I just want him back.

May 28, 2009 5:35 PM

Oh joy, it's another cat piss question! Sort of. Please share your experiences with cat perineal urethrostomy (PU) surgery, or other advanced treatments for urinary blockages.

I'm probably going to make a decision in the next few days about whether to have this performed on my 13-year-old boy, and really need to hear about costs, complications, and how your cat is doing now. I even answered this question, which has some of what I'm looking for, but please hit me with anything else you have.

Background, if you want it:

My cat has been on a prescription diet of Royal Canin Urinary SO (dry) for the past 3-4 years, ever since an apparent bladder infection that cleared up with antibiotics. I eventually stopped giving him most treats/scraps, and the condition seemed to be under control.

And then there was a period a couple of months ago where I could, quite literally, barely afford to feed myself, much less him. So I was living off eggs, he was living off $4 Meow Mix or whatever*, and things seemed fine. As soon as I had the money, I went and bought him a big bag of his prescription food. Over my birthday at the beginning of May, I went to stay with my parents for a few days, took him along, and he received a fair number of table scraps.* A day after I brought him home, he very quickly became very sick- straining to pee, vomiting from the straining, bloody urine, extreme lethargy, and trembling from pain. I rushed him to the vet where they cathed him, put him on pain meds, an antibiotic, and a smooth muscle dilator. Labs were still good, and vet didn't believe he was suffering from kidney disease. He passed several bladder stones while at the vet's, stayed three days, and came home peeing fine. All was well for about two weeks.

Then I discovered him straining and grunting again. After he vomited once, he stopped eating. No blood in the urine, no lethargy, just pain and inability to pee. Went back to the vet's yesterday for another catheter, which they removed this morning. There was a big "sandy" plug of mucus and crystals blocking him, which they got out. But he still hasn't peed on his own, so he's spending another night. The vet will be calling me tomorrow morning. I get the feeling that because she knows I'm not well-off, she's not pushing the idea of surgery, but instead would prescribe some combination of ongoing medication.

While I was in the waiting room yesterday, a woman tried to "comfort" me by describing how her cat had the surgery for $3000. I'm willing to travel if there's a chance of getting it done for less. This is an animal that is otherwise very healthy- good bloodwork, good teeth, a little arthritis in the hips that showed up on his x-rays, but doesn't prevent him from jumping, and he is happy and friendly and playful. His quality of life, when this condition is managed, is great. So even though the expense is likely to hurt me pretty badly, it seems worth it to both of us. What can you tell me?

*Correct: on top of everything, I fully blame myself for possibly killing my cat.

posted by notquitemaryann to pets & animals (11 comments total)

My big cat (Zoey, aka w00t) had this done several years ago. I think he was about ten at the time (we've never known how old he was, he was found as an adult stray), he's now 5 years post surgery. He's happy, the only unhappy time was when he had the cone/e-collar for a week. We had to get newspaper based litter for when he healed, as well. Now he eats regular food, no problems since. IIRC, the price was around $1,200 or less. This is in the NY/Long Island area, once again, a few years back.

Good luck with your kitty! I know what it's like, I hope everything works out. Maybe you can do a payment plan or something with the vet?
posted by kellyblah at 5:59 PM on May 28

We had this surgery done to my most beloved kitty ever when he was about 15 months old. He kept blocking. Nothing worked. We knew that if we didn't do it, sooner or later, I'd be gone too long, he'd have a blockage, and he'd die. It was horrifying to me, but not to him. He healed with no trouble ever and lived to be almost 16, when he died of a heart tumor. It didn't change his personality or cause him any noticeable problems.

