PU surgery for the second time?

CASH THE CAT

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Hello. I am a heart broken mess. My cat, Cash is a 14 year old rescue. He had PU surgery back in 2008. Before surgery I had at least 3 ER visits to unblock him. Vet told me about PU and did it. Cash recovery was a little ruff, but it was successful. About a year later we would sometimes have another vet visit to unblock him. I would say almost once every 1 to 2 years. Fast forward to a week ago. I noticed he was dribbling on the floor and his bladder was not emptying. A sign it was time for an unblocking. To the ER we went, this time the Vet told me that she couldn't cath him. She told me his urethra appeared to be closing due to scarring.

Went to my primary vet 2 days later. Explained the situation. Ran blood and urine tests. All came back normal and other then the bladder issue he was healthy. She referred me to a surgeon for a PU reconstruction surgery. Now I love this cat more then words can say. I was in debt for years just in vet bills. 10k later and your telling me I have to do this again!? I want whats best for him. Putting my own selfish want to keep him alive forever, I do want him to be comfortable and happy. That being said what do I do? I fear I do the surgery and the outcome is worse.

I would love to hear from anyone who has done the surgery twice. What was the outcome and how is your cats way of life?

Facts to consider:
- 14 years old. Active, otherwise healthy cat.
- Eats Royal Canin SO can cat food only.
- Funds are limited. Max I could spend is $3500.
- Indoor only cat.

Please give me any advice... I will greatly appreciate your time! ❤❤❤
 

fionasmom

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Welcome to The Cat Site, although I am sorry that you are facing this decision.

Search Results for Query: PU surgery

The above are the threads posted here regarding PU surgery. This probably does not help much, as you are more than likely an expert yourself on the surgery. Ironically, even the VCA article on PU surgery says that it will probably never happen again; most that could happen is a stone which would be easy to remove. They are sure that your boy does have scar tissue?

So, for advice.....what are his chances of surviving the surgery and what are the chances that a second PU surgery brings its own complications? What condition is he in right now? Urethra was not entirely closed, so he is partially peeing? Will the vet work with you financially if you want to proceed with this? Long term prognosis? What has the surgeon seen after second PU surgeries? What about more scar tissue, more quickly? You said your boy is healthy, so if you did this again there is not an expectation of another immediate condition arising? Cash had a rough recovery the first time; is that to be expected this time? Your concerns about money are completely justified and logical, no matter how much you love Cash. The cost of vet care is a pretty common point brought up in many threads here.

Hopefully those who have done PU surgery will respond.
 

silent meowlook

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This is one of the reasons I hate this surgery. The following I copied from Veterinary Journals. The information is older but may be helpful. Couple of questions: Do you remember what he was blocking with originally? Was is crystals? Do you know what kind.? What does he eat? Is he over weight?

J Am Anim Hosp Assoc
. May-Jun 2006;42(3):218-22. doi: 10.5326/0420218.
Surgical revision of the urethral stoma following perineal urethrostomy in 11 cats: (1998-2004)
Heidi Phillips 1, David E Holt
Affiliations expand
PMID: 16611934 DOI: 10.5326/0420218
Abstract
Eleven cats required urethral stoma revision because of urethral stricture following perineal urethrostomy. At surgery, eight cats had evidence of inadequate dissection to the bulbourethral glands, and three cats had evidence of urine extravasation into the subcutaneous tissues. Following revision of the stoma, long-term follow-up was obtained in nine cases. For eight cats, owners reported no complications after the revision. Failure to dissect beyond the bulbourethral glands and inadequate mucosa-to-skin apposition resulted in postoperative stricture formation. Stoma revisions were performed a median of 71 days following the initial perineal urethrostomy, indicating that long-term evaluation of cases is necessary.
 
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CASH THE CAT

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Welcome to The Cat Site, although I am sorry that you are facing this decision.

