Stones In The Urethra?

[greytabby]

Anybody ever have a male cat with stones already in the urethra that *didn't* block subsequently? I have a 9-year-old tabby who had CaOx bladder stones 3 years ago that were surgically removed. So far so good until he started acting up again this month. Took him to the vet, got an x-ray; bladder totally clear but two sizable stones in his urethra. He's able to pass urine, albeit with blood from time to time, so my vet seemed a little stumped. Treated him for a UTI and told me to keep an eye on him in the meantime, but no alarm bells.

We've got an appointment with an internal medicine specialist in a couple days at a hospital where they could perform surgery on him if necessary, but I'm super worried he won't last until then with those stones where they are...

Anybody have a male cat who had stones that far down that didn't wind up needing surgical removal?

 

[silkenpaw]

I can’t believe those won’t have to be removed. You might be able to go after them with some sort of basket contraption through the urethra, without cutting him, but the surgeon will have to decide that. Those must be bothering him. Did the vet give you any medication other than the antibiotic? An antispasmodic and an analgesic would be nice. Maybe also subq fluids to try to flush the stones out.

Do let us know what happens, please.

 

[Stinky15]

Anybody ever have a male cat with stones already in the urethra that *didn't* block subsequently? I have a 9-year-old tabby who had CaOx bladder stones 3 years ago that were surgically removed. So far so good until he started acting up again this month. Took him to the vet, got an x-ray; bladder totally clear but two sizable stones in his urethra. He's able to pass urine, albeit with blood from time to time, so my vet seemed a little stumped. Treated him for a UTI and told me to keep an eye on him in the meantime, but no alarm bells.

We've got an appointment with an internal medicine specialist in a couple days at a hospital where they could perform surgery on him if necessary, but I'm super worried he won't last until then with those stones where they are...

Anybody have a male cat who had stones that far down that didn't wind up needing surgical removal?

Please read this:
Cat Urinary Tract Diseases: Cystitis, Urethral Obstruction, Urinary Tract Infection

 

[greytabby]

I can’t believe those won’t have to be removed. You might be able to go after them with some sort of basket contraption through the urethra, without cutting him, but the surgeon will have to decide that. Those must be bothering him. Did the vet give you any medication other than the antibiotic? An antispasmodic and an analgesic would be nice. Maybe also subq fluids to try to flush the stones out.

Do let us know what happens, please.

He seems pretty okay and the blood in urine has cleared up for the most part. He's acting normally and does not seem to be experiencing any pain. The vet is concerned that the spots on the x-ray may not actually be stones, and so he wants us to check again after the infection has cleared up. Through cystocentesis he got a sterile sample and confirmed that he has a raging UTI.

We have an appointment with a specialist at a big animal hospital/surgery center tomorrow. But I worry about putting kitty through that if it would make more sense to wait a week or so until he can respond to the antibiotics. We could defer it a week and then see if those spots have changed on his x-ray, but then we're risking him getting a blockage in the meantime. It's a tough decision...

 

[greytabby]

Please read this:
Cat Urinary Tract Diseases: Cystitis, Urethral Obstruction, Urinary Tract Infection

Yes! I remember coming across that article when we were going through this a few years ago. I've been following most of those best practices. Also knew to look out for a vet claiming to diagnose a UTI with a non-sterile sample. My current vet insisted on cystocentesis so I know we're in good hands in diagnosing him with infections.

 

[silkenpaw]

Your vet is wise in not simply assuming those opacities are urethral stones. Maybe other views or an ultrasound would help answer that question.

Yes, it is a tough decision about surgery. All things being equal, you’d want to wait for the infection to be gone before you do any surgery, but yes, you pretty much have a sword hanging over your neck here.

Best of luck, and please post here about what happens.

 

[greytabby]

Your vet is wise in not simply assuming those opacities are urethral stones. Maybe other views or an ultrasound would help answer that question.

Yes, it is a tough decision about surgery. All things being equal, you’d want to wait for the infection to be gone before you do any surgery, but yes, you pretty much have a sword hanging over your neck here.

Best of luck, and please post here about what happens.

Makes sense. When he was at the vet, his bladder was always empty because he would pee whenever he got frightened— so he has no issues completely clearing his bladder. In fact, it was a problem because it made cystocentisis very difficult on an empty bladder! I suppose that's what's giving my vet pause in concluding anything about the opacities, given he has zero trouble eliminating fully.

 

[Daisy6]

Makes sense. When he was at the vet, his bladder was always empty because he would pee whenever he got frightened— so he has no issues completely clearing his bladder. In fact, it was a problem because it made cystocentisis very difficult on an empty bladder! I suppose that's what's giving my vet pause in concluding anything about the opacities, given he has zero trouble eliminating fully.

Does he pee in the carrier? The last time I took Daisy to the vet, she pooped in it by the time I unzipped the top door.

There are issues with clearing his bladder if he is straining in the litterbox.

 

[greytabby]

Does he pee in the carrier? The last time I took Daisy to the vet, she pooped in it by the time I unzipped the top door.

There are issues with clearing his bladder if he is straining in the litterbox.

Ha, yes, he peed in his carrier too. Big barky/growly dog came in the waiting room and that did it.

He's not currently straining, thankfully. Just took a sample and it was a steady stream. Hoping that continues.

 

[Daisy6]

That is good news. Too bad a noisy dog came in at that time.

 

[greytabby]

Update: No change in his condition. I take a sample every day, and his urine continues to be 'normal' as far as I can tell (no frank blood, no difficulty eliminating, no straining). If he's still got stones in his urethra, he certainly seems to be unaffected by them right now. I still find that really perplexing, given how narrow that part of his anatomy is.

