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View Full Version : help please - perineal urethrostomy questions - LONG


Nadia
April 6th 06, 05:40 AM
My male cat Ashley (will be 5 yrs old in May) got blocked a little over
2 weeks ago. Took him to the vet, he was cathetherized (sp?) and
unblocked, but the vet said they couldn't get whatever was blocking him
to come out - they just flushed it back into the bladder. The vet said
they couldn't find any crystals in his urine. She suspected calcuim
oxalate stones, but couldn't be sure because she couldn't get a sample.
She said that it's very unlikely for it to be struvite (sp?) crystals,
because he eats only wet food (Medi-cal Hypoallergenic - he's got a
sensitive stomach).

Well, now 2 weeks later he's blocked again. I came home from work and
there were drops of blood everywhere, and he was straining in the
litterbox and leaving only some blood. He's back at the vet's again.

The first time he blocked, the vet mentioned a perineal urethrostomy. I
didn't want to do that at the time, but since he's blocked twice in 2-3
weeks, I'm beginning to change my mind. So I want to know more about
this procedure, and about what to expect afterwards. Could some of you
guys who have had this done to your cats please answer my questions?

1. Is this a complicated surgery? Should I trust my vet to do it (I
don't know if she's ever done it before). Or should I ask for a
recommendation to someone who specializes in this kind of procedure? I
want the best possible person to do it.
2. What are the chances that something could go wrong with the surgery?
And if it happens, would they be able to correct it?
3. After the surgery, how long will they keep him at the vet's?
4. How long does the recovery process take? What should I expect his
behaviour to be during that time? What should I watch out for? Should I
do anything special to keep him as healthy and as happy as possible
while he's recovering?
5. After your cat(s) had this done, did it really prevent future
blocking? I don't want to put my baby through this for nothing...

thanks,
Nadia (and Ashley)

Stacey Weinberger
April 6th 06, 06:12 AM
What are you feeding him? The food could be causing it and a change in diet
could remedy the situation without having to resort to such drastic surgery.
I'd also get a second opinion.

Stacey, who also had a cat who blocked pretty badly


"Nadia" > wrote in message
oups.com...
> My male cat Ashley (will be 5 yrs old in May) got blocked a little over
> 2 weeks ago. Took him to the vet, he was cathetherized (sp?) and
> unblocked, but the vet said they couldn't get whatever was blocking him
> to come out - they just flushed it back into the bladder. The vet said
> they couldn't find any crystals in his urine. She suspected calcuim
> oxalate stones, but couldn't be sure because she couldn't get a sample.
> She said that it's very unlikely for it to be struvite (sp?) crystals,
> because he eats only wet food (Medi-cal Hypoallergenic - he's got a
> sensitive stomach).
>
> Well, now 2 weeks later he's blocked again. I came home from work and
> there were drops of blood everywhere, and he was straining in the
> litterbox and leaving only some blood. He's back at the vet's again.
>
> The first time he blocked, the vet mentioned a perineal urethrostomy. I
> didn't want to do that at the time, but since he's blocked twice in 2-3
> weeks, I'm beginning to change my mind. So I want to know more about
> this procedure, and about what to expect afterwards. Could some of you
> guys who have had this done to your cats please answer my questions?
>
> 1. Is this a complicated surgery? Should I trust my vet to do it (I
> don't know if she's ever done it before). Or should I ask for a
> recommendation to someone who specializes in this kind of procedure? I
> want the best possible person to do it.
> 2. What are the chances that something could go wrong with the surgery?
> And if it happens, would they be able to correct it?
> 3. After the surgery, how long will they keep him at the vet's?
> 4. How long does the recovery process take? What should I expect his
> behaviour to be during that time? What should I watch out for? Should I
> do anything special to keep him as healthy and as happy as possible
> while he's recovering?
> 5. After your cat(s) had this done, did it really prevent future
> blocking? I don't want to put my baby through this for nothing...
>
> thanks,
> Nadia (and Ashley)
>

