Question about cat P.U. surgery

October 17, 2012 4:52 PM

Question about cat P.U. surgery

My male cat was perfectly healthy for 5 years. 3 days ago, his urethra got obstructed by a bladder stone and he had to have an emergency unobstruction. Immediately after the emergency unobstruction, it got obstructed again, and we had to get that procedure again.

First question: The urethra obstruction coincided perfectly with me getting a dog for the first time. Is this likely caused by stress?

Second question: My usual vet recommended P.U. surgery. At first he said it was a difficult type of surgery, and later changed his mind and said he would do it for $1300. I called a different vet, who said much the same and quoted $1700. I called a third vet who said it was a totally routine and common procedure and quoted $450. The third vet has his own clinic building, good reviews on Yelp, and seems otherwise reputable. I can't help but think that either two vets are trying to rip me off, or one is sketchy. (The cheap vet is in the country, while the other two are in the city -- maybe this explains the low price?)

Should I get the surgery? And should I go with the low bidder?

posted by miyabo to pets & animals (10 answers total)

I can't speak to the price side of this (though if you check out each respective vets' surgical facilities, that may explain it), but on the P.U. surgery itself...

My cousins had this same problem with their cat- it's apparently related to diet? Or something. In any case, the cat had the exact same issue- and the surgery did help. He's apparently had further bladder stones since, but since the surgery he passes them without too many issues.
posted by Cracky at 4:59 PM on October 17, 2012 [1 favorite]

Stress can exacerbate the problem, but doesn't exactly "cause" it.

And you should definitely NOT go with the low bidder. This is time-consuming and fiddly surgery, it is certainly not "routine", and it's your cat's life and health you're dealing with. The place to cut corners is not in surgery. $450 is pretty ridiculously low for any kind of surgery, frankly, and I would suspect that the way they manage that price is in ways which directly impact the safety of their patients.

There are medical ways to manage this problem, but it cannot really be cured. Mangled surgery can leave you with an incontinent cat (at best).
posted by biscotti at 6:11 PM on October 17, 2012 [4 favorites]

I am not your vet, so this is not medical advice.

Going with the low ball surgeon is not the best decision, but not because you should pay more but because the services are likely very dissimilar. Please look closely at the written estimates, make sure that the drugs being used are all the same. This particular procedure can be very time consuming because of the location and tissues involved.

It is possible that the country vet owns her building, her husband is her LVT and she doesn't charge for her services the way she should. It is also possible that she is going cut corners on things like drugs, monitoring, pain management and blood work.

In short: make sure you're not comparing apples to oranges.

On preview, Biscotti is spot on, as usual.
posted by Nickel Pickle at 6:21 PM on October 17, 2012 [3 favorites]

My cat's PU surgery was an emergency and was significantly more expensive than any of the quotes you got, so I say go for whatever vet you feel best about. I agree that $450 seems a bit low for that much rerouting of plumbing. The vets that did our surgery did mention that some vets don't provide as much pain management and aftercare as they should, which may explain a lot of the difference in quotes you got. If you have time, you could ask each vet about those sorts of details and compare their answers.
posted by samw at 9:29 PM on October 17, 2012

My cat got this surgery after several blockages. It cost us $1200, and we might have gotten a discount for being such frequent unblocking customers. Our vet said it was somewhat routine, but quite complicated; she referred to it as "major surgery." She had one of the senior vets at the practice (the owner, and head vet, in fact) assist her, that's how seriously she took it.

Now, I really trust our vet, and we have used her for a long time. The facts that it was so expensive, and that two surgeons were involved, leads me to advise you not to go with the cheaper option. That is way, way cheaper than I have ever seen. So cheap that I distrust that it is the actual surgery. I paid that much for one of the unblockings (though that did include a pet hospital stay and many tests).

It may indeed be caused by stress; my cat got blocked during a breakup, when I got pregnant, and when I had the flu. The surgery doesn't solve everything, though. My cat will be on a special diet for the rest of his life, and he gets urinary tract infections whenever I get a cold or tge babby pops a tooth, which is really, really annoying.

YMMV, hope that helps!
posted by esmerelda_jenkins at 9:35 PM on October 17, 2012

Thanks everyone!

Followup question: is it considered normal care to do the PU surgery on a cat that has only been obstructed twice (successive days, so we didn't have a chance to change his diet or water)? I want to get the best for him, but I also don't want to risk complications from a procedure that might not be necessary.
posted by miyabo at 10:03 PM on October 17, 2012

My cat, like yours, was obstructed twice. His were a few days apart. This happened four years ago. Because his blockages were so close together, the vet counted it as "one" episode. She advised changing his diet and enticing him to drink more water. She told me about the P.U. surgery as an option in the future if he continued to have problems. She wanted to see how he responded to the new diet and water. He hasn't had an issue with blockages again.
posted by JujuB at 10:42 PM on October 17, 2012

I think the PU surgery for my cat cost somewhere above $2000 but that was at an emergency hospital in a large city. He'd gotten blocked maybe 3-4 times before that with crystals but not stones. We had already changed his diet after the first time. We finally had the surgery because they felt it would reduce the chance of more blockages by like 95%. All of the unblockings involved overnight stays and probably cost around 1K each time as he kept getting blocked on national holidays. The surgery did solve the problem permanently for us. The post op care was annoying - he had to live in the bathroom for 3 weeks with a cone head and use a litter box with just paper in it to keep the stitches clean. If you get the surgery also ask how the stitches should look as they heal - I made a bunch of unnecessary trips back to the vet because I was worried about how they looked only to be told it was all normal.

Did they analyze his stones / crystals? I believe there are two different types and that might affect the diet or treatments.
posted by oneear at 11:15 PM on October 17, 2012

Country vets are that much cheaper in my experience and it says nothing about how well they will care for your animals. For example, my farm vet treated an entire litter of 5 or 6 dumped kittens for pneumonia and even found homes for a few and charged us like $50. They probably won't have a nice waiting room with coffee and magazines for the owner though.
posted by fshgrl at 10:36 AM on October 18, 2012

Thanks all. We ended up taking him to the state veterinary school's animal hospital, where they were able to determine by X-ray that they were calcium oxalate stones which are unlikely to recur but cannot be dissolved through diet. So they did a cystotomy to remove the stones that were already present, and we'll keep him on low-mineral food to further reduce the risk of a recurrence. The total cost was about $3200, but I think it was worth it to get a firm diagnosis and avoid a surgery with really bad guaranteed side effects and even worse potential complications.

Lessons learned: 1) don't rely on your local family vet to understand a complicated cat-specific disease and 2) get pet insurance, especially if you have male cats.

Here's the obligatory pic of the little guy you helped save.
posted by miyabo at 3:17 PM on October 21, 2012