Post PU surgery, scar tissue closing up urethra

[furbros]

Thank you to everyone for all this wonderful information. I am so grateful for this site and for all these cat people. Ok, so update on Happy.... We did take him to his regular doctor and he did dilate his urethra and cut a little to make the hole bigger. They are going to keep him for a couple of days. They want him to heal with the catheter in. They said he did really good through the surgery. The poor guy has been through so much and he is only a year old.
They did do a full urine test on him and he did have crystals and sludge (I don't know the proper name for it). So for now and until he is peeing without struggle, he will be on prescription food. All of my kitties are on all wet food. They all use to be on both but I took the kibble away the first time Happy got plugged. It use to be if any of my kitties heard a can crack open they were right there begging. They also use to eat any kind of can food you served. Well not since they have all been on wet food for over a year. They now go crazy for crunchy food and are super picky about the kind of can food you serve. I use the kibble now as their treats. They don't know the difference. Occasionally I will give the other two a bowl of kibble. I make my own dog food and mix it with kibble for my dog. I want to make my own cat food but I have just read too many contradicting thing on what they need and should be eating. Also with Happy having all these problems.
Thank you again for everyones info. I read about poor Theodore. Finally I'm reading about a cat with a happy ending. It seem every other story I have read, ends in heartache. I refuse to make that my story.
I will update on how Happy's doing. They said that we can go see him tomorrow, but I almost think that is worse for everyone. Happy gets so sad when we leave and my kids end up crying which makes me cry. So I will probably just call tomorrow. I am not sure when he will come home.

 

[denice]

I am so glad he is getting treated.  I didn't go see my  Patches when he was hospitalized for a week because I thought it would be harder on him to see  me then not leave with me.  I always felt a little guilty about that but I believe that at least for my  kitty it was the right thing to do, 

 

[pushylady]

Poor Happy certainly has been through a lot in his short life. I hope this surgery works and he heals quickly.

 

[puck]

We will just agree to disagree nansiludie. I've dealt with this misconception before, and eventually, with time and patience, most people of your mindset and opinion will see beyond their nose, opening their mind, their third eye, to behoove themselves, their pets, and those they may share their stories and experience with their own sweet furbabies.

Your declaration of one doctor's point of view, and your one experience with, sadly and empathetically, the loss of a single beloved cat, is not justification for many individuals to completely disregard a very viable, proven, safe, effective, and reliable tool or method to manage, care for, or promote feline welfare and wellness. Much like Cinderella's stepsisters and the glass slipper. Anastasia pounds away at it, pops in her big ole foot, from heel to big toe. "There!" she proudly exclaims. Then, off springs the glass slipper with a rocket's launch. Sometimes, that treatment option just won't fit the patient, no matter how many times one pounds it or hides it or tries to Make it Fit. If wishes were fishes....

In science we must be observant, objective, unbiased, and nonjudgemental, to achieve successful and accurate conclusions. We, the scientists, do all this to the point of repetition and trial and error, we eat, sleep, and breathe data. To the benefit of patient care and treatment, so our human clients don't have to, but are welcome to compare and contrast the data if they want. I love prepping a discharge info sheet, so follow up once an owner is calmer and less anxious about their baby is possible, if they feel so inclined.

A single website is not research, is not comprehensive, is not taking into account multiple views and experiences of professionals and personal owners alike, is not based upon 1000s of clinical experiences and observations of analysis, deriving novel and unique effective solutions to particularly unique and problematic scenarios of cats and their caretakers, be they a single owner, a population manager, a group of vet students' "teaching model cats," a large rescue pop., a feral cat colony "keeper," or cattery breeder.

One doctor's view and opinions, or a single owner's experience with a single or a few cats, does not replace research based science or practically applied population management of catteries, adoption centers, and cat rescues of 100-400 cats each in one placed, managed under a single organization or group of people; does not replace the combined lifetimes of experience of a group of such managers, or a group of veterinary nurses and doctors, which can cumulatively be over 320 years at my current hospital, and over 12,500 total years cumulative experience across the course of my career pooling our resources amongst one another, benefiting from one another's unique experience, to help that veteran's pet, or family with an autistic adult, or suddenly blind owner cope with keeping their pets, or a temporarily financially destitute owner that has always been such an advocate and provider for their pets, now struggling, in need of a novel solution to their less than typical home life and environment for a pet. I would never tell them, you can only feed this, and never try anything else, never ask me about anything else. You can only brush, not comb your cat. You can only feel your way blindly around their litter box every day, since you can't see their waste, and touch every urine cake or stool sample, ensuring they're all normal. You must only use topical medications, or only oral medications, or only injectable medications. Think of all the limitations such decrees would have placed on the pets' health, the owners' health and confidence, the effective companion/human bond, the environmental control.

