Should I get my FLUTDed cat a urethrostomy?

October 3, 2009 2:40 PM

My male 5-year-old 20lbs cat has FLUTD. He's been hospitalized once and they thought he was doing better, but now that I have him home he's peeing somewhat, but still seems like he has

Please forgive the gallows humor. I'm rather upset by this.

Originally, he was totally blocked (no clumps for 2 days). When I took him in, the vet flushed out his blockage and gave him a catheter. His blood work was normal (i.e., no toxins due to kidney failure) and he wasn't particularly dehydrated. They took the catheter out the next day and he seemed to be peeing OK. Even though it was a cat-only clinic, the environment was very stressful for him, so they sent him home with me the next evening.

On the night I brought him home, I saw him straining to pee and trying to go outside his box (he doesn't have accidents when healthy). In the morning, I found a few small clumps, but still well below his normal output. He is eating normally and drinking little, but that is normal for him.

As of now, he's on prescription Purina DM (weight loss) wet food (switched from his previous dry food), Amoxi tabs for infection, Methio-Form tablets for urine acidification, Acepromazine (muscle relaxant) to help with urethral constriction and Buprenex for pain.

I'm crossing my fingers that he's going to get better and gradually pee more, but if he gets totally blocked again I'm going to have to take him back. The vet says a urethrostomy would be the next step, but that it may not be worth putting him through that.

I'd like to hear from people who've had cats with serious FLUTD (I've seen the other AskMe threads) and what they did. Particularly if you've gotten a urethrostomy for your cat, how did it turn out? What was the healing time like? Were there major side-effects post-op?

posted by Cogito to pets & animals (8 comments total)

I had a cat with this. It was a very serious case. He did not have surgery and lived for over ten years, even with some other problems. I put a LOT of water in his food (it was almost liquid), so if he wanted to eat, he also got a lot of water. I also put water in a bottle mixed with a little milk or broth and squirted it into his mouth. I gave him a half a cup of water twice a day this way (one cup total, plus the water in his food). Obviously, he was a very tame cat and allowed me to do this.

Initially the vet did not hold out much hope for the cat. This was before drugs and surgery. But the cat never had a blockage after I started doing this. He had frequent life threatening ones before.
posted by fifilaru at 2:54 PM on October 3

When our Sparky suffered from FUS (as it was called at the time), he spent something like three days catheterized in the hospital. (The hospital was very stressful for him as well, but they kept him there. Heck, any time we put Sparky in the car was stressful enough that he made this semi-human, ear-splitting yowls. One time en route to the vet, a police car actually pulled us over because he heard the cries - our car windows were open - and thought we had a baby in distress.) Anyway, when we picked Sparky up, our vet didn't seem very optimistic and told us that Sparky would most likely have to undergo a urethrostomy. However, the three days of catheteization plus the drugs (I believe antibiotics for infection) seemed to solve the problem. He was peeing hesitantly at first (most likely because of the residual catheter pain), but the fact that he did get into the litter box at all was a good sign, because when he was originally blocked up he avoided it completely, and instead occasionally tried to pee in the bathtub upstairs (?). The main problem was changing his diet, because he loved Happy Cat dry food, but because of the high ash content, it was now verboten. We gave him canned food, and had to mix the low-ash Science Diet in with it gradually, since he loved canned food but turned his nose up at Science Diet on its own. Anyway, Sparky never had another urinary problem after that, much to our relief. Keep your fingers crossed concerning your kitty's recovery; I think that sometimes veterinarians, like human doctors, tend to present the worst case scenario "just in case," so that it doesn't hit you like a slap if it the situation gets to that stage.
posted by Oriole Adams at 4:16 PM on October 3

I have worked in animal medicine for many years, but am NOT a veterinarian, so even tho I've seen a gazillion FUS/FLUTD cases managed, my advice is as a layperson only ...

