Post PU surgery complications Distended bladder

[CoowaterChris]

A family members cat had PU surgery on tuesday just gone. He had multiple blockages and it got to the point they struggled to catherterize him.

All was looking fine on the thursday when he wee'd a little. Think 30%.
Later that day he tried to wee again but only a few drops came out.

His bladder become full again and no blockage was found during catherterization.

The vet believes he has a distended bladder which essentially is an overstretched bladder that doesn't work in cohesion with the muscle very well in order to express the bladder.

As far as i know he still hasn't wee'd by himself since the thursday morning.

I have a couple of theories as to why this might be.

Because of his bladder being distended, the peek sensation of needing to urinate is extended. For example if his bladder has stretched to 120% of it's normal size, it would need to fill to a higher point for him to recieve that need to pee.

In combination of the morphine pain relief that he is on, this feeling might be dulled to the point of him not trying to wee.

His wee on the thursday may have been because the morphine had worn off over night at the same time as his bladder being full enough to recieve those sensations to wee.

The second theory is a more grave one.
Something gave him the sensation to wee. That sensation could have been due to a stone or irritation in his wee pipe. If so I don't believe theres a way that that could be managed with home care since it's reliant on irritation the wee pipe.

I have seen on the internet that caring for cats with paralysis involves manually expressing their bladders. The issue however is that I don't know if that's possible on a cat that still has restrictive control over their bladder, meaning he can hold his wee in.

The vet has ordered a drug which will help his bladder muscles to contract, a bit like how a laxative works for your gut.
Why they don't already have it in stock is beyond me and why it's taking till monday to get here is also beyond me.

I'm curious for peoples thoughts on everything i've mentioned.
Hoping for some success stories or possible options avaliable for him to survive

Chris

 

[fionasmom]

Welcome to The Cat Site! PU surgery is a consistent topic here and there are numerous threads, most voicing some level of concern about follow up care or complications.
Search Results for Query: PU surgery

In the case of your family member's cat, your theories may be very correct, as may the vet's, but I have a very high level of concern about any cat who cannot pee under any circumstances. As you said in your last sentence, there is a worry that this may be a survival issue. The fact that the cat is not able to pee supersedes everything at this point.

Morphine is one drug, along with many others, which can cause urinary retention. I had this happen to a dog who was given a fentanyl patch after surgery. All opioids can cause this.

PU surgery can also result in ureteral constriction in some cases. Even if the urge to urinate is not present in the cat, it cannot be allowed to persist for any length of time without serious consequences.

A paralyzed bladder may or may not be what is happening. I expressed the bladder of a GSD I owned for about a year as he suffered from a neurological condition which did paralyze his bladder...but we knew what it was and there was no blockage; in fact, the paralyzed bladder was an expected outcome of the condition. Expressing a bladder is something that can be easily learned, but in the case of this cat, the owners do not have an answer to what is happening. If there is a blockage, expression will not work. If this is to be done, the vet needs to make a determination that it will work.

Thursday to Monday is way too long to let this ride out at home. Your family needs to get medical help for the cat, probably immediately unless he has since been able to urinate normally.

 

[CoowaterChris]

To ease your concerns about the where he is right now, he is still at the surgery. He has been there since tuesday last week.
They have been aspirating his bladder via catheter.
They have reported there to be no blockage each time they have done so.

I want to thank you for your reply. I have been going over this in my head for the last couple of days to try and understand why he wee'd thursday but not since.

I did ask the vet on the phone whether he thought it could have been a response to urethra pain from his sutures but he didn't think so.

However I am beginning to think that this is likely what happened. Either a stone, crystal or suture irritated his urethra and cause him to randomly want to urinate.

Prior to the surgery he frequented his tray fairly regularly, probably because the penis of cats with this condition is generally sore from the crystals they pass. His urethra in his penis was apparently very difficult to pass a catheter down prior to the surgery.

As sad as it is to say, ironically i think the soreness in his penis was the very thing that gave him the desire to urinate before the surgery. But now that that doesn't exist, the desire to clear the irritation isn't there. We both know what it can be like to get soap up there. You immidiately want to pee to clear the sting.

There's the hope that once off the morphine, this area will be more sensitive or irritant enough to help him.

The issue however being time. You know as well as i, whether it's because of the problem they have or because of the cost... time isn't a luxury often given with animals.

I'm the type of person who wants to try every solution regardless of those 2 factors. I want to be able to give him the time to recover even if it's a slim slim chance but I know where they are going to take the discussion.

I can't bare the thought that potentially the last week of his life will be going through all this trauma with a cone around his neck locked in a prison cell.

To summerize my thoughts

I believe he may have lost bladder stimulus
He has now lost penile stimulus
Yet still has urethra control

Now we both know in the text book that's terminal.

If this turns out to be the case, I'm going to raise the the question of making him incontinent as a solution. That though raises ethics.

I personally would rather be incontinent and alive.

Just want to say that I'm not being arrogant with my messaging or thoughts in case it comes across that way. With my anxiety and being prone to odd I tend to think a lot, somewhat obsessively.

Chris

 

[silent meowlook]

Hi. I am sorry you and your cat are going through this.

If a cat’s bladder becomes very large numerous times or for any length of time, they can develop bladder atony. This is where the bladder looses its ability to function. By keeping the bladder small during recovery, the bladder will often go back to normal.

It is important that your cat be on pain medication. If he has been catheterized many times, it is possible that the urethra is very irritated and urine burns, so he is reluctant to go.

Here is an article on FUO.

Managing Feline Urethral Obstruction

Feline UO is a common emergency. Diagnosis of UO in cats is straightforward, but the difficulty lies in recognition of the problem at home.

todaysveterinarypractice.com

 

[CoowaterChris]

So to give an update on Ozzy

I believe it was Sunday after he'd been given Bethanechol chloride he urinated twice, morning and afternoon.
He then repeated this on Monday and provided he urinated Tuesday, he could come home.

He is home

I decided not to update until the news was consistently good as I was reluctant to get my hopes up.as well as those who might read.

The vet believes he does have some issue completely emptying his bladder due to it being distended and we will have to wait and see if he can eventually urinate without the need for Bethanechol chloride.

I'm as cautiously optimistic as i can be. I've a tremendous feeling of guilt seeing him in the state he is in. The trauma this poor fella has had to endure breaks my heart. I feel like I've failed to protect him.

I will continue to update.

 

[fionasmom]

Thank you for letting us know. It sounds as if things have improved somewhat and I hope that he is on the road to recovery.