTIs.  She did not think he needed Prazosin (to relax the urethra) or Buprenorpherine (for pain) at the time.

1.24.15 – I had Meemaw’s dog Chewy at the vet for another issue, and I mentioned to Dr. F that Shadow still seemed to be licking his crotch and going in the box a lot.  He told me that was normal behavior, and offered Prazosin and Buprenorpherine because it was obvious Shadow was still in some discomfort.

At some point in here, Shadow had a followup urinalysis that CB took him to while I was working.  Dr. F did not get any urine from him.  I took this to mean that Shadow was empty.  What I would later find out was that he was “fractious” and they were unable to draw some from him.

1.31.15 – Shadow looked at me and squatted on the floor.  Nothing came out.  It was afternoon on Saturday, which meant the vet’s office was closed.  Rather than call in an emergency, I sequestered him in a room by himself with a clean litterbox.  He had not produced any urine by Sunday morning, 2.1.15.  I called the emergency line and Dr. H answered.  We arranged to meet at the clinic, Animal Hospital.

I have been present for a couple of different emergency procedures – once when Dr. F had to cath Storm over the weekend, and once when Meemaw’s dog Cookie mauled her other dog, Chewy, after hours.  Try as she might, Dr. H could not get a catheter inserted into Shadow.  That was a prospect I had never even considered, since Storm had always been cath’d fairly easily.  We worked on him for a couple of hours, to no avail.  At that point she began to talk to me about a “PU,” or perineal urethrostomy.  I’d never even heard of the procedure, but occasionally male cats will get blocked so badly that they cannot have a catheter inserted.  A PU “fixes” that problem by removing the penis and rerouting the urethra to make it wider, effectively changing the plumbing of the male cat to mimic a female.  Dr. H said they had just had another patient who had to undergo one.

We agreed to withdraw the urine from Shadow (they insert a syringe straight through the stomach to remove the urine – it’s rather startling the first time you see it, but apparently only causes mild discomfort), and try again in the morning.

2.2.15 – Dr. H called me to tell me that she and Dr. B had successfully cath’d Shadow!  They wanted to keep him overnight to thoroughly flush him with fluids.

2.3.15 – We picked Shadow up.  He had a urinary catheter in and had to wear a cone to keep him from picking at it.  Urinary catheters drip constantly, so many places offer to keep the cats while they are in.  In my experience (and my vet encourages this), my cats do better at home in a familiar territory.  We have a collapsible dog crate that we set up when Storm has to have a cath, so we set it up for Shadow.  It keeps the urine contained, keeps the other cats from messing with him, and keeps him in a restricted environment where he cannot be too active.

Shadow on his first night home after having a catheter inserted.
Shadow on his first night home after having a catheter inserted.

Typically, a cath is only kept in for 2-3 days.  They make it easier for cats to catch infection, and they are also apparently incredibly irritating (Storm always seems to get sicker on the 2nd or 3rd day of having his… it’s just him moping and refusing to eat).  Shadow’s was supposed to be pulled on Friday.  Dr. H wanted to leave it in longer because she was afraid his urethra wasn’t really blocked, but was forming a “stricture,” which is where it narrows.

At this point, Shadow is on a diet of wet s/d (dissolution prescription diet food) when he will eat it, and wet c/d and dry c/d (prescription urinary tract health food) when he turns his nose up at the s/d.  He is also on a round of Baytril, since the Clavamox did not kick the infection on the first go around.  I am giving him Prazosin 3x a day, which is a new experience for me as Storm only got it 2x a day.  He is also now on Amitriptyline for inflammation and anti-anxiety, and Buprenorpherine for pain.

Shadow was reluctant to eat while hospitalized.  We theorize it’s because he’s away from home, and also possibly because the pain med dosage was too high (1.5mL – we drop it to 1).  At home, he regains a hearty appetite.

2.5.15 – On my way home from work, I call Dr. H to discuss my concerns about Shadow.  I am worried that if we pull the catheter tomorrow, Shadow may block again over the weekend.  I have already racked up an ungodly bill from the attempted insertion and the actual insertion (basically twice the cost of normal, plus emergency fees).  I ask if it would be possible to leave the cath in over the weekend and pull on Monday, because if Shadow does stricture, we can then have the PU surgery performed.  She does some research and agrees.

2.9.15 – The catheter is pulled.  Shadow is sequestered in my bedroom with a clean litterbox to ensure he is peeing.  He does pee, in the box, and sometimes inappropriately on my bed.  I think he must feel weird after having the cath in for a whole week.  I let him out with the others during the day, but during the night he stays shut up with me so I can monitor his output.  I wonder why he still sometimes pees inappropriately.  I try to encourage him to play with his favorite toy, the feather-on-a-stick, but he mostly ignores it.  Other than that, he is acting normal.

