Post PU surgery, scar tissue closing up urethra

furbros

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Ok, so I am new to this forum so if I am doing this wrong, sorry.
My baby, Happy, had PU surgery in December after being blocked 3 times and "knocking on death's door," as the ER vet put it. He did wonderful during surgery and recovery. In Feburary I noticed he was taking a long time in his litterbox so I brought him to the vet thinking he had a UTI. My vet said that there was a tiny bit of bacteria and if he had a UTI, I caught it in the very beginning. He put him on antibiotics. After his antibiotics he was still taking a long time in the box. I thought maybe he just needed to get use to his "new parts" but then I noticed he was straining. He was able to go but was staining. So back to vet we went and the doctor said he was not blocked. Because of the scar tissue his urethra is closing up when he heals. So the vet kept him for 3 days and dilated his urethra. He wanted to keep him a little longer but it is so stressful on him and his brother, Mr. Whisker, as he will not eat when Happy is gone. This was in the beginning of March. He has been using his box with no problem until a weird thing happened. My daughter was holding Happy and petting him and he peed on her. This has never happened before so I thought maybe he had to go and she wouldn't let him go. Which I know she would never do but he has never done anything like that before. Then I caught him peeing on a pile of clothes. Then last week I picked him up and he peed on me. When he did this, he acted as if he didn't even know he did it. He can still potty but he is pushing it out or it leaks out when he is not in the box. I called the vet on Friday to see where we go from here, if he needs another surgery or what. He told me he would just dilate it again but to first try antibiotics. I am wondering if anyone has had this happen to their baby and what they did. I read that dilating it is only a temperary fix. My poor baby has been through so much and it is really stressing him out. Any advise or suggestions would be much appreciated.
 
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furbros

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Thank you so much for the reply. It seems every article I have read has ended in heartbreak. I don't want that to be my outcome. I am going to ask my vet about the medicine's she suggested.
 

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The surgeons I've worked with have always reported that when they were learning how to do a PU, it was important to not be conservative about the surrounding tissue they excised, being generous enough when taking that tip of the penis and urethra that the opening stays open. Very very few cats experience infections after this, about the same rate of bladder infection as any cat, rare as can be; cats tend to keep a sterile urinary environment as they typically have much more concentrated urine than a dog or human, which is why they're more predisposed to urinary sludge and crystals than bacteria.

I've assisted in some repairs of PU sites, after a less experienced surgeon, who may be good at excising lumps and bumps or castration, but is not skilled at the level it takes to #1) take just enough tissue, not too much to the point urinary sphincter tone is diminished and incontinence is a problem and not so little of the penis that they barely excise any urethra tip and occlusion/obstruction with sludge (mineral deposits, bladder wall epithelials, blood and leukocytes) just recurrs until repair.

It's important they're on prazosin the first 5 to 7 days, to help with urethral inflammation and spasming. Sphincter tone takes longer to return the longer a cat was obstructed and straining.

If a board certified surgeon did not do his PU, I'd get their assessment of his surgical site and remaining urethra, as well as a single abdominal Xray to ensure he has no radiopaque crystal load or stones (uroliths) in the bladder or urethra that would explain his reobstructions. "Scar tissue bulking up around the urethra" shouldn't be a recurring issue if enough surrounding tissue is excised around the penis to start with. Their prepuce, the hood that covers the penis, should be gone. The penis itself is gone.

If he's not already maintained on Royal Canin SO, he needs to be until he is fully recovered for 4 weeks before tapering off. Male cats that don't get a PU stay on this Rx diet for life, or one of RC's many other feline diets with the SO index, meaning it has low enough magnesium, phosphorus, and maintains a balanced pH to not allow Struvite or Oxolate formation (thus the name SO). Canned is best to increased the bladder's water intake from the bloodstream as well as additional drinking, by flavoring one of multiple water sources with sodium-free chicken or beef stock.

After allowing this vet multiple attempts to correct his obstruction, a consult with a surgical specialist is in order. They do many PU's a week, as it is a very common specialty surgery male cats prone to urethral obstruction need.

I hope his inflammation is resolved eventually, and he can worry about other things beyond peeing on his buddy, your little girl, or straining, which is very painful. Buprenorphine is a good pain management while recovering from obstruction and straining. Steroids may be needed for the surrounding tissue inflammation also, help knock back the swollen skin that is enveloping the urethra. Discuss buprenorphine, prazosin, and prednisolone with your surgical vet at the consult.
 
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furbros

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Thank you so much for all this great information. We have a cat hospital that only works on cats close to me. I am making an appointment to talk with a doctor there. The vet that did Happy's surgery is retired but still comes in occationally to do surgery's. He did Happy's. The doctor that is treating him told me he had never done the surgery before by himself and that he felt confident to do it, but didn't want Happy to be his first. The retired doctor has done this surgery a lot.
I read that dilating the urethra is only a temporary fix. Is this correct? Again, thank you for responding and for all the good info. I am so ready for Happy to be well and back to normal.
 