Many cats form urinary stones, usually fine sand, as a result of crystal formation in the urine. The boy cat urethra (tube from urinary bladder to outside the body) has a long, torturous path and is narrow compared to the girl, so blockages are "bread and butter" business for the animal hosp. The whole ordeal can get expensive and painful for all involved, but what the vet WANTS to do is:
1. Remove the blockage (for obvious reasons)
2. Place a urinary catheter. This keeps the urethra open and the pee coming out -- sometimes there is more "stuff" in the bladder and it also counteracts the effects of "spasm", which can happen to anyone that hasn't been able to pee (the ring of muscle that holds your urine in the bladder and "lets go" when you allow it can get confused and "seize up").
3. Do the bloodwork. Some animals get severely wrecked by not being able to go potty, as in permanently, and some are not really at all, with everything in between. Some can be helped alot, some hardly at all, and for some it is useless! The cat's ability to handle the stress of it depends on alot of things, including his age and general health, and if this his first or fifth go-round. It can be useful as well in determining how well any treatment worked, when (ideally) the BW is repeated in 2 or 3 days.
4. Place an intravenous catheter (IV). This is like the urinary catheter except here we are putting fluids in, not out. As we all know, the solution to pollution is dilution, right? We call it diuresis, flushing the system clean, and it works the kidneys too.
5. Of course, this requires hospitalization. Usually about three days, is my experience.

Does your kitty need a PE (perineal urethrostomy)? It depends (sorry). Most vets I know push for a full three-day treatment, but I've seen some lately remove the urinary catheter after about a day, to see how they do (no spasm) as we do not wish to use one any longer than needed. Also, some animals really have trouble (misery) in the hospital environment, if they are really "not that sick" AND miserable too, they can go home with careful supervision. Sometimes a diet change is all it takes, and sometimes moving heaven and earth does not help them without surgery.

Since kitty is home and peeing, try to keep him on track. If he does this again (after trying diet changes and etc.) think about the surgery. If he gets it done, it will change his (internal) anatomy more to a girl kitty, and if everything goes right, he'll be okay on that front forever.

The PU used to be thought of as a last hope and a little "tricky", but lots of vets are doing them now and so many more have experience than before. I would be most confident with a surgeon that had done a few, just like with any surgery for anyone.

One more thing: 5 years is a good age to have lots of likely options, so that is good, but 20# is a very heavy cat, and that might not be so good. Maybe he is not "fat" but if he is carrying 7# of fat he will have a whole bunch of problems in his life, and his weight will contribute to every problem he does have ....
Good luck
posted by bebrave! at 7:08 PM on October 3

My cat, Smacky, had serious FLUTD to the point where he did have a blockage severe enough to cause kidney problems. He did not have the surgery, but after his blockage removed, he was put on prescription food (Waltham S/O or Hill's C/D) and also drinks only purified water in a Drinkwell fountain.

I am really concerned that your cat is not on food to prevent crystals. Smacky was a bit on the tubby side, but we simply watch his portions. In the past 3 years since his blockage, we have had no additional problems.

That said, the first few days after he got home from having his blockage removed, he did have strange litterbox behavior. The first night home, he slept so deeply on our bed that he actually wet the bed ... he urinated all over the bed in his sleep without waking up. However, after he recovered from time away from home and having a catheter inserted in his urethra, his litterbox habits went back to normal -- no straining, no trying to go outside the box. If your cat continues to do this, take him to a different vet. Seriously. The first 2 vets we took him to did not treat him properly for his FLUTD and led to his kidney problems. And I'm pretty concerned about your vet not insisting on putting your guy on prescription food after a blockage like that.
posted by tastybrains at 7:26 PM on October 3

@tastybrains: He is on prescription food now as well as Methio-Form tablets to reduce the formation of crystals.
posted by Cogito at 7:44 PM on October 3

I saw that the Rx food was for weight loss though... just mentioning that we've had NO problems since switching to urinary-formula foods. All medications he took did diddly squat.
posted by tastybrains at 8:43 PM on October 3 [1 favorite]

Our cat Mulder had a serious blockage when he was about a year old. Catherization was problematic (I think his urethra was small but don't recall the details) so the vet recommended the surgery, which we opted to have done.

He's now 12 and healthy, curled up next to me on the couch as I type this. He has had a number of urinary tract infections over the years but he's also had spans of several years between them. He does have a tendency to form crystals that can irritate the bladder and make infection more likely, so we keep a close eye on him and get his urine checked when he seems under the weather.

We feed him Prescription Diet W/D food, the dry kind, and sometimes add some water to this so he's getting more fluids.

