Step 1
An elliptical incisions is made around the scrotum and prepuce
Perineal Urethrostomies
What is a Perineal Urethrostomy (PU) in Cats?
The intent of the PU is to create a new opening (stoma) at the level of the PELVIC urethra. This is where the urethra is at its widest and therefore the least likely to be obstructed by the passage of small uroliths or organic debris. In order to accomplish that, the entire penile urethra (and therefore the penis) must be amputated.
Situational Awareness
This is a LIFE SAVING surgery.
Unfortunately, the PU has a bad reputation because of a reported high rate of stricturing. The truth is that the most common reason why cats reblock/stricture is because the PU was improperly done. In order to get to the wide pelvic urethra, you have to free up the penis and penile urethra from its attachments to the pelvis. This part can give the inexperienced surgeon trepidation (and it should). The inexperienced often stop short of the goal and make the new opening just above the current obstruction, in the penile urethra rather than the pelvic urethra. Don’t make this mistake.
Ascending urethritis/cystitis can occur in PU cats. Although a nuisance, this problem is readily managed medically and should not be a deterrent for proceeding with the surgery.
Get Ready for Perineal Urethrostomy
All the information you need.
Fully narrated surgical videos.
In depth guide and more.
This content is designed for veterinary professionals. If you are a pet owner, please consult your vet if you have any questions about a surgery.
Pre-Surgical Considerations
When is it time to perform a PU:
- Unresolvable urethral obstruction
- Recurrent urethral obstruction (see video)
- Distal urethral injury or neoplasia
Stabilize the patient:
- Relieve the obstruction (under sedation)
- Place an indwelling catheter
- Push the fluids
- If necessary, empty the bladder via cystocentesis
Preoperative diagnostics:
- Blood work for azotemia and electrolyte imbalances
- Survey radiographs of the caudal abdomen including the perineum
- Urinalysis
What the Client Needs to Know
- PU (properly done) has a high success rate.
- Over 92% of owners have been very pleased with the cat’s quality of life (J Feline Med Surg. 2020;22:582-588).
- PU cats do require monitoring of their urinary habits.
- These patients are now more prone to bladder infections,
- The hair around the stoma may require regular maintenance,
- Dietary management for uroliths and renal support are important.
Step by Step PU in cats
Step 2
The subcutaneous tissues are cleared until the penis and the ischiocavernosus (IC) muscles (arrow) are clearly visible.
Step 3
The IC muscle is isolated, clamped and transected between hemostat and tuber ischium.
Step 4
The ventral fascia securing the penis to the pubis is cut.
Step 5
An incision is made over the urethra and extended with straight iris scissors along the dorsum of the urethra up to and in between the bulbourethral glands.
Step 6
Skin to mucosa sutures are placed at 12o’clock, then 1:00 and 11:00 o’clock. I like to use 4-0 Vicryl Rapide for suturing.
Step 7
Skin to mucosa sutures are continued distally on either side of opened urethra (drainboard); the distal portion of the penis is amputated. The remainder of the drainboard is sutured to the skin.
Get Ready to Perform a PU
Preferred instrumentation for this surgery:
- Straight iris scissors (sharp ones!)
- Small Adson or thumb forceps
- Small needle drivers
- Curved mosquito hemostats (3 – 4)
- 4-0 or 5-0 Vicryl Rapide ™ or MonocrylI ™
Post-operative Considerations:
- Manage the cat’s pain! Otherwise they won’t urinate for 48 hours.
- User an E-collar or equivalent
- Avoid clay based litter (2 weeks)
- Manage urolithiasis with appropriate diet
- Recheck in 2 weeks, expect to see some constriction to the new stoma
Get Ready to Perform a PU
Preferred instrumentation for this surgery:
- Straight iris scissors (sharp ones!)
- Small Adson or thumn forceps
- Small needle drivers
- Curved mosquito hemostats (3 – 4)
- 4-0 or 5-0 Vicryl Rapide TM or MonocrylITM
Post-operative Considerations:
- Manage the cat’s pain! Otherwise they won’t urinate for 48 hours.
- User an E-collar or equivalent
- Avoid clay based litter (2 weeks)
- Manage urolithiasis with appropriate diet
- Recheck in 2 weeks, expect to see some constriction to the new stoma
The best way to be more confident when doing this procedure is to have an experienced surgeon looking over your shoulder guiding you and encouraging you. The information in this virtual workshop is the next best thing. Surgery is more than following a step-by step pictorial description.
- It is important to be comfortable with the anatomy of the area. I will help you understand the relevant anatomy from a surgical perspective.
- I also have a fully narrated video of me doing the surgery on a patient. When you watch the video, listen carefully to my words, I give a lot of little details, tips and tricks, that will help make the surgery easier for you. You will see how to handle the instruments and the tissues.
- Watch/listen to the video several times so that when you are in surgery you will continue to hear my voice. There is no shame in playing the video while in surgery, you are trying to save a life, not impress someone with your surgical skills.
What you get when you register for this course:
- A comprehensive look at the feline LUT anatomy for a better understanding of how the surgery works
- A step by step fully narrated pictorial description of the surgery
- A narrated video of a PU being performed on a patient.
- Tips and tricks to help make the surgery go smoothly
- An understanding of what to avoid while in surgery
- A list of instruments needed to perform the surgery with greater ease
- A discussion on catheters for cats
- Information on how to manage a urethral tear in a cat
- Information on short and long term post-operative care
Price: $450 CAD
Perineal Urethrostomy in Cats: Q&A
How long do cats live after PU?
- A PU cat can have a long life with a successful unblocking and surgery
- Renal issues can be expected if they have had prolonged/multiple blockages
- Cats presenting with severe azotemia are more prone to succumbing to renal failure if not managed quickly
What is a cat’s quality of life (QoL) after a PU surgery:
In a study published in 2020, 100% of cat owners reported a good-to-excellent QoL after this procedure (75% reported excellent). Re-blockage in cats with a properly done PU occurs in less than 1.7% of cases (J Feline Med Surg. 202022:582-588).
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