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I'm wishing Happy well! I can only imagine the stress and worry you're feeling.

My cat Simon had a PU in the fall. His vet assured my Mom and I that he made the new opening so wide that he could theoretically place not one, but two catheters side by side in it. Not that he would, but after Simon had surgery I had to rush him back in four days later because the little bugger wouldn't drink or eat for anything and was dehydrated. His vet checked him over though and assured us that he was fine, just stubborn and that because of the size of his opening, he really shouldn't have any issues in the future.

Best wishes to you and Happy!
 

nansiludie

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Wow, I am sorry this happened. I have a question, do you feed dry food? Rx or not? Another thing you might want to read catinfo.org It saved me from making this decision on my cat. I sure hope he does well with this surgery. I am hoping he has not become incontinent. Is he on pain medication as I would this sort of thing is extremely painful?
 

nansiludie

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I am wishing I'd seen your post before this surgery, as my cat was this way and the vet wanted to do it, but I could not afford it and I went ahead brought him home, fed him regular canned cat food with extra water added and he is fine, in July will be a year without any blockages. Yet, another cat, a colony cat, blocked the first time, two weeks ago, kidneys failed and he had to put down. With these things nothing is really sure. I hope for a speedy recovery for your cat.
 
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furbros

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Ok, so this morning we are going to meet with our vet to discuss Happy. He wants to dilate him again and while he has the cath in, go ahead and make it bigger. I called the cat hospital down the street and they don't even do the pu surgery. I found some board certified surgeons and called and they only take by referral. So this morning I am going to talk to my vet about them. Happy was on prescription can food for the first month or so. Now he is just strickly on wet food. All of my kitties are on wet food only. They are on Purina Pro Plan. Not my first choice, but it seems to be the only thing they like. And I have tried EVERY. CAN. FOOD. My vet said it was fine even though I only see crap ingredients. They were on Wellness kibble before.
I am sorry your Simon had to go through the Pu surgery too. I am so glad he is doing well. Everyone I have talked to that has had the surgery has had no problems. I will let you know what the doctor suggests.
Thank you all for your great advise and well wishes.
 

detmut

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Ok, so this morning we are going to meet with our vet to discuss Happy. He wants to dilate him again and while he has the cath in, go ahead and make it bigger. I called the cat hospital down the street and they don't even do the pu surgery. I found some board certified surgeons and called and they only take by referral. So this morning I am going to talk to my vet about them. Happy was on prescription can food for the first month or so. Now he is just strickly on wet food. All of my kitties are on wet food only. They are on Purina Pro Plan. Not my first choice, but it seems to be the only thing they like. And I have tried EVERY. CAN. FOOD. My vet said it was fine even though I only see crap ingredients. They were on Wellness kibble before.
I am sorry your Simon had to go through the Pu surgery too. I am so glad he is doing well. Everyone I have talked to that has had the surgery has had no problems. I will let you know what the doctor suggests.
Thank you all for your great advise and well wishes.
Purina Pro Plan has a Urinary Health formula. 
 

nansiludie

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The urinary health program just regulates the minerals in the cat's diet. Cat's need those minerals and I think over time the cat could possibly get sick from not having them. 
 
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furbros

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He does eat the Pro Plan Urinary one, along with all the other flavors too. I thought the same thing about the urinary food. But my vet said he needs to be on it for the rest of his life. I need to do more research on that. I do think the urinary foods have a bunch of crap ingredients in them. But for now, he is going to eat them. We talked with the vet on Friday and what is happening to Happy is he has a very, very narrow urethra. It is healing together. He said that the reason he could be leaking is bc he might have a little mucus plugging it and when it releases, the pee comes out. Or he is having spasms. But he know he has sensation there bc Happy knows when he has to go to the bathroom. He also said he could tell bc he was so clean down there. Cats that have no sensation just drip and don't know it. They usually have urine all on their fur. So he wants to dilate him again and this time make a small incision (like an episiotomy) and sew his opening back a little more. He said it was very minor and he would come in in the morning and be able to come home that evening. He was going to do this on Friday, but I had already fed Happy. So he will go in on Monday morning. He feels very confident about this and I am just praying this works. This poor baby has been through so much. I just want him happy and healthy.
 