2.13.15 – I have a bad night.  I have been plagued by nightmares about Shadow.  I spend the night tossing and turning, alternating between burning hot and freezing cold.  I think I am sick and I call into work.  I try to sleep it off.  I wake up at about 10am and feel somewhat rejuvenated.  Shadow halfheartedly plays with the feather-on-a-stick and I think, “Hey, I need to have another urinalysis done to make sure we have kicked this infection.”  I have also noticed that he seems to be straining some, but I have written it off as a side effect of having the cath in that long.  I call Dr. H and ask.  She does not think he should still be straining and asks me to bring him in right away for a urinalysis.  She has a half day but will wait for me.  I rush Shadow in.

His bladder is “moderately full,” and the vet tech brings a litter box out.  He squats.  Nothing happens.  He stays in that position for 15 minutes.  Fuck.  Dr. H looks at me and I ask about the PU.  See, my vet does not perform the PU.  It’s not exactly a rare procedure, but it’s not really common.  There are two other vets in town who perform it, both of them at another location.  Dr. H recommends them wholeheartedly and says they do great work.  They also charge around $700.  The other vet she could recommend is in Nashville and charges around $2500.  I ask her to make the arrangements.

Dr. H calls and fortunately, Dr. S is able to perform the PU that afternoon.  She gives me copies of Shadow’s records to take, along with a dosage list of the drugs he is on.  I take Shadow home for an hour to cuddle with CB while I gather his meds and food and cone.  I deliver them all to the surgeon, where I briefly meet Dr. S.  He tells me I should be able to pick Shadow up in the morning.  He will have stitches and a catheter for two weeks, and must wear the cone the whole time.  If he pulls the catheter out, it could be “disastrous.”  I describe how I will contain him in the crate and Dr. S agrees that it seems like a good deal.  He advises me to pick up some Yesterday’s News litter, as Shadow will not be able to use regular litter for some time while recovering.  I leave Shadow there, pick up some litter, and head home.

I receive a call that afternoon saying the procedure went well and that Shadow is waking up and is comfortable.

We celebrate with Mexican food and margaritas.

Last minute cuddles before the surgery.
Last minute cuddles before the surgery.

2.14.15 – I call at 9am to see about picking Shadow up.  I am told that they want to keep him “for observation” over the weekend.  This is crushing, since I expected to bring him home.  Later I call back because I have been worrying, and am reassured that he is peeing okay and is acting fine, but he is not eating and they just want to make sure he is okay.

2.16.15 – It’s the snowpocalypse.  Schools are cancelled.  My work is closed.  I call and the vet’s office is closed.  WTF!!  I call the emergency line and get through to a different Dr. H, who is at the clinic trying to take care of the animals by himself.  He told me Shadow had not eaten anything and he did not want to send him home if he wasn’t eating.  I told him that Shadow does not do well away from home and I was certain he would eat when I brought him back.  We had observed that same behavior in the two nights he stayed at his vet’s.  I ask about the pain med dosage – he’s getting Buprenex 1.5mL.  I advise Dr. H that he wouldn’t eat on that high of a dosage before, and he agrees to drop it to 1mL.  He tells me he will feed Shadow without the cone and call me back to tell me whether or not I should come get him.

An hour later, he calls and tells me to come get him if I can safely do so.  I’m married to a damn Canadian.  We take over a half hour to clear the car off and make it safely there.  He is discussing taking the animals home with him because he is afraid the power will go out.  Shadow is not properly discharged, but I get the gist of aftercare and get some pain meds to administer along with another round of Baytril.  The Prazosin is discontinued.

Post-Op, Week 1 – We get 6 inches of snow and I am damn glad that my mother’s intuition led me to stay home on Friday and deal with Shadow.  Everything is closed and I dread thinking of what could have happened if I hadn’t noticed / had waited to get the PU.

All goes well for some time.  I discover that the catheter after a PU is not like a normal cath… it doesn’t just drip constantly.  Shadow actually controls it and urinates out of it.  I begin to let him out of the crate some.  I am off work on Monday and Tuesday and get to stay home with “Conehead.”  We also  wind up working from home the rest of the week, so “Shadowlite Dish” gets to spend his days outside of the crate, acting somewhat normal.

Shadow spent a lot of time sitting on the loveseat, which is right next to my desk.
Shadow spent a lot of time sitting on the loveseat, which is right next to my desk.

I have him in a smaller cone than they one they sent him home with.  That one was so big he could barely move in it.  We are confident he cannot get to the stitches or the catheter with the smaller cone.  I begin to notice that sometimes he tries to wedge the cone against the catheter.  I am vigilant in stopping him when he goes to attempt to lick his crotch.