I can't speak to the expenses - this was more than 20 years ago. I can only say it doesn't affect the cat as much as it does you, and it works. I was always glad I had done it.
posted by clarkstonian at 6:00 PM on May 28

We did this, though we had to make the decision in the middle of the night after the vet called to tell us they couldn't get the catheter in. The vet kept him for a couple of days for monitoring and recovery after surgery, and he was still wobbly when he came home. He had to wear a cone around his neck for a couple of weeks, which he hated, so he wouldn't lick his sutures out. But after the cone came off and the sutures healed, he's been a-okay since then (knock on wood). My cat was a great candidate for the PU surgery because his urethra was half the width of a normal cat, only 1mm, so it wasn't just that he was prone to crystals but any little thing was going to get stuck. Honestly, it's been a relief to know that his narrow bits are gone and nothing will get stuck any more.

If you're going to do the surgery, just do the surgery and don't waste your money on other treatments. I actually kind of resent that we still had to pay the vet $600 for the catheter that didn't work. (I know, they did it, we pay for it, but $600 is a lot.) I think I've repressed how much it cost us, but $3000 sounds about right. However, ours was at an emergency vet on a weekend, not a previously scheduled surgery. Call around -- you never know.
posted by junkbox at 6:07 PM on May 28

Blocked cats should be on fluids and a urinary catheter in place for a minimum of 48 hours (as per the vets in my practice). Your vet might think 24 hours is ok, but many of the cats we see do fine after 48 hours and the proper diet. You say your cat did well until you changed his diet so you might give this one more try.

The surgery can work well for some cats. You should be warned, however, that there are some possible complications with improper tissue granulation that makes recovery difficult. I don't want to give you horror stories, but I worked with a surgeon who had many complications with his PU surgeries, a few that we ended up euthanizing. Unfortunately, I can't say you get what you pay for because this was a boarded surgeon. I have seen some very successful surgeries with no or few complications as well and cats that went on to live quality lives.

Obviously, only you can make this decision but if it were my cat, I would try recatheterizing, flushing the bladder and diuresis with a urinary catheter in place for 48 hours. If not successful, I might try the surgery. This will mean the added cost of recatheterizing him and 2 days of hospitalization on top of the surgery charges if it comes to that. If you think your vet has done what she can then I would try the surgery.
posted by little miss s at 6:14 PM on May 28

This is from my vet tech wife:

PU surgery is pretty much a last ditch effort for urinary blockages. It is going to run you at least $2000, including hospitalization, and it is not without complications (anesthesia, scarring, dripping). For a 13 year old cat who is only now starting to block there are a couple of things she might talk to your vet about trying first. (1) Get on the right food and stay on it. NO scraps. If this is not possible, you might as well do the surgery. Getting a prescription food into him consistently is essential. (2) Increase water intake. Try those constantly flowing fountain-style water dishes. (3) Have more litter boxes around the house, and keep them clean.

If you do end up going to surgery, you may want to look into CareCredit. It is offered by GE Financial, and is essentially a credit card that is accepted at many veterinarians. You can even get up to a year or 18 months with no interest.

Good luck with your little buddy.
posted by Rock Steady at 6:24 PM on May 28 [1 favorite has favorites]

I feel for you on this one, one of my cats, ten years old, inherited from my late Mum, has been fully blocked once and partially blocked twice. The first blocking took twelve days of hospitalisation, 3 x 3 days of catheterisation/flushing and several months of anti-inflamatory medicine,along with monthly urine analysis and the usual anti-struvite prescription foods to sort out. The second and third partial blocks were due to crystals forming in scar tissue in the urethra. The x rays of the first blockage showed a bladder totally full of struvite sand. The subsequent partial blocks have been caused by crystals forming in old scar tissue in the urethra.

Stress has been the major factor in causing all three of these blocking episodes. Minimising environmental stress and a rethink from our vets on how to manage this problem has been the key to keeping him happy and blockage free. Yes, the big operation has been mentioned, but only as a very last resort, if a change in the way we manage the condition doesn't work.

As little miss s and Rock Steady already said, it's not an easy operation, it needs a very skilled and practiced surgeon to pull it off successfully and there will be dripping after recovery - for an older cat, the dripping may make him utterly miserable and reduce his quality of life. However, if my vet said that this op' was the only place we had left to go, I would get the surgery done.