Gail
April 6th 06, 04:04 PM
My male cat (now 3 yrs) was getting recurrent urinary tract infections that
the vet thought were crystals. He is now taking one Albeta pill daily (to
keep the urine acidic) and prescription CD food (canned). He has done well
for awhile now. I don't have personal experience with this procedure. I
would get a second opinion before proceeding with the surgery. Why not try
posting on alt.med.veterinary?
Gail
"Nadia" > wrote in message
oups.com...
> My male cat Ashley (will be 5 yrs old in May) got blocked a little over
> 2 weeks ago. Took him to the vet, he was cathetherized (sp?) and
> unblocked, but the vet said they couldn't get whatever was blocking him
> to come out - they just flushed it back into the bladder. The vet said
> they couldn't find any crystals in his urine. She suspected calcuim
> oxalate stones, but couldn't be sure because she couldn't get a sample.
> She said that it's very unlikely for it to be struvite (sp?) crystals,
> because he eats only wet food (Medi-cal Hypoallergenic - he's got a
> sensitive stomach).
>
> Well, now 2 weeks later he's blocked again. I came home from work and
> there were drops of blood everywhere, and he was straining in the
> litterbox and leaving only some blood. He's back at the vet's again.
>
> The first time he blocked, the vet mentioned a perineal urethrostomy. I
> didn't want to do that at the time, but since he's blocked twice in 2-3
> weeks, I'm beginning to change my mind. So I want to know more about
> this procedure, and about what to expect afterwards. Could some of you
> guys who have had this done to your cats please answer my questions?
>
> 1. Is this a complicated surgery? Should I trust my vet to do it (I
> don't know if she's ever done it before). Or should I ask for a
> recommendation to someone who specializes in this kind of procedure? I
> want the best possible person to do it.
> 2. What are the chances that something could go wrong with the surgery?
> And if it happens, would they be able to correct it?
> 3. After the surgery, how long will they keep him at the vet's?
> 4. How long does the recovery process take? What should I expect his
> behaviour to be during that time? What should I watch out for? Should I
> do anything special to keep him as healthy and as happy as possible
> while he's recovering?
> 5. After your cat(s) had this done, did it really prevent future
> blocking? I don't want to put my baby through this for nothing...
>
> thanks,
> Nadia (and Ashley)
>

-L.
April 6th 06, 05:36 PM
Nadia wrote:
> My male cat Ashley (will be 5 yrs old in May) got blocked a little over
> 2 weeks ago. Took him to the vet, he was cathetherized (sp?) and
> unblocked, but the vet said they couldn't get whatever was blocking him
> to come out - they just flushed it back into the bladder. The vet said
> they couldn't find any crystals in his urine. She suspected calcuim
> oxalate stones, but couldn't be sure because she couldn't get a sample.
> She said that it's very unlikely for it to be struvite (sp?) crystals,
> because he eats only wet food (Medi-cal Hypoallergenic - he's got a
> sensitive stomach).
>
> Well, now 2 weeks later he's blocked again. I came home from work and
> there were drops of blood everywhere, and he was straining in the
> litterbox and leaving only some blood. He's back at the vet's again.
>
> The first time he blocked, the vet mentioned a perineal urethrostomy. I
> didn't want to do that at the time, but since he's blocked twice in 2-3
> weeks, I'm beginning to change my mind. So I want to know more about
> this procedure, and about what to expect afterwards. Could some of you
> guys who have had this done to your cats please answer my questions?
>
> 1. Is this a complicated surgery? Should I trust my vet to do it (I
> don't know if she's ever done it before). Or should I ask for a
> recommendation to someone who specializes in this kind of procedure? I
> want the best possible person to do it.
> 2. What are the chances that something could go wrong with the surgery?
> And if it happens, would they be able to correct it?
> 3. After the surgery, how long will they keep him at the vet's?
> 4. How long does the recovery process take? What should I expect his
> behaviour to be during that time? What should I watch out for? Should I
> do anything special to keep him as healthy and as happy as possible
> while he's recovering?
> 5. After your cat(s) had this done, did it really prevent future
> blocking? I don't want to put my baby through this for nothing...
>
> thanks,
> Nadia (and Ashley)

I would take your cat to a feline specialist, if your vet is not one.
It's unusual for a vet to recommend PU at first blocking. He may have
a very large crystal in the bladder that needs to be removed - did they
ultrasound his bladder? Did they test his urine for pH? PU is usually
a last resort for male cats that have repeated (3 or more) blockages.