Shadow has his one week followup visit.  He is doing well and Dr. S plans on removing the catheter in a week.  At this appointment he removes a couple of stitches.  He also clears some scabs that are starting to form.

He likes to sit with a paw near his little plastic penis.
He likes to sit with a paw near his little plastic penis.

2.23.15, Day 10 – I go back to work in the office.  CB texts me updates on Shadow.  I know he spent a good part of the day laying in my computer chair.  CB crates him before he heads to school at 4pm.  I get home at 6pm.  The first thing I notice is that the catheter is gone.

I rush Shadow to the vet in a panic.  Dr. S is not there, but another vet sees Shadow.  She expresses his urine and says it is coming out okay and I can take him home… or they can keep him overnight and let Dr. S look at him in the morning.  I decide to let them keep Shadow overnight for Dr. S, his warning of early catheter removal being “disastrous” playing through my brain.

2.24.15 – I receive a call around noon from the surgeon.  Dr. S is concerned that Shadow’s urine is not expressing easily.  He wants to reinsert a cath to prevent Shadow from stricturing and has to receive my permission to do so.  I give it.  They call when I am leaving work to tell me the insertion went fine, and I can pick Shadow up tomorrow.

2.25.15 – Shadow is home again, this time with a “less irritating” catheter.  We plan to leave it in for another 7 days.  I make him wear the larger cone and give him a firm talking-to about needing to leave this one in.

Acting adorable, even though he’s in the giant cone.


2.26.15 – Shadow twists violently, rams the seam of the cone into the catheter, and pops it out.  It’s 10:30pm.  I don’t panic, but am filled with despair.

2.27.15 – I wake up early and take Shadow back.  Dr. S wants to keep him to see if he will pee.  By the time late afternoon rolls by, he has not peed, and Dr. S wants to keep him overnight.  He expressed his bladder earlier and it expressed easily, so he thinks maybe Shadow just hasn’t felt the urge to go.  I agree to this plan.  Then I have misgivings.  I talk things over with CB and we basically decide that Shadow is so damn contrary and hates being hospitalized so much, he’ll probably withhold it because he’s not home.  I drive to the vet and ask to see Shadow and Dr. S.  I discuss my misgivings with him and promise to sequester Shadow.  Dr. S says to bring him back in if he fails to pee, but just call if he pees okay.

As soon as we get home, Shadow goes straight for the litter box and pees!

2.28.15 – By the time morning goes around, Shadow has only peed a little bit more.  I see him jump into the box and nothing happens.  I take him back in.

Dr. S says his bladder is “moderate” and expresses him, but it is a little more difficult than it was yesterday.  He says I can take Shadow home because he is peeing, but he would prefer to do a minor procedure to open the urethra even more.  It involves making three small incisions and stretching him.  After thinking it over, and feeling uncomfortable about having Shadow home all weekend in case he does close up, I agree to the procedure.

Dr. S calls two hours later to tell me things went really well.  He shot liquid into Shadow’s bladder and it flowed out quite easily.  He was worried about a small flap of skin that he couldn’t get to, but didn’t think it would be a problem.  He has a new catheter in Shadow, but that is just a precaution over the weekend, and will be pulled Monday when I pick him up.  The cone must stay on for two weeks while the stitches stay in.  He does not expect that he will need to see Shadow again until that time.  I am overjoyed.

3.2.15 – I pick Shadow up.  I love watching him pee freely.

Shadow and Storm sleeping in the bunkbeds I just built them.
Shadow and Storm sleeping in the bunk beds I just built them.

3.5.15 – Snowpocalypse 2.  I work from home.  I don’t know what happens, but I start to get worried about Shadow.  I watch him closely.  He seems to be peeing frequently, but not very large amounts.  I talk myself down – he’s acting fine.  He’s eating A LOT.  He’s cuddling and being adorable.  I still feel like something is wrong.  The vet’s office is closed and I don’t feel like it’s an emergency, but I start to think about taking him back in for a recheck, even though it’s a week early.

3.6.15 – I work from home again, and only a half day this time.  I make up my mind to take Shadow in for a recheck since I got off early.  At the least, it’ll calm my nerves.  I call, and Dr. S is out.  I make an appointment to see another vet but am told I may be charged for it because it’s not Dr. S (all of his rechecks have been free, covered under the original surgery).  I call my original to see about having another urinalysis done, and Dr. H says we should do that in another two weeks.  I cancel Shadow’s appointment and decide he’s okay.  I go run some errands.  When I get home, I see Shadow jump in the box.  This time, he keeps a leg propped up on the side, so I can clearly watch him urinate.  He pees a great deal… but he pees very slowly.  It drips like a tap that’s barely turned on.  I don’t think that’s right.  We go to the surgeon.