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I hope this works, one more time, handsome studly man above ;]

Some caution may be needed as you advocate for your boy, and asking your vet to go ahead with the referral so you can at least consult the surgeon, they look at the site, and determine how much deeper it needs to go. If the urethra is already excised enough, and it's a separate issue, they can tell from exam. They do 5 perineal urethrostomies a week, and follow up for free, if slow to heal, or needs warm compresses, or more meds after a fast surgical recheck of site, compared to a regular vet going in and trying 5 a year, max. Many reg vet PU's get reassessed and redone by surgeons, as they are conservative, trying not to damage the remaining urethra, or surrounding nerves, unsure of their technique and the anatomy,  but ultimately not helping prevent obstruction, leading to distended bladders, and potentially bladder rupture. These are scenarios that have happened too regularly just in my small area of the world. As long as some urination is seen, even dripping, we avoid a septic/shocky state and/or rupture, while figuring out if a male cat will benefit from just a urinary catheter versus PU. Ucaths should stay in a minimum of 24 hours to give them a chance to truly by effective, allowing the urethra to heal, the spasming and pain to subside as meds take effect, and the bladder to return to normal.

I can see why the cat hospital doesn't do the surgery, as most boarded feline practitioners will not touch such a delicate, skill-sensitive surgery, knowing they can cause either complications or not effectively remove enough of the urethra with the penis to go past the area that has suffered from past obstructions and is now damaged urethral tissue, prone to spasming that Prasozin can only help so much, to a limit. It's one of those kind of surgeries we humans wouldn't ask our regular GP or PCP doctor to do, we'd go to a surgeon; PCP can zip off a basal cell tumor from the face or hand, a sun spot, but no invasive surgeries, or surgery involving, nerves, vascular blood supply, and preserving function/continence.

Good luck with your decisions, and may your vet have patience, modesty, and wisdom with his own decisions. Wishing you the best outcome!
 

puck

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"The urinary health program just regulates the minerals in the cat's diet. Cat's need those minerals and I think over time the cat could possibly get sick from not having them."

This is stated as a fact, a declarative statement, and is false. They accumulate acellular "sludge" and/or crystals made of magnesium, phosphorus, and calcium when these are in dietary excess. Animal feeds are not fool-proof, and are not tailored to the individual male cat being fed. We win some, we lose some, with balanced diets. Ultimately, we win, as maldevelopment, neurological and cardiovascular deficits, and eventually death were the results of not feeding "balanced" foods before 1950. We can limit these primary minerals, control the acidity of a diet (in other words, its pH, promoting acidity in a struvite prone cat, and alkalinity in a calcium oxalate prone cat, reaching as close to neutral 7.0 as possible - many do great at 6.0, not too acidic, just right), and ultimately help our male cats that are all to prone to urethral obstruction.

They do not suffer any ill effects of being on Royal Canin SO their whole lives; I've had many many patients live to be 20 on the earlier, even less nutritious/urinary balanced Rx diets of before, the Walthams, the old Hill's s/d and c/d formulas, and the slightly better Purina UR st/ox. Those diets saved their lives. And prevented them from obstructing and needing a very expensive, potentially risky surgery. If we can avoid surgery we do, but some reobstruct even on the controlled Rx diets and increased water intake. No way around PU at that point. Urinary SO and the whole Royal Canin line of Rx feline diets with the SO index are top notch diets for UO cats. If you need the dental diet for a chronic periodontal diseased cat, whamo, they have RC Dental w/ SO index, so your cat's dual problem with urinary obstructions is now also treated. Anxious cat, Feliway just isn't enough? Bam, RC Calm w/ SO index, a great diet for inappropriate urinators.
 

puck

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Some cats that prefer dry or won't eat enough canned are fooled into better hydration and diuresis by adding water to dry food. They drink all that extra water to get to the food. Just enough to float the food off the bottom of the bowl by a 1/2 inch. I've had owners call describing their cats that prefer dry, have only ever eaten dry their whole life, respond to canned like it isn't even food, just walking away, or burying it, or even scooping it out of the bowl, and then sitting next to that empty bowl waiting for their peon servants to serve them their dry kitty crack.

If I catch a client when a cat is still pretty young, pretty new to food, I always recommend feeding both canned/wet/soft diets and dry/kibble diet intermittently, adding a little of the one multiple types a week if an owner wants to primarily feed the other, at a minimum. Some folks have an emergency, suddenly need to up and leave to run to the hospital or the airport without planning for a petsitter. Dry food has saved them big time. Wet food can't just sit out in a large volume for a cat to graze on, ya know? I work in a medicine mecca, and I have so many chronic disease patients as clients with pets it's astounding. When the owner becomes acute, planning for cat care is very difficult. They just gotta get themselves to the hospital, not worry about their cat, which would just stress them out and make their own health worse.

Some cats will need the added groceries in dry food per volume, if they ever lose weight and need to regain it fast or most economically for their owner.

