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How to perform a perineal urethrostomy in cats | VETgirl Veterinary Continuing Education Videos

In this VETgirl online veterinary CE video, we briefly review how to perform a perineal urethrostomy (PU) in cats. Typically, this surgery is reserved for male cats with recurrent feline urethral obstruction, or who have developed distal urethral strictures or anatomical defects. This surgery may be performed in conjunction with a cystotomy to remove cystic calculi. Depending on the underlying disease, PU surgery is typically performed in cats with bladder stones that have failed strict medical and dietary management.

Patients that require PU surgery often have a good long term quality of life; however, pet owners should be aware of important considerations and potential complications. Although the risk of re-obstruction is significantly reduced, there is still a possibility of re-obstruction. Other risks include stricture formation (e.g., from scar tissue developing at the surgical site), urine scald, recurrent urinary tract infections, and urinary incontinence. Due to these potential complications, revision surgeries have been developed and may become necessary (typically performed by a board-certified veterinary surgeon, if needed).

Initial postoperative recommendations include an E-collar until the incision has fully healed, analgesics (e.g., buprenorphine), barrier dressing (e.g., petroleum jelly, zinc oxide, etc.) along the skin to reduce urine scald, and minimizing manipulation of the perineal region (e.g., don’t manually remove any blood clots, due to the risk of disrupting the incision!). Urinary catheterization should be avoided during the immediate post-operative period. Perioperative antibiotics are typically all that is necessary, unless indicated by culture and sensitivity results. Long-term management includes clinicopathologic monitoring every 6-12 months (e.g., urinalysis, urine culture) and dietary modifications to reduce the risk of crystalluria or calculi development.

The PU surgery is an extremely delicate surgery, where even a single misplaced suture may lead to long term complications. Ideally, VETgirl recommends a board-certified veterinary surgeon perform these, although with experience, this can be performed routinely in practice. The PU surgery can be a life-saving surgery that may provide a long term quality of life for cats with recurrent urethral obstructions.

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