Some cats, no matter how much you switch it up, leave it down, add baby food, isolate them or encourage them, add flavor enhancers or toppers, give them privacy closed in a room, or competition with a bunch of cats around ready to steal it, they will NOT eat canned food, fresh food, whole meat, etc. Just. Ain't. Happening. I am not gonna make an owner force feed to adjust them, as this often leads to food aversion or lung aspiration if not done a certain way, at a certain time, with a certain finesse and patience. I am not gonna force my limited view onto an owner, and say too bad, you just gotta keep trying, so what if your cat is hungry, caterwauling, scratching, redirecting onto his cat and dog and kid buddies. Or that you just cannot tolerate the smell, handling, or ingredients of most moist diets, due to allergies, being vegan, or feeling nauseated as a side effect on drugs you yourself must maintain.

Some cats will only eat dry food. Their whole lives, be it 5 years or 20. Some will eat everything they find or your put down, not always the blessing it sounds like, for those cats that are just obsessed with all things rubber, or plastic, or electrical, God help them.

Some cats cannot be indoor only, must go out some, or all of the time, due to behavior, inability to ever cope with being forced into a limited indoor only environment. Some people cannot get scratched, bitten, or have their house destroyed, cords, baseboards, carpet, wood floors, cabinets, bedding, drapes, electronics, etc anymore, after trying behavior modification, meds, if they can medicate, and once outside, the cat is a dream, purring on the patio, sunbathing in a lawn chair.

Some cats won't use clay litter, no matter how much you try to convince an adult with preconceived notions about the whole world is his litter box of leafy detritus and real soil, they'd rather hold it 3 days, or urinate on the dog, than use that silicone clay litter. We don't make them stick to one litter stubbornly, knowing they aren't using it, and start to give the cat more options, more boxes, some with privacy, some near their owners, finding what works for that individual. It doesn't matter that Most Cats will use clay, or it's the easiest available litter, we gotta formulate a better plan. Sometimes with the least costly, yet effective, option worked out for the owner or rescue that has taken on a bunch of apartment dumpster cats peeing everywhere inside but their 10 boxes.

Some cats just do not eat from a bowl or plate; be it their whiskers are too sensitive near the confined restrictions when they lower their head to eat, or it's just too clean or against their predisposed behavior before domestic life with their new owner to eat off anything but the ground.

Some cats refuse their cat food every time, but as soon as dog food is down, bam, best thing ever. Visa versa for some dogs. We go through some unique approaches sometimes, to convince each that the other's food is not "greener on the other side of the fence." Some have problems with species other than the cat getting in the litter box, such as the baby or the dog. Some owners are devoted enough to follow a recommendation of drilling a small hole into a laundry room door that only the cat can access, or modifying a room attached to their garage with an elevated access door between the room and garage to enter a constructed bathroom or feeding area separate from the rest of inhabitants that the cat can reach anytime it wants.

Some people are placed on blood thinner medications, something they have to adjust to for their own well being and survival. Some cats don't know they now have to jump gently and softly, some just grow their nails right back, as they sharpened them for 24 hours on that sisal or rug, since their human somehow erroneously confused their claws with their human nails, because obviously mom never meant to cut my naturally shedding and sharp nails to nubs for any real reason. Then many accidental lacerations of gushing proportions happen all over their owners lap, to many times in a row, despite nail caps, or a throw rug over the lap, or trying to train the cat to only leave the lap if picked up and placed on the floor or nearby sofa arm. Giving up their companion they've had up to this point isn't an option, just so they can stay on their new medication without life threatening nails digging into their flesh. Life without their cat is not a good quality life. That cat's life up to now has been its devoted owner, their bond, their love...we aren't gonna recommend rehoming or dropping at the shelter or forcing the cat outdoors first. Our goal is to have that cat stay with its family. This is one of the few exceptions for a declaw, as flaming a response as it gets from people that have only one view, one answer for that. These devoted owners, and devoted cats, have never led to a regrettable declaw, or a defensive cat postop...somehow these particular ones always become the ideal, easy recovery, happy purrbox in the litter, and lover on the lap.