Our blocking cat now has Royal Canin High Dilution (HD) Prescription food (dry) which seems very palatable (judging by how keen my other cats are to eat it) This food is designed to make the cat drink more water - the latest thinking on managing blocking cats is to get them to drink more - the ph altering qualities of the older types of prescription foods are now not thought to be so effective in some cases. Making the cat drink and pee more makes the bladder environment less supportive for stone formation. The crystals are less likely to form in a bladder that fills up and empties more often. It works, he drinks like a fish and pees like a horse since he's been on the food and his urine analysis (including specific gravity) is perfect.

I have four cats and there are six large bowls of fresh water set out around the house. Just the presence of extra water encourages all four cats to drink more.

The blocker gets a daily dose of Cystaid (N-Acetyl D-Glucosamine) sprinkled on his food. This type of glucosamine is the precursor to the formation of the mucosal lining of the bladder - when cats are under undue environmental stress, this lining breaks down and often causes cystitis, if untreated, the ph of the inflamed bladder (and urinary retention) causes sand/stones to form in the urine. Keeping that mucosal lining intact and easily replenished is important.

I always mention Feliway - the facial pheromone spray/diffuser, because I've found it very useful in helping my cats adjust to new events in their environment - less stress = happier bladders.

So far, this approach has worked and our big old blocking fella has remained unblocked, despite there being some nasty old scar tissue in his urethra.

Best of luck to you both :)
posted by Arqa at 1:07 AM on May 29

My cat had PU surgery after his second bout of blockage in less than six months. The surgery itself cost about the same amount as the week of board and meds when they kept him with a catheter and flushing. He was very groggy and disoriented when we got him home and hated the e collar they put on him, lots of growling and loopy walking around which was heartbreaking to watch. He recovered well and he hasn't had another incident in the past two years. The vet recommended surgery to me because of the short time between incidents. I'd second the recommendation for CareCredit and definitely making sure your vet has lots of experience with the surgery or has someone in their practice who is confident in their skill.
posted by blueskiesinside at 3:09 AM on May 29

Okay, one of my boys had that surgery. It was a few years ago and I can't remember what it cost. I just remember he was dying, so I said 'do it' and figured I'd worry about paying it off later. And I did.

The worst part was it was just before I went on an already paid-for week's vacation on the other side of the country, so I had to leave some of the follow-up care with friends of mine. Let me tell you that was nerve wracking! But apparantly everything went fine.

His butt area was a mess. Keeping that clean is a must. Making sure he takes all his meds is a must. Watching to make sure he's going to the bathroom okay is a must. Making sure he's eating okay and drinking is important.

Its now four years later and he's fine. You wouldn't know he had the surgery unless you looked closely at his nether regions. I've had NO issues with stones or straining or anything. He had a lot more energy after the surgery, though he's always been a lazy bones. Aside from having more energy and not peeing everywhere, his personality didn't change. He's still a suck, he's still lazy, he still comes running to me when the other two cats 'pick on' him (i.e. stand too close). I don't regret it at all.

If you can afford it, do it.
posted by sandraregina at 8:42 AM on May 29

My cat had it after many complications (about 10 years ago) and it cost me $1000, at the time I was in college so I don't know if they cut me a break because at that point I'd already spent about that much. He was fine after and never had any bathroom issues after that. He seemed happier and I was happy to not be cleaning up cat urine - good luck!
posted by heartquake at 10:40 AM on May 29

I was just coming in to third the recommendation for Care Credit, if your vet takes it. While in some ways, it's nothing more than a vet-bill credit card, they give you 3-6 months to pay off your bills interest-free. A few months ago, my Sammy Katz had a bout of constipation that necessitated a $1000 vet bill/hospitalization, and care credit approved me in the middle of the night via phoen at the emergency vet; they were a godsend.
posted by PhoBWanKenobi at 2:10 PM on May 30

I know it's generally annoying to mark all answers as best, but they are, and I'm that grateful. Thanks, you guys.
posted by notquitemaryann at 7:24 PM on July 1