Okay, so let’s talk perineal urethrostomy in cats. It’s not pretty, but sometimes it’s gotta happen.
It all started last week. I had this tomcat, Mr. Whiskers, come in completely blocked. Bladder was huge, the works. Classic FLUTD case. Tried unblocking him with a catheter, flushed everything out, got him stable, and sent him home with meds. Thought we were good. Nope.
Two days later, he’s back. Blocked again. This time, I’m thinking, “Alright, Mr. Whiskers, we’re not messing around anymore.” We talked to the owners, explained the situation, and they opted for the PU. So, here we go…
First, I got him prepped. Shaved everything back there – and I mean EVERYTHING. Gotta have a clear view of the perineum. Then, the good ol’ betadine scrub-a-dub-dub. Sterile drapes, the whole nine yards.
The trickiest part is the dissection. I made an elliptical incision around the scrotum and… well, removed the scrotum and testicles. Gotta get those out of the way. Then, carefully dissect down to the urethra. You’ve gotta be super careful not to damage anything. I used a combination of blunt and sharp dissection, just kinda picking away at the tissue until I could clearly see the urethra.
Next, I made a midline incision through the penile urethra, extending it dorsally. You’re essentially opening up the urethra to create a wider opening. This is where the magic happens, or at least, where you hope the magic happens.
Then comes the anastomosis. This is where you suture the urethral mucosa to the skin. I used a fine, absorbable suture – 5-0 Monocryl, I think it was. Starting with the dorsal aspect, I placed simple interrupted sutures, making sure to get good apposition of the mucosa and skin. It’s tedious work, but it’s crucial for a good outcome. Went all the way around, ventral aspect last.
Flushed the urethra to check for leaks. Thankfully, everything seemed tight. The new opening looked… well, it looked like a new opening. Not exactly beautiful, but functional.
The post-op care is just as important. Pain meds, antibiotics, and an e-collar – absolutely essential to prevent him from messing with the site. I also sent him home with a special diet to help prevent future crystal formation.
We kept him overnight, just to make sure he was urinating okay. And he was! He went home the next day, a little sore, but hopefully, a lot less blocked in the future. Follow-up appointment in two weeks to check everything’s healing properly. Fingers crossed this is the last time Mr. Whiskers needs a plumbing job.
PU’s aren’t fun, but they can be life-saving. Just gotta take your time, be meticulous, and hope for the best.