I'd definitely get a second opinion. If you search for feline
specialty veterinarians, you should be able to find one near you.

Good luck,
-L.

Stacey
April 6th 06, 08:50 PM
In article <[email protected]>, Nadia says...
>
>Stacey Weinberger wrote:
>> What are you feeding him? The food could be causing it and a change in diet
>> could remedy the situation without having to resort to such drastic surgery.
>> I'd also get a second opinion.
>>
>> Stacey, who also had a cat who blocked pretty badly

>
>He's been eating wet food only since he was about 1.5 years old. It's a
>vet-prescribed food called Medi-Cal Hypoallergenic. Its main ingredients
>are duck and rice. He has a sensitive stomach and throws up dry food,
>and most other wet food as well. The Medi-Cal brand is a Canadian brand,
>I think (I am posting from Canada). It seems to be the brand most vet
>clinics prescribe here - there's all kinds of different ones, for
>kittens/senior cats/obese cats/etc.
>
>Is there anything specific I should look for in the list of ingredients?
>
>I did get a couple of cans of Royal Canin Urinary SO, which is supposed
>to help prevent the formation of struvite crystals, as well as "minimize
>the risk of formation of calcium oxalate uroliths". At least that's what
>it said in the little pamphlet I got with the food. I'll be mixing it
>with his regular food and hopefully he'll be able to keep it down...
>
>I don't want him to have the surgery unless it's absolutely necessary.
>It's just that when I got home and saw drops of blood all over my
>bedroom, I got pretty scared :-( I've never had a male cat before
>Ashley, so I have no experience with blocking - I don't know what to
>expect... I thought once he was unblocked he would be fine - stupid me :-(
>
>Nadia (and Ashley)

Phil on this list would be the best one to answer that with ingredients and
percentages. I do know the ash and magnesium % need to be low. There should be
as much meat (should be the first ingredient) as possible. If your cat has
struvite crystals grain causes a cat's system to go alkaline and you want it
to be on the acidic side. Sebastian's surgeon told me to add water to his food
to keep him "fluid" so the crystals and the goo that forms the block won't form.
I add enough to make it the consistency of thick oatmeal. He likes it because
he thinks he's getting more to eat!

Stacey


--
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Nadia
April 7th 06, 05:43 AM
Stacey wrote:

> Phil on this list would be the best one to answer that with ingredients and
> percentages. I do know the ash and magnesium % need to be low. There should be
> as much meat (should be the first ingredient) as possible. If your cat has
> struvite crystals grain causes a cat's system to go alkaline and you want it
> to be on the acidic side. Sebastian's surgeon told me to add water to his food
> to keep him "fluid" so the crystals and the goo that forms the block won't form.
> I add enough to make it the consistency of thick oatmeal. He likes it because
> he thinks he's getting more to eat!
>
> Stacey
>
>

I talked to the vet this morning, and the news is really good. It turns
out he wasn't blocked at all - in fact, he seems to have passed whatever
had blocked him before. That's where all the blood came from.

I got him back from the vet late morning and since then he's used the
litterbox twice!!! And there's no straining, and no visible blood. I am
so relieved... Of course, now his appetite is a little bit off, but he
makes an exception for home-made turkey soup, so I'm getting liquids
into him anyway.

I think the vet suggested the urethrostomy before because she couldn't
get the blockage out. She basically told me then that he could get
blocked again at any time, since the obstruction (possibly a calcium
oxalate stone) was still in his bladder, and that there was no way to
dissolve oxalate stones and the only sure way to get it out was the
surgery. Of course, now that he's passed it, I'm not going to even think
of doing the surgery!!!

I really never expected him to get crystals. He's on an all wet food
diet, with water added to his evening meal. The food is a quality
vet-prescribed food, the first few ingredients in it are duck, duck
liver, brewers rice and duck meal (and water, of course). It says on the
can that ash is max 3%, magnesium is max 0.03%. I thought there was no
way he could get crystals, and according to the vet, with this diet it
is impossible for him to have struvite crystals.