If I had restricted any of these cats and their people to a single plane of thinking, a single plane of ethics and morals, lacking understanding and compassion that could adapt and morph to a new situation, and strive to find a balance for that particular set of pet and owner, if we don't do this, we fail as patient advocates, as owner advocates, and people that bring a domesticated animal into our lives, only to fail it. We will not ever do this without giving it our all, combining our efforts with those of the family, and maybe their trainer, their human doctor, their in home aide, their adult kids, or friends.

I will never say never, to resolutely be blind to ever-evolving information, human factors affecting a novel idea or a novel problem to help a care team resolve said problem in the best interest of both a family and their cat. We veterinary professionals, passionate about our work, never stop learning and gleaning information from many networks of new and veteran veterinarians, nutritionists, and practically applying technicians and nurses, let alone what some analytical owners have taught me, thinking outside the veterinary science box, researching international science journals and formulating possible treatment options for their cat that may not yet be common knowledge in their or my current country. Diets especially, will lead to lots of questions and rarely assumptions about varietals they'd like to try to feed, if considered safe enough, to give their feline food pantry options, armed to address a picky, reduced appetite kitty if needed, while its reduced appetite is worked up by us, it is supported by some dietary options if not too rich, too fatty, too fishy, or too

No matter that I have over 6 years of nutritional science, nutrition of domesticated animals, comparative animal nutrition, practical animal care management techniques, human nutrition, and ethics of feed animals and nutrition, pieces of the puzzle that join with other studies and research of anatomy, physiology, behavior, repro, growth/development, parasitology, pathobiology, ecology, and medical ethics; or 15 years of nursing and laboratory applied science experience. My daily interactions discussing unique individuals' home environment, lifestyle, philosophy, management thus far and effects upon their pet(s), health and behavior history, and what their goals are, short term and long term, provide more data and opportunity for growing my arsenal of tools and treatments to help others help their pets, to advocate patient care and well being, to find the balance of what a single person or family can do and what a cat needs, more tools and knowledge than all the lectures and books and seminars.

No single method is fool proof, the Bible for all cats, the single all encompassing answer. We'd still be feeding scraps of human food or a can of tuna a day, without any heartworm prevention or awareness, without parasiticides, without vaccines and with much shorter lifespan kitties and infectious disease spread to humans, without advances in diagnosing and treating all the common kitty ailments, hyperthyroidism, renal disease, male cat urethral obstruction, female cat idiopathic/intersititial cystitis, diarrhea, IBD, cancer, GI foreign body, etc if we did not try new things, different things, change our stubborn unilateral approach, be willing to be flexible, learn, grow, and behoove the domesticated animals we've made that commitment to just by our ancestors domesticating them all those years ago, let alone the pet/owner companion bond we advocate and promote now.

It would be foolish and unethical of me to broadly recommend one "rule of thumb" or absolute "diet solution" to the 1000s, and I do mean Thousands, of people and pets I've served over time, and the many more I will continue to serve. And I do not condone promoting a single resource or reference, especially a website, a fluctuating, biased view of a few or one, that is not reviewed by many experienced, skilled, and keen minds, before being presented as "fact." Thus, I don't quote websites in any of my posts, even university, research, veterinary, or "evidence based" sites. My answers are a combination of my own experience, gleaning information from cohorts, paraprofessionals, and data over the years aka networking, interpreting, and presenting it in an understandable, applicable way, for pet owners to use in their every day life.

Dry food, nor prescription diet, is the crux of all evil, or all health problems in cats. Genetics and Stress vie for the lead role as causes that trigger/induce health problems in cats.  A good dry food is better than a poorly manufactured and formula-ed canned/wet/raw food in many many scenarios, as evidenced by thriving patients, suffering from no urinary, dermatological, gastrointestinal, endocrine, nervous, renal, hepatic or cardiovascular disease or problems. There are, in fact, cats that unnecessarily go without eating, dangerously so, for many days, with a buffet of delicious, meaty, stinky, varied texture, varied temperatures, varied flavor canned, moist, cooked, or raw options. All dry food are not coated in animal digest, and animal digest is not heinous to include in a manufacturer's ingredient recipe. Liver, ground intestinal or stomach lining, kidney, gizzard, and heart are often included in digest or by-product, and are very healthy sources of dense protein, macronutrients, and micronutrients, as well as really really tasty to add to the dry food formula. I'd rather a patient ate Purina ONE dry than Cat Cafe in a can; man I remember that stuff from the 70s and 80s, youch.