Shadow is seen by the other Dr. H, the other vet who performs PUs.  Dr. H says the bladder is small, but there is some urine in there, and he expresses it.  He is concerned that Shadow is starting to stricture again.  I nearly have a damn breakdown.  Dr. H tells me that this is not uncommon.  PUs have a fairly high complication rate – about 30% – and the primary complication is stricturing.  The urethra just keeps trying to heal itself beyond what we want it to.  He does not want to make a judgement call on Dr. S’s patient without his input, so he calls him.  Dr. S will be in the office tomorrow.  They think that they may have to open Shadow back up, clear the stricture, widen the urethra a bit more, and put a catheter in for a full two weeks.

Dr. H is a really, really nice guy.  He tells me that we are nowhere near the point where Shadow would need to be euthanized.  He says that this is fairly normal, and that things turn out all right in the end as long as we “have some patience and work together.”  Shadow may need a couple of more surgeries to fix things, but as long as we are vigilant and stay on top of things, he will recover fully.  I am incredibly stressed out because now this has been ongoing for 6 weeks.  Really, though, what are my options?

A PU is performed basically as a last option.  Your cat is blocked and cannot be cath’d.  They have a PU, or they die.  Shadow is not even two years old.  I’ll be damned if he dies from this.  He is not even sick anymore… that’s what’s so distressing.  His urethra is just trying to heal itself shut against this surgery.  Do I regret him having the PU?  Meemaw observed that he wouldn’t have all these problems if we hadn’t had it done.  No shit, but he would be dead, and that is a far bigger problem.  Our only choice right now is to continue with these procedures, or have him put down.  And I will NOT put down a cat that can be healed.

As it stands right now, as of 10pm on 3.6.15, I have Shadow at home.  I have watched him pee again since we got here… again, a large amount, but at a trickle.  Shadow seems to be comfortable.  He ate a large dinner and is cuddling in bed.  I plan to take him back to Animal House at 8am when they open so Dr. S and Dr. H can look at him again.  I am hoping they think he is okay and nothing else needs to be done, but I am planning on them having to open him up for a second round at the PU.  If that is the case, I will not see him again until Monday morning, and we will somehow have to make him keep a catheter in for two whole weeks.  I have taped the seam of his cone shut so it cannot be used as leverage, and Dr. H is hopeful that if we keep him constantly on Buprenex this time that he won’t really feel the catheter and therefore won’t mess with it.

To say that I am worried about my son is an understatement.  But I am very happy with the care he has been receiving.  I think we can get through this, but we seem to have hit every damn possible complication.  I look forward to the day that everything is alright again… maybe a month or two down the line.  To be perfectly honest, I’m not sure I’ll ever be completely at ease again.  I am going to constantly worry about Shadow’s tiny urethra.  But I am keeping my fingers crossed and trying to stay hopeful that everything is going to work out okay.

3.7.15 – Shadow and I arrived at the vet’s office at 8am.  It was kind of heartbreaking to take him in, because he was rowdy and playful and acting otherwise like he felt good.  Dr. S felt his bladder and said that while there was urine in there, there wasn’t much. He had a hard time expressing more urine, and said that he thinks Shadow might just be a difficult cat to express – some are.  He said that Shadow’s behavior was good, that it shows that he’s not building up too much urine and poisoning the kidneys, making him sick.  He hypothesized that perhaps Shadow wasn’t stricturing, but rather that there was a plug near the opening that was composed of mucus, cruddy urine, and hair.  He was hopeful that Shadow would not need to be opened back up, but he wanted to run a catheter just to make sure – he said that would let him “really clean him up and see what was going on.”  If there were no issues, I could bring Shadow home at noon.  I left him there and waited for a phone call.

At around 11am, Dr. S called to update me.  He said that as soon as he sedated Shadow, urine began flowing out of him.  That made him suspect that the problem is not physical; rather, Shadow is just holding his urethra shut. He gave him an injection of Valium to help him relax.

He said he debated and debated, but since there was a bit of the surgery he was unhappy with last time, he decided to open him up and clean that out. He said he went in “a little more aggressively” this time and widened the urethra a little bit more, removing that “little flap of skin” just in case it became problematic

Right now the game plan is to keep a catheter in Shadow for 2 weeks, if possible, and maybe longer – he said he’s successfully kept them in for up to a month before to let the urethra heal and relax around it. The challenge is to keep him from pulling it out.

We are putting Shadow back on Prazosin to help the urethra stay relaxed. He wants to discontinue the amitriptyline for now.

Dr. S was very positive and reassured me several times that “we will fix this” and Shadow will heal up fine, but that we need to remain patient and go through the steps. “The bladder and the urethra are not communicating very well to each other,” but he thinks this surgery would have fixed any potential physical problems and now we will focus on medicating Shadow so that they “begin talking to each other properly again. And they will.”