Search Results for Query: PU surgery

The above are the threads posted here regarding PU surgery. This probably does not help much, as you are more than likely an expert yourself on the surgery. Ironically, even the VCA article on PU surgery says that it will probably never happen again; most that could happen is a stone which would be easy to remove. They are sure that your boy does have scar tissue?

So, for advice.....what are his chances of surviving the surgery and what are the chances that a second PU surgery brings its own complications? What condition is he in right now? Urethra was not entirely closed, so he is partially peeing? Will the vet work with you financially if you want to proceed with this? Long term prognosis? What has the surgeon seen after second PU surgeries? What about more scar tissue, more quickly? You said your boy is healthy, so if you did this again there is not an expectation of another immediate condition arising? Cash had a rough recovery the first time; is that to be expected this time? Your concerns about money are completely justified and logical, no matter how much you love Cash. The cost of vet care is a pretty common point brought up in many threads here.

Hopefully those who have done PU surgery will respond.

Thank you for responding. Unfortunately every vet I talk to has a different opinion. I actually brought him in the ER again yesterday at 1pm. Told the vet my story and asked if he could cath him. I explained I was just at the ER last week and they were unable to cath him. So I was pleasantly surprised when he cam back and said he WAS able to cath him.

He told me it was a mucus membrane that had formed. Which years ago the first vet I had told me about that. I had forgotten about it and figured the ER knew what they were talking about. Now I am leaving to speak to a surgeon about my options. This second ER told me that they could possibly peel back some of the opening, so the membrane would not form. Sounds like it could possibly work if that is in fact an option this hospital can do for me.

They have already quoted a range of 3k to 6k for surgery. Oh course its a ruff estimate since I haven't gone up to them yet.

I have doubts... I am so stressed. I just want him to be happy. Thank you again for the information. ❤
 
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CASH THE CAT

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This is one of the reasons I hate this surgery. The following I copied from Veterinary Journals. The information is older but may be helpful. Couple of questions: Do you remember what he was blocking with originally? Was is crystals? Do you know what kind.? What does he eat? Is he over weight?

J Am Anim Hosp Assoc
. May-Jun 2006;42(3):218-22. doi: 10.5326/0420218.
Surgical revision of the urethral stoma following perineal urethrostomy in 11 cats: (1998-2004)
Heidi Phillips 1, David E Holt
Affiliations expand
PMID: 16611934 DOI: 10.5326/0420218
Abstract
Eleven cats required urethral stoma revision because of urethral stricture following perineal urethrostomy. At surgery, eight cats had evidence of inadequate dissection to the bulbourethral glands, and three cats had evidence of urine extravasation into the subcutaneous tissues. Following revision of the stoma, long-term follow-up was obtained in nine cases. For eight cats, owners reported no complications after the revision. Failure to dissect beyond the bulbourethral glands and inadequate mucosa-to-skin apposition resulted in postoperative stricture formation. Stoma revisions were performed a median of 71 days following the initial perineal urethrostomy, indicating that long-term evaluation of cases is necessary.

Thanks for responding. I just added a comment on another person's response. Yes it scares me to death. I really dont want to do another surgery. Hes 14 now not 2 like he was from the first.

I am hoping that I will see someone who knows what they are talking about and get at least some sort of relief for him.

Thanks again ❤
 
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CASH THE CAT

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Thanks for responding. I just added a comment on another person's response. Yes it scares me to death. I really dont want to do another surgery. Hes 14 now not 2 like he was from the first.

I am hoping that I will see someone who knows what they are talking about and get at least some sort of relief for him.

Thanks again ❤
Oh yes he did/has crystals. I'm not 100% sure which. I pretty sure its the one where he has a constant formation of them.
 
