Learning that your beloved cat needs urethrostomy surgery can be a daunting experience for doting owners. This is especially true if you are unsure what the procedure is or what it involves. This article delves into the reasons why your cat may need a urethrostomy, read on to find out more! 

A urethrostomy is an operation performed by your vet under a general anesthetic. The aim of the surgery is to create a new opening in the urethra for urine to pass out of the body. It is usually performed to bypass a narrowing or blockage of the urethra. 

It is commonly recommended for male cats that present with recurrent urinary tract obstructions. 

It is a big operation for your cat, however, it can significantly improve their quality of life and also can prevent future problems from occurring. 

What is a Urethral Obstruction? 

The urethra is a tube-like structure that takes urine from the bladder out of your cat’s body. When the urethra is obstructed or blocked, urine is unable to leave the body in the usual way. This very quickly leads to a build-up of toxins that cause serious health issues and can even result in death. In some cases, ureterostomies are carried out as an emergency operation. 

There are many different causes of urethral obstruction. These include: 

  • Urethral plugs 
  • Bladder stones
  • Tumours 
  • Inflammation 
  • Structure formation (scarring)
  • Trauma 

Male cats are more prone to urethral obstruction than females. This is down to anatomical differences in their urinary tracts. The male urethra is a lot longer than the female urethra and it becomes narrower when it enters the penis. This makes it more susceptible to blockage.   

Urethral obstruction can sometimes occur as a knock-on effect of inflammation in the bladder. Some cats are prone to a condition called feline idiopathic cystitis (FIC). It is thought that this inflammation in the bladder is caused by stress. Inflammatory changes can alter the composition of the urine, making it more mucousy or filled with debris. This can contribute to urethral plugs and blockages. 

More research is required to fully understand this phenomenon, the exact mechanisms involved in this inflammatory process are still being investigated. 

Signs of Urethral Obstruction

It is important that owners are able to spot the signs of urethral obstruction as it is a medical emergency that can lead to serious complications if left untreated. If your cat has an obstruction, the following signs may be seen: 

  • Attempting to pass urine frequently with little or no urine coming out
  • Straining when trying to urinate
  • Signs of pain such as crying out or howling 
  • Vomiting 
  • Diarrhoea 
  • Lethargy 
  • Loss of appetite 
  • Weakness 
  • Collapse 

What is a Urethrostomy? 

A urethrostomy involves creating a new, permanent opening for the urethra, bypassing the damaged or obstructed portion. In male cats, a perineal urethrostomy is usually the surgery of choice. Here a new opening is made over the perineum which is the space between the scrotum and the rectum. The urethral opening is made larger to allow for passage of urine freely. The cut part of the urethra is surgically attached to the skin. The new opening reduces the risk of future obstruction occurring. In male dogs, the surgery is usually done in a slightly different location, over the scrotum. 

What are the indications for a Urethrostomy? 

In cats, a urethrostomy is indicated when recurrent or chronic urethral obstruction occurs. 

If your cat has repeated urethral blockages, despite being unblocked by your vet or receiving medical treatment, your vet will chat with you about a urethrostomy surgery. 

Common reasons for the surgery include:

Urethral plugs and urinary stones 

These frequently cause urethral blockages or obstructions in cats. If your cat is prone to developing stones and plugs they are more likely to experience recurrent urethral obstruction. 

Urethral plugs are made up of lumps of mucus, urinary crystals, and other debris that block the urethra. 

Urinary stones are hard mineral deposits that can form anywhere in the urinary tract and cause blockages. The narrow diameter of the urethra means it is easy for stones to become lodged and stuck. 

Injury or trauma

This can cause damage to the urethra. If the damage is severe, a urethrostomy may be indicated to enable your cat to pass urine freely again. If an injury has occurred, often a new opening is made which allows urine to be passed out of the body before it gets to the damaged part of the urethra. This is frequently required as the damaged part of the urethra may become infected or have scar tissue and will not serve its purpose. 

Infections 

Any infection can cause inflammation and swelling of the urethra. This can result in a blockage. If long term damage occurs or if the infection keeps recurring, a urethrostomy may be indicated. 

Usually if a cat has multiple incidents where it is difficult or not possible to unblock the urethra or manage the condition medically, surgery is the next option. Your vet will ensure there are no underlying health issues that may mean they are unable to have surgery. They will also address any issues that may cause the obstruction to recur. 

When will your vet consider Urethrostomy

The decision to perform this surgery is not taken lightly by your vet. As mentioned above a urethrostomy will often be recommended if your cat has recurrent or chronic urethral obstructions despite medical treatment. Surgery is usually the best option for your cat especially if the obstructions are causing significant pain and discomfort. 

There are some factors your vet will need to consider when planning the surgery. These include: 

  • General health status of the cat – The general health, age and weight will be taken into account to assess if the benefits outweigh the risks of performing the surgery. 
  • The severity of the condition – How bad the obstructions are and the frequency in which they are occurring has a role in determining if surgery is required. 
  • Complications – Potential complications and risks unique to each cat are to be taken into account. Complications include bleeding, infection and incontinence. 

Your vet will discuss all of this with you before they decide to go ahead with the operation. 

The Urethrostomy Procedure

A urethrostomy procedure typically involves the following steps: 

  1. The cat will be given a premedication injection then anaesthetised. 
  2. The cat will be positioned appropriately in theatre and the area will be aseptically prepared. 
  3. An incision will be made in the perineal region. The urethra is identified and exposed to decide where to make the incision.
  4. A new opening will be made in the urethra, bypassing the affected area. 
  5. The edges of the urethra are sutured to the skin on either side.

Post Operative Care 

A buster collar will be placed on your cat to prevent them from licking the area. Your cat will have pain relief to go home with. It is important that they are monitored closely at home to make sure they are comfortable and able to eat and drink. It is vital that they stay well hydrated after the surgery. They must be kept quiet and not allowed to jump around and play while the surgical site is healing. Your vet will have booked some post-op appointments to check on your cat. It is important to attend all of these so that your vet can monitor how well your cat is healing and check the surgical site. The majority of cats will make a full recovery and go on to live a normal life. 

Home Improvements 

Cats that have had urethrostomy surgery will have a lower chance of the obstruction recurring. However, there are still some measures that can be taken at home to further reduce any more urinary problems going forwards.

Owners should try to reduce stress as much as possible for their cats. This can be done by spending more quality time with the cat, playing their favourite games with them, or just cuddling and stroking them if that is what they enjoy. Some cats love to have a safe place high up so they can see everything in the room from a vantage point. Cat trees and perches can reduce stress for these cats. 

Making sure there are enough litter trays available and cleaning them regularly is vital as anything that discourages the cat from using them may cause urinary problems. Having multiple litter trays can help, especially in a multicat household. 

It is important to keep your cat well hydrated at all times to ensure they are passing urine that is not too concentrated. It is possible to increase some cats’ water intake by changing to tinned food. Lots of cats like to drink from water fountains. Putting multiple water bowls around the house may encourage them to drink more during the day. 

In some cases, the use of synthetic pheromones can help to reduce stress in cats.  

Final Thoughts 

Urethrostomy surgery is a valuable surgical option for cats with urinary tract obstructions. It can significantly improve a cat’s quality of life and reduce the risk of future complications. As with any operation, it is important to assess the potential benefits and risks before going ahead with this procedure. If you have worries about your cat’s urinary health, speak to your vet to discuss your cat’s condition and determine if a urethrostomy is the best treatment option. With proper care and management, cats who undergo urethrostomy surgery can live long and healthy lives.

Further Reading