I wish you the best of luck with your kitty!
posted by altcountryman at 8:24 AM on October 4

First of all for a totally blocked cat that seems a very short time to be catheterised. In my experience a minimum of 48 hrs is the norm (UK here, with a repeat blocking cat)

My ten year old male neutered cat has been blocked three times - first was a crystal block in his old home - he'd been through a terribly stressful time. His life was being turned upside down due to the death of his owner and several nasty minded care staff had been terrorising him. Second was a partial crystal block - intruder cats invading his garden here. Third time was 3 months later - a primary mucosal block with partial blocking from crystals formed in scar tissue.

He's been block free since February this year.

For every blocking event he's been catheterised and repeatedly flushed for a minimum of 48 hours - the first block was the most serious, he was catheterised for 5 days (with repeat flushings) then when the catheter was removed he blocked again immediately. His bladder was full of struvite sand and it was still forming. He was recatheterised straight away.

He's been given antibiotics throughout each treatment. He was sedated for cystocentesis and the catheterisation and given Buprenex for pain. As I understand it, for the 2nd and third blocking, the vets thought it absolutely essential that he had a full oral dose (in food only) of the anti-inflamatory drug Meloxicam (cox 2 inhibitor - safer than steroids) to ensure that inflamation from the condition AND from the catheterisation (cannot be avoided) was controlled. Meloxicam provided extra pain control too. It's important to give the exact dose for weight and kidney function is an important consideration - if there's kidney damage, it's not wise.

For the first block there was evidence of some nephron damage and this was thought to be transient as his previous values were normal. He was put on Fortekor - an ACE inhibitor to give his kidneys a chance to recover, which they did.

Management of the 2nd and third blocks, was successful with antibiotics, Buprenex, Meloxicam and a new food from Royal Canin which encourages the cat to drink more - cats have a very low thirst drive and newish research has found that cats who drink more, thus keeping the bladder flushing through have a lower incidence of crystal formation and blocking. The food is called Royal Canin HD (High Dilution) We also have a large bowl of clean water in every room in the house. The food works astonishingly well in increasing the amount he drinks.

About 4 months ago, we reduced the HD food right back to 5g a day and started all of our cats on a totally grain free/soya free food from Sweden called Bozita, which is a complete wet food, low carbohydrate (3% - cats don't need more - MD is over 36%) and he's doing very well on it and is losing weight slowly. He was never that overweight, but slimmer is better for blocking male cats.

Urethrostomy was mentioned as a future possibility at the last blocking as he has got some scar tissue in his urethra. It isn't going to be considered unless he has another major blocking event which results in more urethral scarring. To me, your vet is jumping the gun a bit here, PU is major surgery which may possibly leave your cat dripping pee forever and thoroughly miserable. It can happen, but some cats do very well after a PU.

I'm surpised your cat has been put on ACP it's quite a heavy drug and may be disorientating him a bit along with the Buprenex. Our cat did not have a tense bladder, yours may have. I would give your cat a chance to adapt to his new diet, up his drinking opportunities and ask your vet about trying a totally grain/soy free wet food to help with weight loss. MD may be lower in carbs than the standard stuff, but it still isn't so easy for cats to lose weight on a diet which is a bit species innapropriate.

If your cat has blocked and has crystals due to stress related issues (the mucosal lining of cat bladders breaks down during stressful times) then it might be worth speaking to your vet about a supplement called Cystaid or Cystease, it contains a type of glucosamine which is the precursor for bladder mucus formation. My blocking cat is on this stuff, it's good - that mucus is important, it's the teflon of the bladder. You can also have a look at stressful stuff in his environment, Feliway is good stuff, the diffusers are very helpful in our multicat household and also when a cat is recovering from illness. Finding out if he gets stressed from seeing dogs/cats outside the window or from visitors or noisy people in your home, will also help you work out how to change things to help him

Your cat may feel very uncomfortable in his nether regions, catheterisation can be a rough ride, no matter how skillful the vet, cat urethras aren't all nice and easy and the same. Some are short, narrow, twisted and every kind of awkward. It will take a while for him to feel himself again.

I'd be very wary of a vet who says that a PU is the next step after one blocking event., PU is an expensive and drastic surgery. Vets have to make a living, but sometimes they jump to the expensive surgery without giving the cat a chance to recover from their blocking and to adapt to a new diet.

We may have been lucky with our blocking cat. We did have great and experienced vets each time, but I think that extended catheterisation, flushing and use of anti-inflamatory drugs was the key.

I'd seek a second opinion if it was me.

Best of luck!
posted by Arqa at 9:47 AM on October 5