Perineal Urethrostomy
Unblocking Patients
What is a Perineal Urethrostomy?
Feline Lower Urinary Tract Disease is commonly diagnosed in young to middle aged, overweight, cats. The diameter of the urinary tract at the level of the penis is very small and is prone to blockage with urinary crystals, sediment and also due to spasm of the muscles of the lower urinary tract. In male cats there are several factors thought to be responsible, such as urinary crystals or stones, infection (cystitis), or behavioral and stress. Urinary tract blockage can also occur in male dogs due to bladder stones, trauma or tumors, and is less commonly seen in females. Obstruction will prevent the patient from urinating and cause excess accumulation of urine in the bladder, making the patient very ill due to a build-up of toxins and electrolyte imbalances.
How can my pet be treated for urinary blockage?
Urgent veterinary attention is required in these situations to relieve the bladder and correct the electrolyte imbalances. Once these are stabilized the patient may either be managed medically with a combination of dietary control, or surgically to bypass the obstructed urinary tract or widening the urinary tract opening to reduce the risk of future blockages.
A urethrostomy is used to bypass the urinary tract blockage and widening the urinary tract opening to reduce the risk of future blockages in patients where repeat episodes of obstruction have occurred. In cats a perineal urethrostomy effectively removes the penis at the level where the urinary tract is wide enough to minimize the risk of blockage. The final outcome means that 'he', will urinate like a 'she'.
What happens after the surgery is complete?
Complications associated with surgery are immediate post-operative swelling, bleeding, wound opening with urine leakage, and scar tissue formation. Dr. Pedraza does not place a urinary catheter after surgery. This technique allows the patient to urinate on its own without having a catheter placed. The patient is then monitored to ensure that it urinates without difficulty and strain. Scar formation usually can occur at any stage in the weeks to months following surgery. Leakage of urine should be identified early, and additional sutures placed to close the leak. Bleeding may occur during or following urination for 1-3 weeks after surgery, but this should resolve gradually without intervention. Urinary or fecal incontinence has been reported but is rare. Longer term complications include bladder infection in 15% of cases, which are treated with antibiotics, and late scar formation.
The prognosis as reported by owners following surgery is good in the majority of patients who have urethrostomy for the management of lower urinary tract obstruction.