Hospital Cases

Perineal urethostomy

Trevor was presented when the owner noticed he was having trouble urinating. He had been squatting and not passing any urine, and was uncomfortable when his abdomen was touched. On examination, he had a very distended bladder, about the size of a tennis ball. 

We made a tentative diagnosis of Feline Urological Syndrome (FUS) where a small percentage of cats make crystals in their urine, similar in appearance to salt granules.

In male cats, the crystals can cause a blockage in the urethra (the tube running from the bladder to the end of the penis along which urine travels). In female cats, the urethra is wider than in males, so it is pretty rare to see an obstruction.

When the urethra gets blocked, urine builds up in the bladder as the kidneys keep producing it. Before long, the back pressure can cause damage to the kidneys and levels of potassium in the blood start to rise. The high potassium (hyperkalemia) can stop the heart beating within 24 hours.

A blocked FUS case is an emergency. Pressure must be relieved ASAP otherwise damage to the kidneys can be irreversible and death is rapid.

Trevor was given a gas aesthetic using Isoflurane and oxygen.
 
We inserted a needle into his bladder and emptied out 200 ml of urine. This brought us some time as it took the pressure of his kidneys. We then tried to flush out the blockage in his urethra by passing a soft rubber catheter into his penis and flushing fluid though the end of it as we advanced it towards his bladder. Unfortunately, the tube would go no further than 1" in.

After 20 minutes and several attempts to remove the blockage, we decided he needed to have surgery to remove the crystals at their point of obstruction.

We performed an operation where we opened up the penis along its entire length and stitched its edges to the surrounding skin. The incision went al the way to the level of the blockage where we found a large mass of crystals.

Trevor recovered very well and was using his litter tray by day 2. We took his stitches out 10 days later.

We placed him on a special diet called Hill's Feline S/D (Struvite Diet) which makes his urine more acidic thereby dissolving the crystals (much like sugar dissolving in a cup of tea). Once he has "cleared his system out" and has no more crystals, we will be placing Trevor onto Hill's Feline C/D/S diet (Cystitis Diet Struvite) to prevent any reoccurrence.

See also…
Feline Urological Syndrome (FUS)

Click on thumbnail images to enlarge
Normal cat lower
Cat fus
Ug urethostomy 1
Ug urethostomy 2
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Ug urethostomy 7
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Ug urethostomy 18
Ug urethostomy 11