More good news is that they are not charging us for any of these corrections. I’ve had comments made like “Wow, that must be really expensive!” and such. Fortunately, the PU itself was just under $700, and all of this is considered “continuing care” and part of that original procedure.

Some interesting things I learned… I asked Dr. S about putting Shadow on Buprenex, as per Dr. H’s suggestion.  Dr. S said we could, but said that there have been new studies that have determined that Buprenex is not absorbed very well and is not very effective on cats.  He said that in his opinion it would just be money I would be throwing away.  I asked about other painkillers, thinking of Metacam, and he told me that he could put Shadow on Metacam, but it is not recommended with kidney issues because if Shadow withholds urine, it can exacerbate kidney failure.  He does not recommend using it in urinary tract cases.  He thinks the best bet is to just try to be hyper vigilant about keeping Shadow calm and keeping him away from the catheter.

Dr. H asked me out of curiosity how old Shadow was when I had him neutered.  I told him about 4 months.  He said he has noticed a correlation that many cats with blockages seem to have been neutered young, and he has read some studies that suggest the urethra is not fully formed by that age and that neutering stunts its development.  He says he always recommends waiting until 6 months of age or older – the downside is by then you start dealing with marking behaviors like spraying.  I found that fascinating, because both Storm and Shadow were neutered young, while I waited for what I thought was far too long for Rain – just over a year.  Rain’s recovery was more difficult, but he has not yet had a single UTI issue *knocks on wood*  I can say with certainty that now in the future I will wait to neuter any male cats I adopt.

Click here for part 2 of Shadow’s PU story

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      1. My daughters 2 year old cat is going through some issues. They are considering PU. I’m wondering how things are for your cat now?


        1. Fortunately, Shadow is doing well. He has had another UTI since the surgery, but things are mostly normal. I would recommend the surgery as a last-ditch effort to save your cat’s life. Make sure you explore all medical routes first (anti-anxiety meds, prescription food, etc). It is definitely an intensive process with a rough recovery.

          1. One year later and my cat Harry is doing good, no UTI or anything but I can say that it was INTENSE to go through, I did it to save his life after he just kept getting the UTI’s and then blocked, I was worried that if I didn’t do it one day I would be out of town and this would happen and no way would a pet sitter know what to do. I recomend not feeding any dry unless you have to becuase you are gone from home more than an hour or so.

          2. That is so good to hear!! Congrats to you and Harry, and may you both live long and happy lives! :)

            Shadow and Storm now primarily eat wet food. I do keep some dry urinary food on hand for them because sometimes they get picky and turn their noses up at the wet… I know, who woulda thought?! They do enjoy their “crunchies” occasionally. But canned is definitely the way to go!!

  1. We are going through something extremely similar with our cat right now and it’s heartbreaking. We took him in for neutering surgery at 6 months, about mid-February. The vet there thought his bladder looked too big during the procedure and decided to run in a catheter to check for blockage or infection. They found no blockage, no infection. Unfortunately while checking for infection they ended up GIVING him an infection!

    He hasn’t been able to pee on his own since then – we ended up taking him to another vet, who put him on various meds and sent him home a day or two later saying he peed at night and was fine. We were so happy, but by the next day he still wasn’t peeing! We took him back and they drained 400ml of urine out of him – I have no idea how they thought he peed before, because it would’ve been less than 24 hours from him peeing to him somehow gathering 400ml of urine. After that he didn’t even feel like he needed to pee anymore, a bad sign since now they suspected nerve damage. They catheterized him again – he ripped it out twice, but the next day they for some reason decided to send him home *again* even though he hadn’t peed. They put him on new meds and thought that would be enough. It wasn’t enough. A couple of times when we rushed him in they had us wait 2, one time maybe even 3, days at a time for his bladder to fill up, hoping that would make him pee. It didn’t. His bladder was now distended.

    I noticed some swelling around his penis and asked the vets to check for blockage – they found no blockage with the previous catheters, but I was afraid maybe there was some injury or scarring from when he ripped out his last catheter. They didn’t think there was any and said the light swelling was normal after repeated catheterization.

    After a series of red flags at this vet (and when they started talking about putting him down if their last ditch idea to run a catheter through his abdomen hoping that this would help his bladder rest so that he could contract to pee) we took him to another hospital 2 hours away for a second opinion – this is meant to be one of the best hospitals in the country.

    They put him on stronger medication, didn’t help. I again asked about checking for blockage – they didn’t think there was any, but they said they’d like to do a full bladder biopsy to find out exactly why his bladder was so flaccid and not responding to medication. They wanted more information about the neuron damage, muscle damage, or whatever else is going on in there. At the same time they tested for blockage by trying to pass a catheter in from the inside of the bladder out. It wouldn’t go. They then barely got it in from the outside in, and then finally passed it through from inside out again. The surgeon said there seemed to be a stricture which could be contributing to the problem.