Other cats will need to find canned somewhat palatable, to get crushed/slivered meds in them, or tease them into a carrier, or mix with fish oil/powdered meds like Cosequin. And canned is preferred for very ill, very old, and post-anesthesia cats, so having some drive to eat it at least occasionally is never a bad idea to instigate in their youth. Some Rx diets that can become very necessary, like Hill's y/d for a hyperthyroid cat, is best fed on a wet matter basis, so palatability for that texture is needed.  We all know how all too common hyperthyroid disease is, especially, as it just happens, in those buggers that refuse to be medicated, orally or transdermally.
 

nansiludie

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@puck   I got my info from Catinfo.org which is written by a Vet, Dr. Pierson. I've even contacted her several times, she was very kind and very polite. I thought the same of dry food for many years but its not true. Convenience for people is bad a reason to feed dry. I'm sorry but you can't just leave a cat unattended for such a length of time that you need to leave dry food out because you can't feed them on time. Who is to clean their litter? Anyways, dry food is one of those things, pay now or pay up later in the form of health issues from not feeding a healthy, meat based, wet diet. Cats are meant to eat meat and have water in their food not just dry grain-based food that is wet down with water.  Also Hill's RX diets are not actually prescription in the sense of the word. Go online to amazon and you'll see you can buy it there, online, expensive sure, but you can buy it. Why is it you can't buy, say, clavamox like that? Because it is prescription only by law. Those diets just trademarked the name. Please @puck   read her site with an open mind. I thought the same as you, but I was wrong, I lost a cat because of it. Nearly all cats can be broken from dry food, the only reason they find it so yummy is because they're sprayed with animal digest, a mix of fats and meats boiled down to a broth and then the kibbles are coated in it. I'm feeding walmart brand, special kitty, canned and have had no tummy upsets.   

@furbros  I hope your kitty does well. Yes, it is a good idea to see the surgeon, and see what he says. Could I ask, why hadn't the surgeon done the surgery himself? Your cat is very handsome.  The urinary diet is canned right? Please keep us posted on how he does.
 

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@puck   I got my info from Catinfo.org which is written by a Vet, Dr. Pierson. I've even contacted her several times, she was very kind and very polite. I thought the same of dry food for many years but its not true. Convenience for people is bad a reason to feed dry. I'm sorry but you can't just leave a cat unattended for such a length of time that you need to leave dry food out because you can't feed them on time. Who is to clean their litter? Anyways, dry food is one of those things, pay now or pay up later in the form of health issues from not feeding a healthy, meat based, wet diet. Cats are meant to eat meat and have water in their food not just dry grain-based food that is wet down with water.  Also Hill's RX diets are not actually prescription in the sense of the word. Go online to amazon and you'll see you can buy it there, online, expensive sure, but you can buy it. Why is it you can't buy, say, clavamox like that? Because it is prescription only by law. Those diets just trademarked the name. Please @puck   read her site with an open mind. I thought the same as you, but I was wrong, I lost a cat because of it. Nearly all cats can be broken from dry food, the only reason they find it so yummy is because they're sprayed with animal digest, a mix of fats and meats boiled down to a broth and then the kibbles are coated in it. I'm feeding walmart brand, special kitty, canned and have had no tummy upsets.   

@furbros  I hope your kitty does well. Yes, it is a good idea to see the surgeon, and see what he says. Could I ask, why hadn't the surgeon done the surgery himself? Your cat is very handsome.  The urinary diet is canned right? Please keep us posted on how he does.
I think most of us have read her site.  I actually used to include links to her site but I usually don't anymore.  I don't believe that there is a one size fits all with kitties, what works for one does not necessarily work for another.  I have seen many kitties here who need either the prescription food or the addition of dl methionine to food.  Adding it yourself can be tricky but is doable if your vigilant about checking urine pH.  We have had kitties here whose owners followed the generic advice about high meat content, no grain wet food or a raw diet to avoid prescription diets only to have their kitties re-block.  There are other factors at work besides diet some of those factors being genetic which can't be changed, just dealt with..
 

nansiludie

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Yes, what you are saying is very true but I'd like for her to be aware, as most vets aren't aware that Hill's has trademarked that name and it can be bought at other places besides vet offices.  

Also @furbros   I have a kitty named Whiskers. Have they done a full urine test on him and say why he blocked? Was it mucous or any type of stone?  Yes, please do not take any of my comments to go against what your Vet says but I would like for you to be informed about these things. Dr. Pierson does do phone consultations but they are a little expensive but they go towards the rescue works she does.
 
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@furbros, there was another TCS member who had a heck of  time with her kitty's PU surgery. Had first surgery and then two more because the opening keep closing up with scar tissue. The final surgery was going to be their last attempt. They went to a different vet who put in a "stent" of sorts for 6 weeks so that the opening stayed wide while surrounding tissue healed and did its thing. I would suggest reading this thread:

http://www.thecatsite.com/t/282195/theodore-has-taken-a-turn-for-the-worst-advice-please

Post #183 is a photo of the stent. It's not overly graphic, but it is a close-up!

As of the latest update on the subject, the cat is still doing well.
 
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