Feline PU Surgical Debate

To better understand what I am getting at, some of you may have been in this emergency situation before.  Your male cat starts vocalizing in the litter box, making frequent trips to the box, straining to urinate, and there are no visible urinary piles.  He is lethargic and in visible pain.  These are common symptoms of a urinary obstruction that can occur in male cats.  Unfortunately, it is a life-threatening emergency.  If the blockage is not treated, your cat will die.  

You are now faced with these words in an emergency clinic in the middle of the night.  You are scared, your cat is painful and sick, and you have to make a decision.  Sometimes, as a first line treatment (which is what I am protesting), PU surgery is offered to relieve the blockage and help prevent future blockages.  I feel that clients may be talked into this surgery because they are frightened and don’t know what else to do.  This is the issue I would like to discuss.

PU surgery stands for perineal urethrostomy.  I am going to quickly describe the procedure, which is very graphic, so skip to the next paragraph if you don’t want to know.  The simplest description is that the penis is cut off, a linear incision is made at the 12:00 position of the urethra, and the urethra is butterflied open and sutured to the skin.  

This is comparable to human sexual reassignment surgery.  IT is a big deal!!!  It is considered a SALVAGE procedure.  In 12 years, I have only seen 1 cat that NEEDED the surgery due to 5 previous blockages that had led to urinary stricture formation.  We were unable to pass a soft urinary catheter and his urethra actually tore at the site of the scar tissue.  Complications can occur from a PU surgery and include chronic urinary tract infections or possible urinary leakage/incontinence.

If you are ever faced with this situation in the middle of the night, the best plan of action is to have your pet stabilized and let them relieve the obstruction with a urinary catheter, until you can talk with your vet in the morning.  If it is over the weekend, keep him at the ER with the urinary catheter in place and talk to your vet first thing Monday morning.  As long as the urinary catheter is flowing, you have time to make a decision.  Blockages are serious, and they can block again within the first week or two, but they still don’t need a PU unless there was irreparable damage to the urethra.

The best analogy I have heard from a specialist was this “If you get constipated, do we cut your rectum off??  NO.  Then why is it okay to cut their penis off for a urinary obstruction?”

I will leave you with those powerful words.

Dr. Leah Wulforst, DVM

Riverside Veterinary Clinic, Knoxville TN