    And if this is the case it’s likely he would’ve had this since he ripped out his catheter days and days ago! Since the previous vet sent him home on new meds to contract his bladder! And if that’s true the meds could never have helped at all because the stricture would’ve prevented him from peeing! He was TRYING to go, he just couldn’t get anything out – we saw it.

    Anyway, this third vet should be getting biopsy results back today, but in the meantime they did the urethrostomy (yesterday) to remove the stricture. The surgery apparently went smoothly, but they do not know if this will save him because they don’t know if the primary problem now is his very distended bladder (which the urethrostomy wouldn’t fix) or the stricture. We have no idea what else to do and just hope that they can now express him manually (it seemed to be impossible before, maybe due to the stricture), and then maybe teach us how to do it ourselves at home.

    Sorry about the rant – this just reminded me a lot of our situation, starting off with a UTI and going on to the urethrostomy. Unfortunately now our kitten (only about 7 months old) also has bladder damage and we have no idea what’s going to happen. I can’t believe this all started with a routine neutering surgery.

    1. L, do you have an update on your cat? I am curious as to how he is doing now. I hope everything is much better for you. I am also curious as to which medication he was prescribed to constrict his bladder… do you know the name and the dosage? I know that many people wind up having to express their cats over the litterbox 2x a day. It’s doable.

      I am so sorry that all of this happened to your cat. The idea that they just straight up ran a catheter in him in the first place is so crazy. My vet would have just withdrawn a syringe of urine and done an urinalysis to see if there was infection. It sounds like that first vet was a real piece of work.

      I will be crossing my fingers that all turns out well for your baby. Please feel free to update me or vent as you need to… it’s a frightening and heartbreaking ordeal. I am here if you need to talk.

      1. Hi Britt,

        It’s been a while, but our kitten is still here. It’s touch and go – he’s on a lot of meds and was almost put to sleep, but right now he’s happy and peeing. I wrote a detailed post about what actually happened, I hope it’s ok to link you to it to explain instead of rewriting it here!

  2. Thank you so much for your story, I have my baby boy sitting right here who had the PU surgery on Teusday, he does not like the catheter either, who would… he may get it out Monday but I am hestitate I surely would be very upset if it closed up. Cats generally dont want to eat in a strange place so I took him home a day early and he wolfed food down that gave him diareah, I gave him that pumpkin patch stuff from Weruva and it worked! I have learned to make sure to feed him in little bits in between buprnex, I think he needs it or he would be badly bothered by the catheter. I let him sleep it off right next to me with his collar off for a break, plus I found a blue intertube type that works better than the cone. I put it on when i cant sit right next to him and overnight. I too had my baby neutered at about 4 months!! I had another male cat that was not neutered until 6 months and never had all this, so I firmly belive this is the culprit!! Why on earth would vets not know this!! What you went through and now me should never had happened! Also I keep wondering about food. Cats where probably really not meant to eat anything but rodents and the commercial food is the big problem too. I sure hope this works
    how is your baby doing since?

    1. No, THANK YOU for sharing your story! The point of these posts is to help put more first-hand knowledge out there about the PU procedure. I found woefully small amounts when I began researching, literally as Shadow was under the knife.

      I actually wound up using “the doughnut” for Shadow too, in conjunction with the cone. It seems like it’s much more comfortable and it further immobilizes his head so he can’t scrape the cath with the side of the cone. Just like you, I let Shadow sleep some of the buprenorpherine off without the cone, while he lays in my lap.

      I know Weruva is a good quality food. My cats eat Blue Buffalo, also good quality. I would love to feed them raw, as I think that’s the best and most healthy diet, but that is just not possible for me at this point in my life. I know wet food is the next best thing, but I can’t get them to eat it other than small amounts here or there. What I’ve taken to doing since all of this started is pouring some water on top of the Blue when I feed it to them. They lap it up as they eat and it helps hydrate them.

      I don’t think there’s ever really been studies done about UTI complications / early neutering. Still, I will NEVER, EVER neuter a cat that young again!

      I just updated with a new post on Shadow – things got worse, and hopefully they’ll now get better. How’s your baby doing?

