Hey Pet Parents & Pet Lovers,
At this point, it should be no surprise that we had to go forward with Beau getting a PU Surgery. This decision, at first, was a difficult decision to make. We had battled previous urinary tract infections (UTIs), switching to all different types of food, and even tried reducing his stress by building him safe spaces.
Unfortunately, even with all of this, we had a devastating experience where Beau got blocked 3-times within 2 days, resulting in a: we may have to euthanize him, talk from the vet (which I still find unacceptable.)
PU surgeries, while life-saving, may not always be recommended to pet owners. We actually didn’t know they existed even though we had been to the vet 4 times within the 2 days. It wasn’t even a topic they brought up. On the 3rd visit, my partner and I did research on the car ride to see if there was another alternative to putting a catheter in Beau since that wasn’t working, and we discovered the surgery. When we brought it up to the vet, they kept saying, “Oh, we don’t need to do that, it’s also super expensive, let’s keep trying this…” while the results hadn’t been positive and Beau wasn’t getting any better.
The next morning we took Beau to our regular vet who had the opposite reaction stating, “The PU Surgery is quite frankly the only option you have in situations like these.” After taking a quick look at Beau’s urethra, they discovered that it was quite narrow (more narrow than the average cat), which was why there were no signs of recovery. They stating that the swelling from the catheter made it even worse and that without the surgery there was a high chance his bladder would rupture and that we should seriously think about having the surgery in the next few days and leave him with them to monitor and drain his bladder in the meantime.
My partner and I scrambled to do all the research we could, while also asking lots of questions to the vet, making sure we had all the information we needed to go forward with such a serious, but important operation. So, here’s a little info for you who are interested in getting more knowledge or may be going through a similar circumstance to what we were in.
What kind of cats generally need this surgery?
Well, the majority of cats that have recurring UTIs tend to be neutered male cats. If neutered too early, a cat’s urinary tract may not develop properly, leading to a smaller urethra. Unfortunately, this has been the case for both of our cats and both times we weren’t involved in the decision making or we would have waited a bit longer before getting the procedure done.
What are some factors for blockages?
A lot of times blockages come hand in hand with urinary tract infections, crystals, stones, or “sludge”, while other times blockages happen due to muscle spasms which can actually close off the urethra.
I’ve tried medications and they’ve worked in the past, why would you suggest this surgery?
Well, I wouldn’t recommend this surgery for “first-time offenders.” In the 2 years we had Beau, he has gotten about 3 blockages before the final few leading to the surgery (around the age of 3). The medications worked in the past, and Beau had a good stream of urine coming out of him for months, but even with all the advice we got from the vet and the precautions we took, it still wasn’t good enough for him. While we can’t necessarily pinpoint why Beau got blocked that often (whether it was him not drinking enough, that his urine wasn’t acidic enough, he was too stressed out, or because his urethra spasmed too much) we knew it was time to put the pills down and try something different.
What the medications do…
Sometimes we don’t ask all the questions we need to, so you may not actually know that the medications don’t actually solve the problem. The medications given to you for urinary tract infections and crystals are commonly painkillers, anti-inflammatories and muscle relaxants. It’s still your cat’s responsibility to pee out all the gunk that’s left in their bladder, and dependant on how acidic their urine gets, they may not be able to pee it all out.
In Beau’s case, his bladder was filled with sludge that was thicker than his urethra and the crystals that formed were starting to get bigger, but the sludge blocked the urethra making it almost impossible for anything to come out. This is something that you can’t see as a pet parent, so we were unaware that Beau wasn’t doing well, especially because the days leading up to his blockage he was peeing like normal. Beau also suffers in silence. He’s not a very chatty cat and doesn’t let us know when he’s sick ever. Even when he was at his worst he tried to sit in our lap quietly as he pushed and pushed and pushed. Walker, on the other hand, is the kitty who tells us as soon as he’s sick. He cries and whines and puts up a fuss until we take him to the vet.
So are you saying the food doesn’t work?
Absolutely not. The food works the majority of the time, but like everything, there are some cats that it doesn’t work on. When feeding a urinary specific food it’s extremely important to make it at least 90% of their regular diet, including treats. We made the mistake of switching off of urinary specific food with our cats. Now, again, this isn’t true for all cats, but some cats will have to remain on this food for the rest of their lives.
Why is this important? Well, the urinary food raises the acidity in their stomachs to make sure that crystals do not develop. A lot of pet store food is made for the general/average cat and doesn’t take into consideration cats with special needs. Even Royal Canin, Science Diet & Purina (pet store level) urinary care won’t help regulate your little one’s urinary health. (This may not be true of places outside of Canada as all “vet prescription food” is only sold at the vet and not in regular stores, and I know some places like Europe allow for “prescription food” to be sold in regular pet stores.)
To make it straightforward and clear, the foods you are interested in are Urinary S/O by Royal Canin, and Science Diet C/D (although there may also be other ones dependant on where you are, and make sure to consult a vet which is best for you). Ones you are trying to avoid are Royal Canin Urinary Care, Science Diet Adult Urinary Hairball Control, and Purina Proplan FOCUS. Although marketed as “urinary care” they don’t actually get the job done, but can sometimes regulate and keep your cat conditioned, but even if you take a closer look at the bag/can they advise that they are not substitutes for “vet prescription food.”
I’ll delve deeper into the topic of urinary food in the future and will link the article here, but back to the main topic!
When may it be a good choice to get the PU Surgery done?
If your kitty is getting blockages commonly or hasn’t been seeing drastic signs of improvements after medication/food treatments, I highly recommend talking to your vet about the PU Surgery. It’s a better choice to get the surgery done while your cat is younger since your cat will be able to recover faster and with fewer chances of complications. This surgery is also quite a large surgery that will require your little one to be under for an extended amount of time, which can be unsafe for cats with heart problems (which sometimes comes with age.) Always, always, always talk to a vet about your cat’s medical history, especially if they are not your regular vet and take time to decide.
So what exactly happens?
Well, the PU surgery will require the vet to remove your cat’s penis and create an artificial permanent opening instead. They shorten the distance from the bladder to this hole and make sure that the tubing is wide enough to pass any crystals or sludge.
What is the success rate?
There is no definitive answer to this, as this highly depends on your vet. It’s true that the perineal urethrostomy is a difficult surgery to perform, but in our case, our vet never had a cat left on the table and only one cat with any long-term complications.
What are some of the long-term complications?
The chance of future UTIs
Well, since PU surgeries don’t cure the underlying issues, (ie. don’t cure stones/crystals), your cat is still prone to future UTIs (and actually more prone). The only difference is… they shouldn’t have any difficulty passing these stones or crystals, improving their long-term health and making sure you don’t have blockages in the future.
Not Using the Litter Box/Leakage
Sometimes cats have been known to disregard litter boxes because of the negative association they have towards it, they have also been known to dribble because they can’t feel when they are done peeing. This was true of Beau until he had his stitches removed. We thought it was going to be a longterm issue, but it went away immediately.
Scar tissue closing/resealing
Though rare, scar tissue may close and actually block the new urethra. The good part of this is, it’s super reversible and most vets will insert a catheter to reopen the hole. This should not be a worry after the healing process is complete, however again if it does happen, your cat will be fine!
What is the healing time?
For us, the full-healing time was around 3 weeks (because Beau had a double cystotomy as well). You can read a day by day account of the first week here. After the first week, you should be in the clear, but again this depends on the age and health of your cat. You can also check out that article for post-operation care and extra information. I’m also here if you want to chat and make sure to ask your vet if you can e-mail them any of your questions!