Cat PU Surgery and Recovery (Perineal Urethrostomy in Cats)

A urethral obstruction in cats is a medical condition where urine cannot be emptied from the bladder due to blockage in the urethra. This can be caused by crystals, stones, inflammation (most commonly), or in rare cases, a tumor. 

Urethral obstruction in cats is considered a medical emergency and should be handled by a vet immediately. The only treatment is to medically unblock the urethra under heavy sedation or general anesthesia. If left untreated, it is fatal because of the potential for bladder rupture and toxins building in the bloodstream. 

Unfortunately, cats who have urinary blockages are prone to blocking again. These cats are often recommended to have a surgery called a perineal urethrostomy (PU), performed by a board-certified or highly trained veterinary surgeon.

What Is PU Surgery in Cats?

A perineal urethrostomy (PU) in cats is a surgery performed when a recurrent urethral stricture (tightening) or blockage will not allow the passage of urine from the bladder.

In male cats, the rule for recurrent obstructions is that if it happens two or more times, a perineal urethrostomy should be considered to help avoid obstruction in the future. 

This procedure is rarely (if ever) performed in female cats, due to their larger urethras. Female cats who chronically obstruct often require different types of therapy or surgery, depending on the cause of the obstruction. In female cats, the most common causes of urinary obstruction are stones, a tumor, or congenital issues.

PU surgery is often performed after your cat is unblocked and already in the hospital. The surgery usually takes about 1-2 hours to complete. 

The procedure costs can vary, based on the following: 

• Severity of the obstruction

• Trauma

• Stricture formation (a narrowing of the tube)

• Inflammation of the urethral tissue  

• Stability of the patient 

What to Expect When Your Cat Has PU Surgery

Your cat is kept in the hospital for about 1-2 days for placement of a urethral catheter, monitoring of the incision site and urination, intravenous fluid therapy, and pain medications. 

Your cat’s hospital stay may be longer, depending on how well they are healing and their level of stability. The surgery’s success rate is high for decreasing the risk of another obstruction, unless severe stricture (narrowing) or tumors are the cause of the blockage. 

PU surgery in cats does not eliminate the underlying cause of their lower urinary tract issues. These cats are still prone to crystals, stones, and feline idiopathic cystitis (FIC) episodes in the future. 

Also, postoperative male cats are at a higher risk for urinary tract infections (UTIs), since their urethra is now larger in diameter and can allow more bacteria into the bladder.

Proper, consistent veterinary care is necessary to help alleviate these issues as they arise, even after PU surgery is performed.

Cat PU Surgery Aftercare

Post-operative care is very important following PU surgery in cats. Since surgery and hospitalization are stressful for cats, place your cat in a calm, quiet room with a litter box for the first few days for close monitoring. 

Caring for the Incision

During the healing process, which is usually 14-21 days, your cat must wear an E-collar or bodysuit to prevent them from grooming and licking, which can cause secondary complications like tissue damage and infections.

Watch for these signs of infection and contact your vet if you see them:

• Pain

• Redness

• Swelling

• Discharge

Eating and Drinking

After PU surgery, your cat should eat and drink as they normally would. If your cat is not showing interest in food or water for over 24 hours after discharge, contact your veterinarian, as this could be a sign of a complication.

Peeing and Pooping

Urine dribbling, frequent urination, and blood in the urine are common for up to 3-5 days after surgery.

Cats should be urinating small amounts almost immediately upon returning home.

If your cat shows any of the following signs of blockage or pain, bring them back to the vet immediately, as these can be signs of postoperative complications:

• Straining to urinate with no urine passed in over 4-6 hours

• Vocalization while straining to urinate

• Severe lethargy (moving slowly, sluggishness)

• Vomiting

Watch your cat for constipation or diarrhea, as both of these issues can cause complications to the surgery site and can be common side effects of anesthesia and certain medications. 

Straining to poop can place pressure on the surgical site and can cause sutures to loosen. Diarrhea can cause infection at the surgical site. If you notice either of these, please contact your veterinarian to discuss options.

Medications

Continue all medications, especially those that control pain and inflammation. This is critical during the healing process.

Vet Follow-Ups

Schedule a follow-up with your veterinarian after surgery. Sutures will typically need to be removed around 14-21 days.

Your veterinarian will assess your cat’s urinary tract by pressing gently on the bladder and watching for urine flow through the urethra or via urethral catheterization. They will also discuss factors that cause urinary blockage and how to help avoid any complications in the future.