Q: I have a 7-year-old male cat named Oscar. He is a big orange tabby, and he could not be a sweeter animal. His problem is that, for the third time, he has become blocked up and cannot urinate. He forms crystals and they plug his urethra. On this most recent occasion, he became very sick and we almost lost him. We have tried changing his diet, checking for infections, giving antibiotics, etc. Nothing has worked and now we are being told he needs a surgery to prevent this from happening again. The surgery sounds pretty radical. What would you recommend, and does the surgery really work?
A: Oscar has a condition known as feline urologic syndrome (FUS), or feline lower urinary tract Disease (FLUTD). Patient factors such as metabolism, activity level, age when neutered and obesity play a role, as do environmental factors. Indoor cats are more at risk, and there is some evidence that regional factors, specifically the water supply, may play into this as well. However, since relatively few cats in a given environment have this problem, it appears that patient characteristics predominate.
When cats show any sign of difficulty urinating, the situation bears watching closely. Frequent trips to the litter box with little urine production, crying out when urinating, sitting in the litter box, even inappropriate urination in odd spots can signal FLUTD. If a cat is completely obstructed with a crystal plug, it constitutes an emergency. The condition will worsen by the hour and within a day the situation can turn from unpleasant to life-threatening. So don’t delay a visit to your veterinarian if the early symptoms appear, and if you suspect an obstruction, it is then an emergency requiring immediate treatment.
For Oscar, it sounds as if he has proven himself to be predisposed to crystal plug formation, despite what sounds like appropriate medical management. So, I (Henri Bianucci) agree with your veterinarian that it is time for a surgical approach, and as you alluded to, there is no way to make this procedure sound pleasant, at least in the short run. So, readers who are squeamish about anatomical, and surgical descriptions of the genitalia may want to skip the next paragraph.
During embryologic development, the penis and the vagina begin life looking pretty much the same. As things progress, this changes as the origin tissue either cleaves into a vagina, or elongates into a penis. In the males, the urethra continues as a longer, narrower tube, while the female urethra is both shorter and wider. Fluid dynamics dictate that the female anatomy will accommodate a much freer flow of urine than the male, and herein lies the premise for the surgery.
It is called a perineal urethrostomy, or PU, and it essentially does what nature would have done had Oscar been born a female. The backside of the penis is incised, creating a cleavage to about the level that the female urethra would end. This creates a much wider opening, allowing crystals and mucus to be expelled without causing an obstruction.
This procedure is extremely effective, but not a fail-safe. Even females can become obstructed, but the incidence of re-obstruction is minimal. Having said that, it is still important to address the other risk factors, such as diet, obesity and activity. These will all act to further reduce the risk of obstruction and provide for optimal urinary health.
Significant risks of the surgery are low. In the early term some bleeding, swelling and, yes, pain are likely. Generally these are all controlled with good post-op care, and resolve quickly. In the long term, the risk of urinary tract infections is increased slightly, and incontinence has been reported, but in the right surgeon's hands, these are very rare. Re-obstruction has been reported as well, but compared to the risk of not doing the surgery, this is a minuscule risk.
Overall, I highly recommend this procedure in cases like Oscar's. Without it, he is a ticking time bomb, and a visit to the emergency clinic is predictably unpredictable.
Often we hear clients who are questioning the procedure make comments like, “So you’re going to turn him into a girl!” or “So he’s having a sex-change operation.” These points are irrelevant, and inaccurate. This procedure no more changes the gender than neutering does.