Now I have another question, though. When I got him back, the vet just
gave me some pain medication and something for bladder spasms, in case
he started straining. But no antibiotics. Is that normal? I would think
that, judging from the blood, he must be pretty scratched up inside.
Shouldn't he have gotten antibiotics to prevent inflamation or
infection? He did just stop taking Clavamox a week ago (after the
cathetherization), maybe the vet didn't want him to take more
antibiotics again so soon?

Anyway, I am just very, very happy that he's ok and that there's no need
for this surgery. Thank you to everyone who responded (both on the
newsgroup and in email).

Nadia (and Ashley)

Nadia
April 7th 06, 06:03 AM
-L. wrote:

>
> I would take your cat to a feline specialist, if your vet is not one.
> It's unusual for a vet to recommend PU at first blocking. He may have
> a very large crystal in the bladder that needs to be removed - did they
> ultrasound his bladder? Did they test his urine for pH? PU is usually
> a last resort for male cats that have repeated (3 or more) blockages.
>
> I'd definitely get a second opinion. If you search for feline
> specialty veterinarians, you should be able to find one near you.
>
> Good luck,
> -L.
>

First, as I mentioned in another post, I found out this morning that he
wasn't actually blocked, but had passed the crystal or whatever it was,
which is why there was blood all over everything.

My vet has a cats-only clinic - I assume that makes her a feline
specialist... She didn't do an ultrasound when he got blocked, but she
did an x-ray and said that she could see the blockage on the x-ray. She
didn't say that it was larger than normal, though. I asked about surgery
to remove the blockage from the bladder, but she said that it (the
blockage) wouldn't stay in the bladder, but will move back into his
penis, so the only surgery that could remove the blockage would be the
urethrostomy. I guess she didn't think he would be able to pass it on
his own - but he did, thankfully.

I don't know if they tested his urine for PH while he had the cathether
in. I didn't know to ask :-( And once the cathether is out, it's
impossible to get a sample from him while he's at the vet's - he holds
it in as long as he can, and only goes late at night, so by the time
they come in the morning, I guess the sample is no longer fresh enough
to test... I have been trying to get a urine sample from him at home,
and I'll keep trying until I get it - hopefully tomorrow morning...

Thank you for the recommendations and the questions - now I'll know what
to ask the vet when I get that urine sample to her. And since Ashley
managed to pass whatever was blocking him, there's no way we're doing
the surgery. I'll just have to find him food which will prevent any more
crystals from forming, and at the same time doesn't make him throw up...

Nadia (and Ashley)

Anna via CatKB.com
April 7th 06, 07:24 PM
>I don't know if they tested his urine for PH while he had the cathether
>in. I didn't know to ask :-( And once the cathether is out, it's
>impossible to get a sample from him while he's at the vet's - he holds
>it in as long as he can, and only goes late at night, so by the time
>they come in the morning, I guess the sample is no longer fresh enough
>to test... I have been trying to get a urine sample from him at home,
>and I'll keep trying until I get it - hopefully tomorrow morning...

A urine sample should be obtained at the vet's by cystocentesis; I'm
surprised your vet didn't mention this.

http://www.peteducation.com/article.cfm?cls=0&cat=1476&articleid=995

You take the litter box away at night and take him to vet in am (as early as
possible) and they do this procedure. This way the sample is sterile. If
you take it at home there's a possibility it could become contaminated with
bacteria simply by touching the top of the container to something accidently
such as his fur, etc. If you were just testing him to see what his urine
specific gravity was (important to know for cats who have kidney disease),
then a urine sample at home is fine but if you're checking for a urinary
tract infection, cystocentesis is recommended.

>the surgery. I'll just have to find him food which will prevent any more
>crystals from forming, and at the same time doesn't make him throw up...