      1. WoW! I read your new post, I thought I was having a hard time! My boy got is cath out at 630 am yesterday, they gave him a sedative and brupenx shot to last 12 hours so he would come home and sleep, which he did, then I woke him up a few hours later and he ate his S/O canned food and I gave him water by dropper. He fell back to sleep but then got up and tried to go in the litter box but didnt, then he was growling and hiding which scared me so it had been more than twelve hours hours so I gave him more brupenex and then more water and he then peed on a towel. I’ve got a call in now to the vet to ask about the antiinflamatory and euretha relaxer you mentioned because they do not have him on that as of now. I a, so sorry you are going through this and it’s just a shame no one seems to know why this happens
        I did read that it could be a genetic thing or my cat seemed to have these episodes a few days after things like seeing a new person or load noises, he has a pretty easy life not much stress no kids around! I do know that if you can find a holistic vet that they should be able to do a homeotox liquid that may help. I have an another cat who has failing kidneys she is 15
        But was about 12 when she first got symptoms I took her to this type of vet they did all the regular blood work but also put her on a homeotox easily given twice a day and she is doing wonderful, so Harry will be on that too as soon as he is off the other meds. My thoughts are with you and I hope he pulls through this!

        1. Alli,

          Please keep me updated on how Harry is doing. It’s great that other people are commenting on here and sharing their stories. I hope this post and all of its comments are able to help others out when they search for information on the PU procedure and aftercare.

          Did your vet give you an anti-inflammatory and urethra relaxer? Shadow’s not on a specific anti-inflammatory, but he does take Amitriptyline (Storm, my other cat with FLUTD, does also). I HIGHLY recommend you ask about the Amitriptyline. It’s an anti-anxiety drug that has the side effects of lowering inflammation and creating cotton mouth, which promotes drinking more water. I think it’s a very good option to look into, since your cat seems to have these episodes after experiences that frighten him. Storm had his last two blockages after we were away from home for a day or two (and he had his last UTI after my in-laws stayed for a week), so we put him on the Amitriptyline to help keep him calm during potentially stressful situations.

          I don’t think we have a homeopathic vet around here anywhere. I did read some good things about “Tinkle Tonic” and have considered asking about that. I am just wary about introducing another drug, or herbal supplement, on top of what Shadow is already getting.

          Go check out the comments on my updated post – Sarah responded today to tell her PU story, which sounds a lot like Shadow’s and has a happy ending!! It really bolstered my spirits to read it today.

          Keeping you and Harry in my thoughts!

          1. Update on my cat Harry,
            it has been a very long journey to recovery. For anyone who is considering this surgery, it is definitely worth it but you must be more prepared than I was. Plan on not sleeping much for two weeks or however long it takes to get the initial catheter out. I don’t think I slept at all for a solid two weeks. I was so afraid that he would try and rip out the stitches and he was in such misery over the whole thing I just didn’t want to take my eyes off him. Have all your grocery shopping and cat food done prior. Have a friend available should you need something, make a notebook available to keep track of meds. DO NOT I REPEAT DO NOT give your cat medacam more than what the vet tells you, in my case it was once every 48 hours for a few days and even that is bad, but the buprenx made my cat more loopy than pain free, however I did try a trick that a vet tech told me, try HALF of the dose if your cat seems loopy, and try to get it in the cheek pouch not down their throat. This worked great for my cat. Medacam on the other hand can be deadly to cats as it is an anti-inflammatory and cats do not tolerate it its only used for these some circumstances and not very much. I also bought a Kong brand tube instead of the ecollar which worked pretty well. He actually seemed to get used to it and liked to rest his head with it on. My cat Harry was doing great after he got the catheter out then the stitches however he had a terrible set back, he was very lethargic and not eating and threw up blood, and not peeing all of a sudden! I rushed him back to the vet one Sunday and the vet though at first he had medacam poisoning, however my wonderful vet, put in a small catheter and when he came back to check on him early the next morning (4:30 am)
            he was 100% better, what had happened was he has feeling so good that he had jumped (as cats do) and ripped his urethra from the inside so urine was actually poising him, he was peeing inside himself! It was terrible. BUT he was saved by my vet and now after a few days with a small Cather in and a round of an good antibiotic that I gave at night that actually made him sleepy, he is as good as new!!! YEAH!!! I think the cost and the hard work is very much worth it. I have a second job to pay it off, but at least I have my cat back!!!
            Anyone doing this make SURE after your cats stitches are out and everything seems fine to really keep another hawk eye on your cat for a few weeks in case of a set back like mine and
            make sure your vet thinks of the ripped from the inside urethra my vet new this because he has done many of these surgeries and he is in his 60’s someone younger may not figure this out, EXPERIENCE IS EVERYTHING!!!!

  3. also, i use “rescue remedy” by bach will transition him from the buprenex to this once he gets the catheter out it helps with stress and anxiety each cats reacts differently, i put quite a bunch , about half the dropper full for each paw, on his front paws and rub in gently, it takes about 20 min to kick in.

