24 Hrs After Perineal Urethrotomy

My 3 year old male cat Leo just had a PU and I was able to bring him home 24 hours after the surgery. He was given an antibiotic and pain meds, both of which he is to receive starting tonight. He is also to wear an Elizabethan collar for he next two weeks. Since coming home (five hours ago), he has ate and drank a little, but has struggled to urinate. While at the vet, I was told that I may have to push on his bladder to help him urinate if he fails to. I watched the vet do this and a decent amount of urine came out. He has went into the litter box twice and dribbled some, the first time with me pushing lightly on his bladder.

I am curious as to how other's cats reacted after this surgery, if anyone else was able to observe or take home their cat the next day. What were their eating, drinking, and urinating habits like and what was their activity level? Leo has been very sleepy all day.

Any tips/past experiences would be greatly appreciated!!

I have no experience with this, but you might find this thread helpful.  http://www.thecatsite.com/t/264960/my-experience-with-blockages-and-pu-surgery

My cat had to have PU surgery after a long month of vets not being able to figure out what was wrong (first another vet introduced an infection to his bladder, so they started treating it as an infection, but at some point either by original vet or after numerous catheterization a stricture was introduced that was not found until very late and at that point he had PU. However his bladder was already distended and nerves damaged). The vets actually thought he was going to die and sent him home to be put to sleep as the PU surgery did not seem to work - stricture was gone but no one could express him by hand and he still wasn't peeing. On the morning he was scheduled to be put to sleep at home he miraculously peed for the first time in a month.

So my point is, my situation is probably quite different from yours. I guess your cat has no bladder damage? I will try to make a list of what may be the most relevant points in terms of post-surgery care.

We did not get much information about post-surgery care as the vets expected him to be PTS the next day, so we had to sort of figure parts out on our own.

• Age: ours was about 7 months at the time of the PU surgery, the problems started after his neutering surgery at 6 months.
• The collar - he had a huge collar, but he was still trying to lick and despite the size he was able to twist himself into a position where he could not reach the stitches, but the edge of the collar would jut  into the area of the surgery, disturbing it. I could actually see the plastic edge digging into the stitched up location as he tried to reach it. My makeshift solution was to get some transparent wide tape and make a bigger soft  edge around the edge of the collar. It wasn't pretty, but it kind of dulled down the edge and made it less sharp when he did jut himself down there.
• He ended up learning to wriggle out of the giant collar. To solve this I got him a walking harness and tied the bandage that was used to tie the collar around his neck to the neck area of the harness. This helped to prevent him from sliding the collar off, as he couldn't slide the whole harness of.
• He ended up constipated after the surgery. We expected this and read that this happens to some cats. It was a big issue for us as his peeing seems closely tied with his pooping - if he can't poop he just doesn't even think to pee, it's like he gets confused. Not sure if all cats are like this, but worth keeping an eye on - you said he is "dribbling" - has he pooped? The vets recommended something called Lactulose  here which we added to his food. It helped. However be careful as apparently Lactulose basically draws liquid from the body to soften the stool, meaning - less liquid goes to the bladder to actually pee. I'd consult with your vet first.
• The stitched up area ended up getting a little infected. Trying to minimize our trips to the local emergency hospital (the one that did the surgery was hours away and we could no longer get in contact with them) was important to me. He just  miraculously peed and stress is known to play a role in cats' bladder/urinary issues, so I wanted him to just relax after staying at hospital and being drained with a needle daily for weeks and avoid making him go to "that place" again. When I first noticed that the area looks a little weird I got a cup of warm water, mixed a spoon of salt in it, and very gently tapped around the area with a cotton pad. I had to be very careful as bits of the pad would sometimes catch on the stitches and leave little bits of cotton. I was so paranoid about anything blocking the opening again that I gently pulled away any leftover cotton. I did this every night and it seemed to help (that or the infection cleared up on its own. But one time we did  have to take him to hospital when he ripped out a stitch while playing and they cleared the area by also using saline solution also, so I am assuming it at least did not hurt).

I am attaching some photos  of the urethrostomy site (advance "gross" warning for those who are a little more squeamish). This is when I fear there was some infection. Here is how I described these in writing back then in an email to a holistic vet who was helping us check on him at home: "You can see some brown/dark red and yellow (not sure if urine or pus) there - a lot of it is kind of caked on, so seems to be from yesterday, but it is still moist and there are wet parts. To me it looks pretty bad, but not sure if it's just something I should clean off with the solution from the apotek."



