PU surgery not working

[poseidonb]

Three year old Poseidon had PU surgery.  He blocked two days after the surgery. And he blocked again. They said it was just a small scab or some litter.  But now we are taking him in again.  The vet said the wound is healing well.  But I am at my wit's end.  The vet has said no sign of stricture.

I am thinking of taking him to UC Davis.  Any idea how long it takes to completely unblock after PU surgery and what my options are at his point?

Thank you.

 

[moggielover]

PU surgeries are, for the most part, usually successful, provided your vet is well-versed in the procedure. It is a difficult surgery to perform, as the male feline urethra is TINY, and, because it is TINY, it can be quite difficult to perform the surgery without causing nerve damage or scar tissue formation.

Some of the most common reasons a re-blocking occurs are:
*formations of strictures due to the vet failing to adquately dissect the ischeourethralis muscles from the pelvis
*formations of strictures due to failure to correctly appose mucosa to skin.
* failure to apply tension-free anastomosis
*failure to use stents, when indicated

Right now, the "re-blocking" symptoms your cat may be experiencing could be due to post-surgical swelling, scabbing, or post-surgery irritation, if the surgery was done very recently (past week).

If your cat had the procedure done more than 2 weeks ago, and is still blocking, you may want to make an appointment with a specialist. They will have more diagnostic tools at their disposal, which can help in determining the best course of action.

A few questions:

Was your cat sent home with any medicine such as antibiotics, sedatives, anti-spasmodics?

Did they teach you how to perform aftercare (vaseline on to prevent urine scald, proper pain management, diet, etc.)?

Was your cat catheterized after the procedure? Usually, they don't cath cats post surgery, fearing the irritation could lead to strictures, but others will cath for a couple of days post-surgery to keep the urethral opening dilated enough to pass any remaining "sand" that may not have been flushed out during the procedure.

Did they teach you how to perform a bladder palpation and expression in the event of a partial re-blocking? Knowing how to do this can be a literal life saver in the event you cannot get to the vet for a day or two, if your cat partially re-blocks. A full re-block is ALWAYS an emergency, as the urethral opening is fully blocked, which means no matter how much you try, you will not be able to express an adequate (if any) amount of urine from the bladder.

And last, how far out from the procedure are you (when did it take place)?

A consult with another vet (or UC Davis) would not hurt, especially if your cat is not showing any improvement.

Please, if you are unable to acheive the desired result with your current vet, contact a specialist, and after consult, discuss your options thoroughly. A primary revision of the original stoma (they go in, cut everything back open, look around to make sure all is functioning properly, fix what is broken, and then revise what was done incorrectly the first time...sometimes it is just the way the cat was originally stiched up that is the problem!) is the preferred treatment of choice for failed PU's, and the more experienced surgeon you get, the better/more successful the revision will be.

 

[poseidonb]

Thank you so much for your very comprehensive answer. 

Poseidon had one blockage cleared and then when he re-blocked shortly thereafter had the  pu surgery. His brother had a blockage but no relapse after one year and no pu surgery necessary.

I am not sure if a catheter was given after the surgery.  He peed well and they let him go home.  A few days later he re-blocked.  They put a catheter in him and he peed well in the hospital with the catheter for a few days.  They took the catheter off the day before he went home and he was peeing well in the hospital.  He re-blocked and we took him in . The gave him a catheter and the vet said it was a very light blockage.  They cleared him and he came home.  He did not pee in 24 hours and he is back in again.  They were unable to pass a catheter in him last night.  They were going to go in and do a dye study to see what is going on with him and try to pass a catheter.  It is an emergency animal clinic with supposedly good doctors.  They said the procedure was routine and it has been everything but.

My plan now is to see if they can get him peeing again in a catheter and take him to UC Davis on Friday, which is about an 8 hour drive. 

I am concerned about the length of the drive, but want the very best to check him for strictures and see if he needs revision surgery. I am not a doctor but I can imagine he is probably pretty irritated down there by now.

No antibiotics were given. He has gotten pain meds, buprenex 3 times a day and Prazosin. .5 ml.  They did not mention Vaseline.  He is on urinary royal canine.  HIs water intake is low when he comes home.  I have tried a little salmon and tuna.  His appetite has been fair.

The pu surgery was about nine days ago.

This cat is three years old and otherwise very healthy and active.  I hear that UC Davis is the best.

Do you think he might still be able to recover if in the hands a very good specialist?

You don't know how much I appreciate your answer.  It is more detail than I have received from the emergency clinic.

Posideon and Family

 

[moggielover]

If in the hands of a specialist, his recovery chances are quite high, as is a successful revision surgery, if needed.
Some male kitties are just chronic re-blockers, due to the shape and anatomical placement of their penis. Poor things!

 

[lavishsqualor]

I think you should bite the bullet and get him checked out at UC Davis.

 

[poseidonb]

Thank you for your support.  He is getting a road trip to UC Davis on Friday.  I will keep you all posted.

Poseidon and Family

 

[poseidonb]

Thank you for your supportive message.  We are going on a road trip on Friday, five hundred miles, to UC Davis.

 

[poseidonb]

Thank you for your encouraging and supportive messages.  We are going to Davis on Friday. Will keep everyone posted. 

 

[poseidonb]

2.28.17 poseidon rear end.jpg

• poseidonb
• Mar 1, 2017

All of you who said to go to UC Davis were correct.  I drove the five hundred miles up there from San Diego with Poseidon NOT sedated (big mistake)

He had the revision surgery and I had to go back for him in a week.  Two thousand mile road trip.  We arrived back exhausted. I have slept with him every night to keep him from shedding his cone and licking and scratching.  He managed to get out once but everything appears ok.  This is like having a toddler X 10.  You can't put him in a baby carriage or play pen or he gets restless and might block again.  It is a 24 hour job for a week to take care of him

But the good news is it is working. The folks at UC Davis are caring and the best at what they do.  They even gave me a $2,000 hardship grant when they saw how much money I shelled out for this little fellow. The pet insurance and go fund me helped but certainly haven't been enough.

So good to see the brothers together again.  As I see them stare out the window together, I feel great happiness and hope. 

Thank you all !

. 

3.2 dos hermanos.jpg

• poseidonb
• Mar 1, 2017

 

[1CatOverTheLine]

Originally Posted by PoseidonB  

3.2 dos hermanos.jpg

• poseidonb
• Mar 1, 2017

Just fabulous !

.

 

[poseidonb]

Thank you so much.  I have never been an "animal fanatic," just a normal guy with two cats, but I can tell  you that they have both won my heart.  To see so much courage and will to live by Poseidon, is inspirational.  There is a time that we can't do more, but when we take on the responsibility of a pet, to me that is a sacred commitment to do what we can. 

 

[poseidonb]

This is an update on Poseidon.  He is now urinating well and re-gaining his strength.  Never give up on feline urinary disease. These boys can be cured.  It just take a large amount of patience and love.  

Probably the hardest part is getting him to eat and drink properly when he has his cone on . It is supposed to come off this Friday.  Also if there are other cats in the house, it makes it more difficult because they like to groom the wound site.  The patients have to be isolated from the other cats for at least two weeks.

Again, if your cat has unsuccessful PU surgery, get him to the best near you.  UC Davis is the gold standard.  Their care was incredible.  Seeing the small fortune we had already spent, they even gave me a "grant" of $2000, cutting our bill in half.  What an incredible staff and team of surgeons!

Thank you again for your encouraging messages.