Cat Perineal Urethrostomy (PU) Complications. Should I Go Through the Procedure?

Hey Pet Parents & Pet Lovers,

It can be difficult to choose whether or not you should put your cat through the trauma of a surgery, especially when complications are serious. Last year when we had to make the decision of whether or not we would put Beau under the knife we called a number of our vet friends for second (and third… and fourth… and fifth) opinions to make sure that it was the right choice. All-in-all, we’ve had a very positive experience with Beau’s operation and he has not experienced any complications other than a couple of urinary tract infections after the surgery (induced by stress) which was easily fixed with medication.

If this is the first article you read from our site I also recommend you check out my post about Beau’s recovery after his PU Surgery as well. It covers a detailed account of the first week of recovery as well as suggestions for aftercare. However, let’s get back to the main reason you’re here.

What are the Most Common Complications Associated with a Perineal Urethrostomy?

Re-Occurring Urinary Tract Infections

It’s an odd thing to hear that your cat may experience urinary tract infections after going through such an extreme procedure, but it’s important to note that the PU Surgery isn’t meant to cure the underlying issue (ie. the development of stones and crystals.) Unfortunately, cats who undergo the PU Surgery are actually more prone to getting UTIs due to how exposed the manufactured urethra is. Although this is true, as mentioned above, Urinary Tract Infections are fairly easy to cure after the surgery and your cat will be at a much lower risk of blocking (although that is still possible.)

To put this into perspective, since Beau’s surgery in November 2017 he has gotten 2 urinary tract infections. We are uncertain what the causes of his original urinary tract infections were before the surgery (although we assume it was from food that altered the pH of his urine), but we are 99% sure that the two urinary tract infections this year (2018) were caused by stress (as he got one soon after we adopted a new kitten and the other was after we moved.) I will make sure to keep this page updated with if Beau gets any other urinary tract infections so it can help you make a decision whether or not this procedure is for you.

Urinary & Fecal Incontinence

Incontinence usually occurs in the first few weeks of recovery and does not usually occur after, however, this doesn’t mean that this is always the case. Beau experienced urinary incontinence until he had his stitches removed. This was believed to be caused by the stitches irritating the tissue of his manufactured urethra, causing him to dribble or want/need to urinate. Cats may continue to express urinary incontinence until they get used to the sensation of peeing from their new urethra as they no longer have a muscle to control the stream of their urine. The majority of cats will learn how to control their urine, however, there are a few who will continue to be incontinent for the rest of their lives.

As for Fecal Incontinence, this is a bit more complicated. It is rarer than urinary incontinence and is often a sign that the brain is not communicating with the colon properly. Although that is true, fecal incontinence is also caused by infections on the anal glands or medications. Medications being the primary reason for fecal incontinence early on in a feline’s recovery after a perineal urethrostomy.

Rectal Prolapse

Similar to humans, prolapse usually is tied to other conditions such as constipation, struggles to urinate or diahrea. If you notice your cat struggling to urinate or defecate after surgery make sure to consult with your vet as there are plenty of medications that can help relieve your cat of these problems. This will help make sure that they are healthy and safe. (We had the issue of Beau not being able to defecate for days, we were given a stool softener that helped him within an hour.)

Avoiding the Litter Box

Cats learn by making connections. I meow, you feed me. I push my head against you, you pet me. So it’s not uncommon for cats to avoid litter boxes if they have experienced a number of blockages/urinary tract infections in the past. It may be useful for you to create some litter boxes out of cardboard boxes if your cat begins ignoring the litter box. Try to break their association to pain from the litter box.

Rectourethral Fistula

This is actually something we were never warned about, but rectourethral fistula is when a hole is created between the anus and urethra causing urine to seep out of the anus or fecal matter to pass through the urethra. This hole is commonly created while in surgery, however, may occur after the surgery. Surgeries that have been known to cause fistulation include surgeries on bowels, cervix, uterus, prostate, or urethra. Oddly enough, fistula can also be caused by radiation therapy, ultrasounds (when intense), and cryotherapy.

Cats who experience Fistula will commonly get extremely sick, so it will be clear whether or not your cat is experiencing this complication. Treatments are not easy to perform and may cause further complications, however, it is possible.

Perineal Hernia

Unfortunately, it is uncertain what causes this form on hernia, but vets seem to believe that it may be caused by the diaphragm breaking or weakening. Perineal Hernias happen to a number of cats, even if they haven’t gone through any surgeries and are most commonly seen in cats aged 7-9.

Perineal Hernias may cause constipation, the inability to urinate, straining, depression, abdominal pain, lethargy, incontinence, swelling on the anus, vomiting and other forms of pains/illness. Cats are able to recover from this form of a hernia, but only through surgery and antibiotics.

Scar Tissues Resealing

When incisions are made tissue seeks other tissue to bind to in hopes of repairing itself. This can, unfortunately, occur after a perennial urethrostomy, however, is completely reversible through a simple catheterization to help reopen the hole. This is similar to the catheterization that occurs when cats need their bladder flushed from crystals or stones.

Conclusion

Although the list may feel long and fatal, I’m really grateful that we have not experienced the majority of these issues. Beau is more active than he has ever been, and while he has experienced a couple UTIs in the past year, seeing him so happy makes us happy. He has more energy than he had (even before the surgery) is much more playful and has returned to his regular cuddly self. I will say, the PU Surgery is not necessary for the majority of cats, however, if it is offered as a last resort for a cat it is definitely something to consider. So far, I haven’t heard of a fatal experience (and when I say this, I mean the folks who have contacted me for advice on the procedure and have gone forward with it. This number is currently over 50 pet parents, which makes me feel like the odds are fairly high for a smooth recovery.) I would highly recommend consulting a few vets before going through the surgery though. Give a few in the area a call to see how many PU Surgeries they’ve performed and ask them how many cats have had complications since. Our vet had a number of surgeries under his belt and only one cat had complications after (being incontinence) so we felt fairly comfortable. It also eased us to know that he had actually adopted a cat who had to undergo a PU Surgery when the cat was surrendered and the original pet parents asked to euthanize the cat. We’re very lucky to have had the vet we had, and I hope that if you have to go through this process you do too.

As always if you see anything missing on this list please let me know and if you have any questions or concerns leave them in the comments below and I will get back to you as soon as possible.