Before the 1950s, we fed our cats bits of our food, just as we did our dogs, and if they could go outdoors, maybe they occassionally supplemented this human food with a mouse or a lizard. Still, taurine deficiency abounded, and neuromuscular and cardiovascular malformation, degeneration, and disease took root, drastically limiting the lives of our feline companions. Parasitism and infectious disease was much more rampant. As their are disadvantages to feeding a cat the same ole "balanced" meal day after day, as some cats don't need that much calcium or magnesium or phosphorus or acidity, there were far more disadvantages to not doing so; the pet food industry opened up a whole new world of possibilities back then, prolonging our cats' lives to the point we had to take veterinary medicine and techniques of animal care to a new level, discovering how to provide medical care and home management for some very old, very sweet souls. We just have to keep it ahead of the past a lil better than some feed companies are willing to invest; if you don't buy their product, they will glom on eventually, or die out.  You can only control what you do and how you handle your own cat, your own choices, to a point.  To try to control every one, everything, every one else's choice can be stressful, insanity, and incite one to be isolated, extreme, and lonely.

Just some food for thought ;] Genuinely, patiently, and honestly presented.

 

[nansiludie]

Yes, @puck  I think you've made some good points and its a good thing to disagree sometimes, as the world would not be as varied a place without it. It never was my intention to force any set ideas on anyone. I just wanted for furbros to be aware of the points I made above. I've also not yet found a dry food without animal digest in it. I'm not an advocate for declawing unless its medically needed for the cat.  Have a good day and thank you for your insight.

 

[stephenq]

@nansiludie

I just went to my cabinet and pulled out my cat's dry food (she gets wet and dry) and its Halo Spot's Stew and there isa no animal digest in it.

@puck, thanks for the well written piece.  I think in many ways what she is suggesting is what I've seen as well, which is that while many people seem to want a one size fits all solution, a magic bullet, the truth is more complex and that what works for one patient simply won't work for another.  Included in the group of one size fits all, is a subset of the cat welfare community who believe that if you only feed the best possible food  (ie the food i tell you to feed your cat), that lovely healthy things will follow.  And they may.  And they may not. I certainly believe in good nutrition, but at some point in age, some sooner, and some later, they all get some combination of kidney disease, cancer, IBD, HCM, insert disease here, because we are all programed to die.  Sorry to sound so down, i'm not intending that at all.  But nothing will change that either.

 

[nansiludie]

Hello, @furbros   any updates on Happy? I'm sorry there's so many posts under your post about Happy, I should have opened another thread. I think we got a little side-tracked.

 

[puck]

@furbros

Ultimately, your Happy may benefit from staying on the diet your vet mentioned, a diet with a mineral formula that caters to cats prone to these mineral deposits in their urinary tracts, prone to the sludge these mineral deposits create, sludge being a combination of mineral deposits and/or white blood cells and bladder wall epithelial cells and cellular structured called casts from the kidneys, whose morphology and contents help us determine if the kidneys are affected by the current bladder infection and/or inflammation.

For your boy, hopefully going back in, placing another urethral catheter to dilate and open the recently cut urethra, will help him. Tying back more of the surrounding connective tissue, stretching away from the urethra and "tacking" that excess skin/fascia to the buttocks, can help keep the urethra more open.

Prazosin is also important to keep urethral spasming and trauma to a minimum. This drug comes in capsules we often open and split the dose twice a day, from a 1mg or 2mg capsule, depending on the severity of spasming in the male cat we're treating. He may need the higher dose.

If not on corticosteroids, follow up with your vet about starting prednisolone, especially maintaining twice daily regimen until inflammation subsides, then tapering down to discontinue. Prednisolone is exceptionally better than prednisone or dexamethasone or Depo-medrol, for cats, as cats are less efficient at converting the latter 3 steroids into prednisolone, the absorbable form of corticosteroid in mammals. Dogs have no trouble converting pred/steroids to prednisolone, so they don't need the "purer" form the way cats do. Prednisolone is more expensive than prednisone, as a result.

I hope Happy is more comfortable, passing urine, even if not a steady stream as of yet! Stay with it, continue your close observations that have behooved him already, and you will persevere!