You can see the area is very wet and there seemed to be some blood mixed with pus caked around it. You can also see some caked on litter there that I was afraid to remove for fear of ripping a stitch, so I just padded as much as I could from the area daily.

I hope this helps, but I realize yours situation is probably very different from ours. Best of luck with your cat - we went through hell with ours over the course of a month and know how hard it is after a blockage and PU. If you are interested in any specific details of our case to compare relevance or anything please ask, or alternatively take a look at my big Rigel saga page with details. 

Wow, thank you for all of the information about your experience! Rigel is a beautiful car and I'm happy to hear that he is doing well for the most part! It does sound like a bit of a different experience, but it is always good to keep that info in the back of my mind. The Dr. had said that his has probably been building up for awhile, but did not talk about previous bladder damage (although it will be something I ask about tomorrow). I will be keeping an eye on the urethrostomy site to watch for signs of infection. Thank you again for the helpful info!!

How is Leo doing now? Has he been peeing? I hope he's recovering well!

Leo is peeing pretty often and he pooped today too so I feel much better! He had a follow up visit this morning and the vet passed a catheter through him again to make sure it wasn't partially blocked and got a good amount of urine out. The only thing that continues to worry me is that when he pees, it is still dribbles verses a steady stream of urine. Vet said that should get better within the next week or so. I'm hoping for the best! Thank you again for the info!!

lizz0221 said:

Leo is peeing pretty often and he pooped today too so I feel much better! He had a follow up visit this morning and the vet passed a catheter through him again to make sure it wasn't partially blocked and got a good amount of urine out. The only thing that continues to worry me is that when he pees, it is still dribbles verses a steady stream of urine. Vet said that should get better within the next week or so. I'm hoping for the best! Thank you again for the info!!

Click to expand...

It's so great that he's peeing! Maybe it still just hurts him to strain too much down there...just a guess, I don't know. Now that you mention it at first when Rigel started peeing it was a smaller amount (big compared to a normal cat with a normal bladder but small for him) and sometimes the clumps at the bottom were broken up in a way that made it seem like it was sort of a sporadic stream vs a strong one. Not sure if he was going through something similar. My biggest fear for weeks after the surgery was that a stricture was reforming as the surgery site healed, as that seems to be the most common complication. I'm still scared of that even 8 months later since I hear you're not really "safe" until at least a year has passed (though I can't find the source now). 

Hi there! I just went through this with my cat Kal about three months ago and the number 1 thing I can tell you is that it gets better! This is a major surgery and super traumatizing for your cat but also for you as the caretaker. Things are just now starting to get back to normal for us. In terms of your cat peeing it will be sort of not normal for at least a week. What I did was write down in my phone notes every time my cat went to the litter box and recorded whether it was a little, or a lot of urine. It really helped me to describe to the vet what was going on. If by the end of the week the urine volume doesn't ramp up, I would suggest talking to your vet again to see if the opening is wide enough. Remember that it's probably really sensitive as well so peeing will hurt a little.

I would make sure your cat can't rub it's cone against the stitches too. I wish someone had told me that... Kal was able to pop a stitch that way which led down a whole other troubled road of infection, Clavamox and not eating for a week (nightmare).

Good luck and keep us updated. I feel your pain... Worst couple of months of my life but I promise it does get better and so will your furry friend!

Kflynn28 said:

Hi there! I just went through this with my cat Kal about three months ago and the number 1 thing I can tell you is that it gets better! This is a major surgery and super traumatizing for your cat but also for you as the caretaker. Things are just now starting to get back to normal for us. In terms of your cat peeing it will be sort of not normal for at least a week. What I did was write down in my phone notes every time my cat went to the litter box and recorded whether it was a little, or a lot of urine. It really helped me to describe to the vet what was going on. If by the end of the week the urine volume doesn't ramp up, I would suggest talking to your vet again to see if the opening is wide enough. Remember that it's probably really sensitive as well so peeing will hurt a little.

I would make sure your cat can't rub it's cone against the stitches too. I wish someone had told me that... Kal was able to pop a stitch that way which led down a whole other troubled road of infection, Clavamox and not eating for a week (nightmare).

Good luck and keep us updated. I feel your pain... Worst couple of months of my life but I promise it does get better and so will your furry friend!

Click to expand...