You need to find out exactly what type of crystals you're dealing with. If
it's struvite, Medi-cal Dissolution disolves them and Medi-cal Preventative
would be the diet he would eat after that or if using Hill's, you would use
s/d to dissolve, then c/d to maintain. If it's calcium oxalate, then Hill's
x/d is made for that. Struvite crystals can be destroyed via diet while
calcium oxalate require surgery to remove. I'm very surprised your vet
mentioned the perineal operation on a first blockage, very unusal.

Perhaps you should look into getting a second opinion from another vet.

--
Message posted via CatKB.com
http://www.catkb.com/Uwe/Forums.aspx/cat-health/200604/1

Anna via CatKB.com
April 7th 06, 07:29 PM
Here's a couple links, the first explains FLUTD and struvite crystals, the
second explains calcium oxalate stones:

http://www.marvistavet.com/html/feline_lower_urinary_tract_dis.html
http://www.peteducation.com/article.cfm?cls=0&cat=1476&articleid=995

--
Message posted via http://www.catkb.com

Anna via CatKB.com
April 7th 06, 07:35 PM
Corrected link for calcium oxalate stones info:

http://www.marvistavet.com/html/body_feline_oxalate_bladder_stones.html

--
Message posted via http://www.catkb.com

Nadia
April 8th 06, 07:43 PM
Anna via CatKB.com wrote:
>
> A urine sample should be obtained at the vet's by cystocentesis; I'm
> surprised your vet didn't mention this.
>
> http://www.peteducation.com/article.cfm?cls=0&cat=1476&articleid=995
>
> You take the litter box away at night and take him to vet in am (as early as
> possible) and they do this procedure. This way the sample is sterile. If
> you take it at home there's a possibility it could become contaminated with
> bacteria simply by touching the top of the container to something accidently
> such as his fur, etc. If you were just testing him to see what his urine
> specific gravity was (important to know for cats who have kidney disease),
> then a urine sample at home is fine but if you're checking for a urinary
> tract infection, cystocentesis is recommended.
>
She didn't think he had an infection. According to her he had stones in
his penis - when she was putting the cathether in to unblock him, there
was resistance and she said she felt something "crunching". So she's
convinced that it was just some kind of crystal, not an infection, and
there's no need for cystocentesis.

I did manage to get a urine sample from him Friday morning and took it
to the vet. She said they found no traces of blood or bacteria, and no
crystals. His PH was good, and his urine was "dilute" - not too acidic
or alkaline.

I'm beginning to think that this might have been caused by the fact that
he usually only urinates once or twice every 24 hrs. I was trying to get
him to go more, but he just wouldn't. Since he blocked, I've started
adding a LOT of water (or turkey broth) to his wet food, and he's going
at least 3 times per 24 hrs.

>>the surgery. I'll just have to find him food which will prevent any more
>>crystals from forming, and at the same time doesn't make him throw up...
>
>
> You need to find out exactly what type of crystals you're dealing with. If
> it's struvite, Medi-cal Dissolution disolves them and Medi-cal Preventative
> would be the diet he would eat after that or if using Hill's, you would use
> s/d to dissolve, then c/d to maintain. If it's calcium oxalate, then Hill's
> x/d is made for that. Struvite crystals can be destroyed via diet while
> calcium oxalate require surgery to remove. I'm very surprised your vet
> mentioned the perineal operation on a first blockage, very unusal.

She said there were stones in his penis, and the only way to remove them
was the operation - otherwise he could block again at any time. Now
that we've seen that he can actually pass them, she hasn't mentioned the
operation again.

She gave me a sample of this food which is supposed to both
disolve/prevent struvite crystals from forming, and help minimize the
risk of oxalate crystals forming. It's Royal Canin Urinary SO. Anyone
heard of it? Does it really work? I'm a bit suspicious of it, because it
doesn't look like it's got any real meat in it. The first few
ingredients are meat by-products, chicken by-products and animal fat.
Doesn't sound like a high-quality diet to me... He's currently eating
Medi-Cal Hypoallergenic (wet), whose first ingredients are duck, duck
liver and rice - no by-products of any kind in it.

>
> Perhaps you should look into getting a second opinion from another vet.
>
Yes, I've been thinking about this, too. I think I'll do some research
into other vets in the area...

Nadia (and Ashley)