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CASH THE CAT

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Oh yes he did/has crystals. I'm not 100% sure which. I pretty sure its the one where he has a constant formation of them.
Not over weight. Actually under. He eats well.... not in the past 2 days, but normally quite well.
 

fionasmom

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So it sounds as if there is some hope that possibly this is a membrane as opposed to a huge adhesion and that might be something that can be fixed? Does this make the procedure any less stressful or risky? If the hospital you go to does not seem to think that this can be done, does the ER dr have a reference he can give you. This sounds like an area where you could end up with a lot of "opinions". Please let us know how this goes for you and Cash.
 

silent meowlook

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I would definitely go to a specialist if you aren’t already. Be sure to ask them if they have done a revision before and what the outcome was.

I don’t know your financial situation, but where I am there is an organization called FACE foundation that will cover some if not all costs of a surgery if the family qualifies. You might want to look and ask around in your area if something like that exists.

I am sorry your cat and you aregoing through this.
 
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CASH THE CAT

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So it sounds as if there is some hope that possibly this is a membrane as opposed to a huge adhesion and that might be something that can be fixed? Does this make the procedure any less stressful or risky? If the hospital you go to does not seem to think that this can be done, does the ER dr have a reference he can give you. This sounds like an area where you could end up with a lot of "opinions". Please let us know how this goes for you and Cash.
Just returned from surgeon. I seen someone who was not performing the surgery. She is a surgeon, but since this was an emergency visit I just had to deal with her for my questions. She was able to speak to the surgeon that was going to do the surgery. Anyway, they did not want to do the surgery the ER vet suggested. She said it would not help if he has scars internally.

She offered one solution and that was close the old PU site and establish a new PU site. This site would be higher closer to the anus and they would have to shave his pubic bone. All of which sounds dangerous and not promising. She did confirm that the surgeon has preformed this type of PU surgery once.

The only other option was to put him down. I am not a vet. However, I feel like I know my cat. I dont think he is that far gone that I would risk a major surgery like this at his age.

The surgery would cost 3 to 7 thousand. I also have no way to cover that expense at this time. Especially since I have just spent $1600 just in September.

I have decided to make him comfortable as possible and take it day by day. I dont know if that is the wise thing, but I can't put him through something and not have any guarantee that he will live a pain free life.

I hope at least he makes it to October. I may consult another surgeon just to see what they tell me.

Cash and I thank you so much for caring and advice. ❤
 
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CASH THE CAT

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I would definitely go to a specialist if you aren’t already. Be sure to ask them if they have done a revision before and what the outcome was.

I don’t know your financial situation, but where I am there is an organization called FACE foundation that will cover some if not all costs of a surgery if the family qualifies. You might want to look and ask around in your area if something like that exists.

I am sorry your cat and you aregoing through this.
Oh that would be wonderful if I can find them in my area. I just left a consult with a surgeon and was not confident with how his out come would be. ( just replied another comment all details)

For now we are taking it day by day. Hes has been drinking water and resting. He took 2 bites of food, but nothing substantial. Hopefully tomorrow he will feel a little better.

Thank you again! Cash and I greatly appreciate it. ❤
 

fionasmom

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Please let us know how you are doing. I can certainly understand your reasoning in this. The second surgery, about which I have no experience, is one where I would want some more details. Letting someone do it, for the money, who has only done it once might be a red flag.
 

silent meowlook

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HI.

Is he urinating at all? If there was internal scarring? They don't know how high up it goes? Um... there should be a way of checking for that before they go to surgery. I would think anyway. I mean I would think they could do a radiopaque dye to see where the obstruction is. He isn't fully obstructed, is he? Is he on any medication right now? I know at my work we use Prazosin in cats recovering from urinary obstruction to relax the smooth muscle of the urethra. I know your cat is a different situation but maybe it would help. Is his bladder able to be expressed?
 

Heart For Cats

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Oh yes he did/has crystals. I'm not 100% sure which. I pretty sure its the one where he has a constant formation of them.
The type of crystals Cash had earlier should be in his medical records. I know diet affects whether they are alkaline or struvite.
 
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