PS  The name Happy has great heritage in my family. Our happy had indomitable spirit, loved so many, and so many loved him. As goofy as his manner and name were, he was a pure spirit, who inspired many people to live life in the moment, in the quiet expectation of good, as a therapeutic companion and visitor to convalescing veterans and children. Your Happy has good energy, good juju, so to speak, with a name like that ;]

 

[furbros]

Ok, so sorry I have not updated. This week has been one crazy busy one. Everytime I sit down to reply, something comes up and I have to stop what I'm doing. So, first let me start by saying Happy is home and so far (fingers crossed) peeing like a champ. He only stayed one night at the vet and I got to pick him up the next evening. The doctor dilated him and cut and stitched all around the hole. I will show a picture. The doctor said his hole was so small it was hard to find. He is confident this will fix him. Happy will go back in two weeks to get checked and make sure he is not healing back together. I don't see how he can because of all the stitches. I am making him wear his cone because he is a licker and I don't want anything jeopardizing his recovery. He is on Clavamox 2X a day. No steriods. I don't know if this matters, but he was just on Prednisone the last time he got dilated. I thought he would come home and be tired and sore like the last time but he came home and immediatly kissed his brothers and ate a whole bowl of food and then was ready to play. Since he wore his cone for so long the last time, he is use to it. He actually uses the sides like they are his whiskers. The last time he wore the cone he could contort himself a certain way and was able to get to his wound. So we ended up doubling the cone with the hard one and the soft one together.
He is on his prescription food and doesn't mind it. I have to feed the other two in the other room because Happy would prefer their food. It made me smile all the things that @Puck was saying because all three of my cats are so different. I once changed their litter to the crystals and my poor Mr. Whisker's refused to step on it and held himself for 24 hours until I changed it back. Pro Plan is the only food that all 3 of my kitties can actually agree upon. One type of food one will like and the other won't touch and you think, "oh, when he gets hungry enough, he will eat" and you wake up at 2 in the morning to howling and one knocking everything off your nightstand. So you say forget it and feed them what they like. I also have one cat, Karmen Boo, that won't eat in front of anyone. I call him the closet eater, or I should say bathroom eater because that's where he eats while the other 2 eat in the kitchen. And you know he's eating something because he's chubby. Also, you mentioned the obsession with rubber and plastic. Happy is obsessed with plastic. He has Pica. He doesn't eat it but he loves to lick it and rub his face on it. It's only a certain types of plastic, like the plastic that your toilet paper is wrapped in. I store extra napkins at the bottom of the pantry and everytime anyone opens that door he jumps in and will sit in there and lick as long as you will let him. I try not to let him. At first I thought this might have something to do with why he was blocked, but the doctor said it wasn't.
I know exactly what you are talking about @nansilude . Everything you read about food, including dog food, is all about - what's the first ingredient? Is it a meat? Is it real food? Does it have corn or grains? I read about the mercury in fish. I also read about raw diets. It's just so much and so contradicting. My kitty Milo lived to be almost 19 and I fed him Purina One pretty much his whole life. I use to give him can food for a special treat until his kidneys started failing and then it was can only and all he would eat was Fancy Feast. So, I really don't know anymore what to feed them. They were all on Wellness until Happy got plugged. They won't eat the Wellness can food. We try to be mostly organic here, at least for my kids. I am glad you didn't start another tread because I like to know what other peoples opinions are. I will take any advise on food.
I thank everyone from the bottom of my heart for all your advise. I have always said that true "cat people" have a special bond. We never run out of things to talk about and never get tired of listening. Oh, and my Happy got his name from my son. My husband and I surprised my daughter with Mr. Whiskers on her 9th birthday, so it only made since to surprise my son with one on his. Happy walked around kneading and purring and sucking on anything he could for the first week. He couldn't stop. He was so happy to have a home and a family that my son named him Happy. It fits. He still sucks on a blanket. He has definantly brought a lot of happiness to our family. It's a great name.
Sorry I was so long winded. I will show a picture of his stitches in the morning.

 

[furbros]

So this is his hole. Gross, sorry. He stitched all around.

image.jpg

• furbros
• May 9, 2015

 

[nansiludie]

Glad to hear such a good update! It doesn't look all that bad. Yes, feeding time can be nightmare especially when there is a rather, greedy cat, trying to eat everything 

 About the plastic, I'm really careful with mine because 3 out of 6 will want to crawl in plastic bags, eat candy wrappers, just about anything. I think they like the way the cool plastic is in their mouths.

 

[Siggi0621]

furbros

I know it has been a few years since you started this thread and I hope your still around to respond but I was curious as to how your Happy is doing since his ordeal. My Siggi is having the SAME issue, part of his urethra has "healed" closed twice now since his PU the first week of August. Im afraid of needing to get a revision surgery to really open him up.

 

[Laney_Jane]

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.

Thanks this is so useful. My cat gizmo had a PU last Friday and for four days has been OK but is now more irritable and trying to lick. He has also been peeing in unusual places for two days, although was in the litter to begin with. He just peed in my suitcase! He is on metacam but i will ask ahain for something to take the pain away too.