What to Do If Your Male Cat Needs Perineal Urethostomy (PU) Surgery

2 years ago

Well, a year and a half after I wrote Help, My Cat Can't Pee on BlogHer, my sweet little black cat, Kizzy, almost died again from a total urinary blockage. Thankfully, before he blocked completely, we'd already decided to take the rather dramatic step of perineal urethrostomy surgery.

Cats become candidates for this crazy surgery after they've been blocked three or more times, according to my vet. A year ago, we thought we'd never do it. The surgery is drastic: The vet cuts off the cat's penis and tacks the sides of the urethra open wider with sutures. After those sutures dissolve, your cat has a nice wide urine highway right underneath his anus. (He's still a "he," technically, albeit a "he" with no penis.) (Genitals don't equal gender, anyway. Kizzy would like you all to know he is indeed, still a mancat.)

Kizzy went in for his third catheterization several weeks ago, and I talked to my husband before I took him about the threshold for surgery. Primarily we wanted to weigh how likely Kizzy was to face problems later in life, like incontinence or pain. Secondarily, we wanted to know how much the surgery would cost. We were already shelling out hundreds of dollars every time he was hospitalized for a blockage, so our tolerance for vet bills is high, but we weren't going to bankrupt my daughter's college fund or anything. Finally, we wanted to know if it would actually work.

I, of course, asked Dr. Google, and that's why I decided to write this post. I did see a lot of message boards, but I didn't find many blog posts that detailed someone's personal experience from beginning to end, and that's really what I wished for when I went looking.

After we agreed to the surgery (which in the Kansas City area cost around $1,200), Kizzy was scheduled for the next day. (He was already catheterized and they needed to let that flush out and make sure he was okay before they proceeded.)

The surgery itself was done by a vet who had done them before and had no real complications from any of her patients. She told me after the surgery that Kizzy had developed scar tissue again immediately after his catheter was removed for surgery prep, and she actually had to amputate the tip of his penis in order to insert the surgery catheter. So, in other words, he was 100% blocked and would've definitely died if we hadn't had the surgery. This removed any doubt I had about whether or not the risk was too great in retrospect.

We went to visit Kizzy in the hospital after he came out of anesthetic. He was very out of it and his pupils looked like silver dollars, but he was also extremely affectionate and happy to see us. It was hard not to take him home that night but I wanted to be sure he was okay. We once made the mistake of bringing him home too early after a catheterization and that was a nightmare. Also, we were going into a weekend and anyone who has ever handed over a mortgage payment to an emergency vet wants to avoid that experience if at all possible.

The next day, the vet cleared Kizzy to come home. He was very eager to leave. We brought him home and put him in the unfinished basement where his litter boxes are usually located. We wanted to keep him down there a) to be very close to his litter boxes b) so he wouldn't have to climb any stairs to meet his basic needs and c) because we weren't sure if he would be a dribble monster. Cat urine is ... difficult ... to get out of carpet or bedding.

We gave Kizzy pain meds every morning. I got up in the wee hours of the morning and went downstairs and slept with him the first two nights after surgery. He was definitely in pain toward the end of the 24-hour pain med period and seemed to take comfort in being held. He also had a cone on his head, which made sleeping difficult.

The day after he came home, I actually had to take him back to the vet to get a bigger cone. He was attempting to lick his sutures (which is devastating to the surgery -- a cat will try to lick the area and if he pulls those tiny sutures out, well, you can imagine the damage) and he was getting about as close as the base of his tail. I was very concerned. The vet told me it was very good that I'd brought him in because if he could reach the base of his tail one day, he'd be licking that incision area by the next day. Cats are smart and good contortionists.

The larger cone allayed my licking fears, but it created a new problem: eating and drinking. We gave Kizzy pretty much exclusively wet food (which I spoon-fed to him) for the first two days so he wouldn't have to try to drink much water. By the third day, he was feeling better and spent a lot of time figuring out how to move the cone around so he could get to his food. We didn't have to spoon-feed him after that, and he was hungrier so he wanted dry food as well as wet. (He eats, then and now, prescription C/D food, though the vet is going to put him on half C/D and half weight watchers going forward, because the C/D food makes cats fat. She said she had to cut deeper than normal when she was doing his surgery because -- get this -- my cat had such a fat ass.)

We kept the cone on for a full eleven days. It would've been ten, but we had house guests over the last weekend and the vet is closed on Sundays, so we waited until the following Monday morning. I knew Kizzy would lick the minute the cone came off and I wanted visual confirmation from the vet that he was healed enough to take the cone off. He was, though he howled at them when they inspected the site because dude, the last time he saw them they cut off his pee-pee.

We are about a month post-op now and though his fur hasn't completely grown back (rendering him baboon-like from the rear), I am very glad we had the surgery done. He doesn't appear to have suffered any problems learning to use his new plumbing. I read on some message boards that some cats spray out the back because they haven't figured out they don't have a way to aim any more, but Kizzy had always been somewhat of a squatter, so he had it down with no problem.

The worst part about the surgery was definitely the first four or five days post-op. It is so hard to watch your pet be in pain, wear a cone, not understand what happened or why you keep taking him back to that awful vet place. The best part? His likelihood of becoming blocked is so much lower now because even though crystals could still form in his urine, the pathway for them to leave his body is so much larger they are unlikely to get stuck. After three catheterizations, we were sort of living in fear and lurking around his litter box waiting for the other shoe to drop all the time, and that's no way to live.

If you've found yourself here because you've got a male kitty who keeps blocking, try to put aside how dramatic the surgery is in terms of genitals, especially if your cat was neutered to begin with. I've seen zero change in my cat's personality, level of affection or desire to play. Once his pain was gone, he went right back to wanting to be walked on his harness outside every morning and jumping on top of the refrigerator to get our attention. Knowing that he definitely would've died at the point of surgery removed all doubt from my mind. He is an otherwise healthy three-year-old cat, and we hope hope hope he is able to live out a very long life with us now.

Rita Arens is the author of the young adult novel THE OBVIOUS GAME & the managing editor of BlogHer.com.

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