A hundred times yes to writing down pee volume! I totally forgot this part in my post - I had a notebook with a little chart I made up to record his volumes each day. I had dots for each pee occurrence with T for Tiny, S for Small, N for Normal, and L for Large next to them. It helped a lot as when you are in the moment dealing with this you tend to have a narrower view of what's going on. I'd see one tiny pee and start worrying, totally forgetting that this is his fourth  pee of the day and that he is probably in no immediate danger right now.

lazer said:

My cat had to have PU surgery after a long month of vets not being able to figure out what was wrong (first another vet introduced an infection to his bladder, so they started treating it as an infection, but at some point either by original vet or after numerous catheterization a stricture was introduced that was not found until very late and at that point he had PU. However his bladder was already distended and nerves damaged). The vets actually thought he was going to die and sent him home to be put to sleep as the PU surgery did not seem to work - stricture was gone but no one could express him by hand and he still wasn't peeing. On the morning he was scheduled to be put to sleep at home he miraculously peed for the first time in a month.

So my point is, my situation is probably quite different from yours. I guess your cat has no bladder damage? I will try to make a list of what may be the most relevant points in terms of post-surgery care.

We did not get much information about post-surgery care as the vets expected him to be PTS the next day, so we had to sort of figure parts out on our own.

• Age: ours was about 7 months at the time of the PU surgery, the problems started after his neutering surgery at 6 months.
• The collar - he had a huge collar, but he was still trying to lick and despite the size he was able to twist himself into a position where he could not reach the stitches, but the edge of the collar would jut into the area of the surgery, disturbing it. I could actually see the plastic edge digging into the stitched up location as he tried to reach it. My makeshift solution was to get some transparent wide tape and make a bigger soft edge around the edge of the collar. It wasn't pretty, but it kind of dulled down the edge and made it less sharp when he did jut himself down there.
• He ended up learning to wriggle out of the giant collar. To solve this I got him a walking harness and tied the bandage that was used to tie the collar around his neck to the neck area of the harness. This helped to prevent him from sliding the collar off, as he couldn't slide the whole harness of.
• He ended up constipated after the surgery. We expected this and read that this happens to some cats. It was a big issue for us as his peeing seems closely tied with his pooping - if he can't poop he just doesn't even think to pee, it's like he gets confused. Not sure if all cats are like this, but worth keeping an eye on - you said he is "dribbling" - has he pooped? The vets recommended something called Lactulose here which we added to his food. It helped. However be careful as apparently Lactulose basically draws liquid from the body to soften the stool, meaning - less liquid goes to the bladder to actually pee. I'd consult with your vet first.
• The stitched up area ended up getting a little infected. Trying to minimize our trips to the local emergency hospital (the one that did the surgery was hours away and we could no longer get in contact with them) was important to me. He just miraculously peed and stress is known to play a role in cats' bladder/urinary issues, so I wanted him to just relax after staying at hospital and being drained with a needle daily for weeks and avoid making him go to "that place" again. When I first noticed that the area looks a little weird I got a cup of warm water, mixed a spoon of salt in it, and very gently tapped around the area with a cotton pad. I had to be very careful as bits of the pad would sometimes catch on the stitches and leave little bits of cotton. I was so paranoid about anything blocking the opening again that I gently pulled away any leftover cotton. I did this every night and it seemed to help (that or the infection cleared up on its own. But one time we did have to take him to hospital when he ripped out a stitch while playing and they cleared the area by also using saline solution also, so I am assuming it at least did not hurt).

I am attaching some photos of the urethrostomy site (advance "gross" warning for those who are a little more squeamish). This is when I fear there was some infection. Here is how I described these in writing back then in an email to a holistic vet who was helping us check on him at home: "You can see some brown/dark red and yellow (not sure if urine or pus) there - a lot of it is kind of caked on, so seems to be from yesterday, but it is still moist and there are wet parts. To me it looks pretty bad, but not sure if it's just something I should clean off with the solution from the apotek."

IMAG3945.jpg

• lazer
• Nov 15, 2015

IMAG3947.jpg

• lazer
• Nov 15, 2015

You can see the area is very wet and there seemed to be some blood mixed with pus caked around it. You can also see some caked on litter there that I was afraid to remove for fear of ripping a stitch, so I just padded as much as I could from the area daily.

I hope this helps, but I realize yours situation is probably very different from ours. Best of luck with your cat - we went through hell with ours over the course of a month and know how hard it is after a blockage and PU. If you are interested in any specific details of our case to compare relevance or anything please ask, or alternatively take a look at my big Rigel saga page with details.

Click to expand...

Did your cat growl after peeing at all?