Perineal Urethrostomy

Urethral obstruction in cats is a serious condition for which medical management is frequently successful.  Unfortunately, recurrent episodes may result in euthanasia due to the inability of owners to afford expensive repeated hospitalizations.  Perineal urethrostomy can be life saving for these patients, as it essentially eliminates the risk of further obstruction.

Generally, I reserve recommendation of perineal urethrostomy for cats that have obstructed more than once.  Occasionally, however, I will have an owner that is interested in surgery after a single obstruction event because they would not be able and/or willing to pay for hospitalization a second time.  In either case, outcomes for cats receiving perineal urethrostomy are usually very good if the procedure if performed correctly.

The most important complication associated with perineal urethrostomy is stricture formation and inability to urinate.  Stricture or recurrent obstruction are typically associated with inadequate dissection leading to too much tension on the repair or not exposing the urethra proximally enough to the point that is significantly wider.  Complications can also occur due to not successfully apposing the urethra mucosa to the skin. 

This is a procedure I perform quite frequently due to working in an emergency hospital that admits urethral obstructions regularly.  We rarely see complications, and when we do it is almost invariably due to patients not wearing or defeating their E-collar.  Thankfully, a robust repair can stand up to a bit of abuse and patients usually recovery without incident.  

If you have a patient that is a candidate for perineal urethrostomy, contact me to discuss.