  4. I asked the vet yesterday about switching him from brupenex to antiinflamatory they prescribed metacam which he has done well on in the past, and I had prazosin (euretha relxer (compunded with chiken flavor) He did well last night and ate breakfast and drank some water, then I gave him the prazosin, tonight I will give him another metacam, I am pretty conservative on the meds, I will do it twice a day morning and night not three times and that works well for him, I would not give the rescue remdy to any sick cats becuase it does contain a little alchohol. I tried those vetriscience composure but my cats dont like them.
    I will ask about that amitriptylyne.

  5. Hi, I’m going through something very similar and i was just wondering how this ended up for you? Is shadow ok/healthy and peeing normally now?

    1. After about six months, Shadow finally emerged perfectly normal! You can click on the link at the bottom of this page to continue on to part two of the story. There are three parts, where I summarize how everything ended up and the total costs.

  6. Our 3 year old Ragdoll cat, Brutus, has just undergone a PU on Thursday. He’s home now his cone on until his stitches are removed 10 day post op. He’s peeing fine (if not in the most appropriate places, fresh sheets for us today :s).
    He’s very tired and extremely cuddly, sleeping in my arms all night.
    Brutus has been blocked up previously with crystals in his bladder, so we recognised the signs that he was was blocked again last Sunday and rushed him the vet. After staying there for 4 days with a catheter (he managed to tear it out the first night), on Thursday they decided to go ahead with the surgery, during which they found a very large stone blocking his urethra, this has been sent off for testing.

    His crystal’s were previously caused by his diet, he’s been on prescribed s/o since then & the vet has said that it is now being caused by stess. At home Brutus seems to be the most relaxed cat I’ve ever seen, we’ve made changes with his kitty litter and living environment to try an eliminate stress but we’re not sure what else we can do.

    I’m thanking myself for signing him up for pet insurance whne he was a baby because the vet stay, procedures and medication has cost us about $5,000 so far, we’re hoping to get 80% of this back from the insurer who have assured me that all of this is covered. He’s my baby and I’ll spare no expense to see him happy and healthy again but we are literally running out of money so it will be a relief to have the money back in case he needs further vet care in the near future.

    Our other cat, Luna, does not seem to be too happy with Brutus. They usuallh get along great, grooming each other and cuddling up most of the day. We’re not sure if it’s the combination of his cone and his funny smell lingering from the vet or if she just enjoyed being an only child a little to much last week. Keeping them separate unless under supervision at the moment as Brutus is so delecate right now.

    He’s being given 1ml of liquid penicilin twice a day and we’re also applying vasaline to his sutured area twice daily. Wet s/o diet food once a day with s/o biscuits and water available 24/7. We’ve lay down old newspapers in the litter box to try and avoid infection from his usual dry paper pellet litter.
    Any other suggestions to make him more comfortable would be so appreciated.

    1. Hannah, I am so sorry, but your comment got lost somewhere in my queue. I completely missed it and just found it this evening – two months later! I’m sure any suggestions I could give for Brutus at this point are far too late. Can you update me on how he is doing now, poor thing?

  7. I posted comments on this site a while back when my cat Harry went through this.
    I opted for this procedure because (PU) becuase I knew down the road this would keep happeneing whenever he got stressed out even at the smallest thing becuase he is a rescue.
    It was very difficult to go through the surgery and very expensive (I am on a payment plan to the vet) but he is totlally fine now, the vet said that he may get chrytals but becuase the euretha is now larger they will go through. I was feeding my cat dry BLUE and I have since switched to natures varietty limited ingredient turkey AND I have cut back on the dry by allot!!!
    I feed them higher end and organic food twice a day sometimes three, smaller meals and only put the dry out if I going to be gone for more than a couple hours. I feel this is best. The more water the better, I use only filtered water from the pur pitcher. There is also a homeopathy drops that can help clear the urinary tract so I also do that…my vet mixes it up its easy to do and not that much money. SO I am so grateful to have my Prince Harry back!!!!!

  8. Dear Britt, I was searching the internet for information about complications after a PU and came upon your article. My cat recently had a PU and is exhibiting similar problems to Shadow’s. He had a PU but is still blocking and has been on Prazacin for a few days but it is not working. I was wondering if it would be possible to put me in touch with your vet who took care of Shadow. I would really appreciate it. Once you reply to my post, we can figure out a way to get in touch. Regards.

    P.S: I entered a bogus website because I dont’ have one.

    1. I think the most important thing is that your vet leaves your kitty’s catheter in for quite awhile, until the opening is good and healed and knows that it’s supposed to stay open. You can email me at thewolfwalker at gmail dot com and I’ll send you my vet’s name/number.

      1. Britt, thank you so much! Just after I emailed you, I finally got a referral from my vet for an animal hospital and I took Tallis there immediately. It turns out his original PU had a complication (stricture) which finally the surgeon operated on and resolved. Tallis is back home now and peeing on his own! I am so relieved. I really appreciate your taking time to reply as I was going nuts. Best

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