Perineal Urethrostomy

PU is typically recommended after a male cat has experienced two or more urethral obstructions, or after a single obstruction that is severe, complicated, or cannot be relieved by catheterization. Reasons the surgical team recommends PU include:

• Recurrent urethral blockages despite dietary management and treatment of underlying urinary disease
• Urethral stricture (scarring that permanently narrows the urethra) from repeated catheterizations or injury
• A plug or crystal type that keeps recurring and blocking the narrow penile urethra
• Urethral trauma that has damaged the tip beyond repair

PU does not cure the underlying cause of feline lower urinary tract disease (FLUTD) — bladder inflammation, crystals, or stress-related episodes can still occur — but it removes the narrow anatomical bottleneck that makes obstructions life-threatening.

PU is performed under general anesthesia with full monitoring. The key steps of the procedure are:

• The cat is positioned with the hind end elevated and the tail secured out of the field
• The penis and prepuce (foreskin) are surgically removed along with the narrow penile urethra
• The wider, pelvic portion of the urethra is identified and its opening is expanded
• The edges of the urethra are sutured directly to the surrounding skin, creating a permanent, wide stoma (opening)
• A urinary catheter may be left in place for twenty-four to seventy-two hours to keep the new opening patent while initial healing occurs

The new opening heals with a mucosal lining similar to the inside of the mouth and remains permanently open without any need for ongoing dilation.

If a cat arrives blocked, stabilization comes first — usually emergency catheterization, IV fluids, and treatment of elevated potassium and kidney values before surgery is scheduled. Once stable, preparation includes:

• Bloodwork to assess kidney function, electrolytes, and overall health
• Urinalysis and urine culture to identify concurrent infection
• Abdominal ultrasound if bladder wall changes or stones are suspected alongside the blockage history
• Food withheld for several hours before surgery; fluids are continued intravenously

Most cats stay in the hospital for one to two days after PU. Recovery at home requires careful attention to the surgical site:

• Days 1–14: an e-collar (cone) must be worn continuously to prevent the cat from licking the stoma, which can cause serious stricture complications
• Days 1–14: non-clumping litter (shredded paper or pelleted paper litter) must replace clay or clumping litter to prevent particles from irritating the new opening
• Days 1–10: restricted activity; monitoring of the stoma for swelling, discharge, or narrowing
• 10–14 days: recheck visit for suture removal and urinary assessment

Blood-tinged urine at the new opening is expected for the first one to two weeks. Normal, clear urination should become apparent once initial inflammation settles.

PU is a procedure with an excellent success rate for preventing recurrent blockage. Important considerations include:

• Stricture (narrowing) of the new stoma — the most feared complication, usually caused by the cat licking the site; the e-collar is non-negotiable
• Increased risk of urinary tract infection — the wider, shorter urethra is less effective at filtering bacteria; annual urinalysis helps catch infections early
• Ongoing FLUTD episodes — bladder discomfort, urgency, and blood in the urine may still occur; PU prevents obstruction, not bladder inflammation

The procedure eliminates the most dangerous aspect of recurrent blockages — the kidney damage and cardiac effects of backed-up urine. The majority of cat owners report a dramatic improvement in quality of life after PU.