Perineal Urethrostomy
What is a perineal urethrostomy and why is it performed?
Perineal urethrostomy is a surgical procedure that creates a permanent, enlarged urethral (tube that transports urine from the bladder) opening along the perineum. This procedure is commonly performed in male cats with urinary obstruction(blockage). The penile urethra in cats has a very narrow diameter is prone to obstructing. This surgery creates a new opening at portion of the pelvic urethra that is nearly twice the diameter of the penile urethra, thereby significantly minimising the risk urethral obstructions.
When is a perineal urethrostomy indicated?
Perineal urethrostomy is indicated in male cats that experience multiple episodes or persistent obstruction of the penile urethra, despite appropriate medical management. In the majority of cases an obstruction will occur at the penile urethra due to a stricture(focal narrowing) or secondary to crystalline/mucous plugs that form with feline lower urinary tract disease (FLUTD), or obstruction with urinary stones. Although this surgery will successfully result in altering the cats anatomy to prevent recurrent obstruction, medical management of the underlying condition is required lifelong.
Only cats with obstructions of the penile urethra benefit from a perineal urethrostomy.
What does perineal urethrostomy involve?
This procedure will only be preformed once the patient is stable.
During this procedure the penis is amputated, and a permanent urethral opening is created at the level of the pelvic urethra by mobilizing and exteriorizing the pelvic urethra, which is then sutures to the skin. A castration(desex) will also be performed at the same time if the cat is entire.
What is the recovery like?
Postoperatively patients will remain in hospital for a few days to ensure they are comfortable and able to urinate normally.
An Elizabethan collar is placed on the patient to prevent licking of the surgical site, which if allowed can complicate healing of the surgical site. The Elizabethan collar will need to be worn until the sutures have been removed.
Patients will likely need to be sedated for subsequent surgical site assessments and suture removal. Following suture removal patients are expected to return to normal.
What is the prognosis?
Majority of patients have an excellent prognosis postoperatively. A perineal urethrostomy will decrease the likelihood of future obstructions but will not prevent the symptoms of lower urinary tract disease.
What are the potential complications with perineal urethrostomy
Potential complications need to be discussed prior to undertaking a perineal urethrostomy.
Although infrequent, major postoperative complications include:
Stricture formation (scarring and narrowing of the urethrostomy site)
Recurrent urinary tract infection
Urinary incontinence