He has an appointment with an internal medicine specialist in a week where I'm sure he'll get new x-rays and an ultrasound. I'm out of town until then -- which could make things worse even though he's still with my wife and her family who give him lots of love and attention. Hoping the UTI getting cleared up will keep him healthy and asymptomatic until his appointment.

 

[silkenpaw]

That’s good news, though puzzling. I’m glad you have responsible people taking care of him. Good luck with his next appointment. I’m curious to find out what happens. Thank you for keeping us updated.

 

[greytabby]

That’s good news, though puzzling. I’m glad you have responsible people taking care of him. Good luck with his next appointment. I’m curious to find out what happens. Thank you for keeping us updated.

Thank you for following this! This site is an amazing support group.

It is indeed SO puzzling.

 

[greytabby]

Update: Our local vet has run the x-ray by a surgeon he often refers clients to for surgery. Although the initial recommendation was to 'wait and see,' given that kitty is able to urinate freely right now, it was concluded that it makes more sense to proactively take care of what they're now convinced are stones in his urethra. Due to a previously existing ureter stone leading to his left kidney, that kidney is no longer functional and he's been living off one good kidney for most of his life. Any blockage for any period of time could imperil that good kidney, so we simply aren't going to take that chance.

He's scheduled for a surgery consultation on Thursday. Hopefully they can admit him for surgery right then. The plan would be to catheterize him and push those stones inside the bladder where they can then be removed with a cystotomy (he's had that surgery twice before; unfortunately the vet who did the initial surgery didn't x-ray him afterward and missed 2 stones that ultimately blocked him 3 weeks later and had to be removed via a 2nd cystotomy). If that doesn't work (i.e. if the stones don't move from the urethra into the bladder), then we'd do the PU surgery and hopefully end his nightmare with urolith blockages once and for all.

Meanwhile he's bilssfully unaware of the awful weekend we have to put him through, and doesn't seem to be in any discomfort.

 

[Daisy6]

My purrsonal opinion: Because two cystotomies have been done already, if it isn't out of your price range now, going ahead with the PU surgery makes more sense. If a third cystotomy fails, it will just be money out of your bank account and make it even harder to pay for a PU surgery later.

 

[greytabby]

My purrsonal opinion: Because two cystotomies have been done already, if it isn't out of your price range now, going ahead with the PU surgery makes more sense. If a third cystotomy fails, it will just be money out of your bank account and make it even harder to pay for a PU surgery later.

That's definitely something we're considering. We'll discuss with the surgeon and see what she thinks.

 

[greytabby]

So this has gotten more complicated!

We dropped him off today for surgery to get those stones removed from his urethra (either pushed into the bladder and then removed via cystotomy or perineal urethrostomy if they won't move) and upon performing an ultrasound on his kidneys, the surgeon & internal medicine specialist were able to see that the kidney with the ureter stone is distended, showing hydronephrosis. That ureter stone is now blocking his right kidney, though his BUN and creatinine levels remain mostly normal at the moment.

So she asked us if we'd like to have them perform a subcutaneous ureteral bypass, at great expense unfortunately. They'd do the cystotomy to remove his urethral stones at the same time, but ultimately treat the entire urinary tract to save that right kidney and restore normal function vs. just removing the urethral stones and leaving that kidney to its demise. Clearly it's cheaper to do it all at once vs. piecemeal, and I'd never want to put my kitty through two separate surgeries when it can just be one big surgery that, to him, is a drugged-out week of weirdness but otherwise could give him a normal life (he's only 9 years old). Thus I don't see another option, really. SUB surgeries have a pretty high success rate, even if the recovery (feeding tube, etc.) is somewhat scary. And he's a very healthy kitty, so that helps his prognosis greatly.

 

[silkenpaw]

So his right kidney is the "good" kidney, right? In that case I don't see that you have a choice, you have to do everything you can to save it if he's going to have a decent prognosis.

Feeding tube is a piece of cake. Check out this site for useful collars to keep the tube from flapping around and general tube info.

Good luck with the surgery, and keep on posting about his progress

 

[greytabby]

So his right kidney is the "good" kidney, right? In that case I don't see that you have a choice, you have to do everything you can to save it if he's going to have a decent prognosis.

Feeding tube is a piece of cake. Check out this site for useful collars to keep the tube from flapping around and general tube info.

Good luck with the surgery, and keep on posting about his progress

Thanks for that link! Really helpful. The tube sounds daunting but seems like just another thing we'll get used to for a bit and then it'll be over.

To clarify: his right kidney is the one that's always had a ureter stone partially obstructing it. In ultrasounds from 2015/16, that right kidney had been slightly smaller than his left (unobstructed) kidney. Now, the right kidney is large and showing hydronephrosis. Our assumption is the left "good" kidney is as normal and healthy as it always was, as it remains unobstructed by any stones at this time.

Digging through my old emails from UC Davis (where we used to take our kitty when we lived in California) gave me some reassurance. One of their primary researchers there on ureter obstructions in cats had initially referred me to their internal medicine specialists to help us monitor this ureter stone. In that email, he mentioned that the standard of care is to monitor with imaging and blood work until such point that the stone was obstructing and pushing out the kidney tissues. At that point surgery is highly recommended. We're at that point.

So we picked up our little 3-'stoned' kitty (figurtively and literally- they gave him some buprenorphine for the day) and he's happy at home until his surgery Tuesday. His raging infection has totally cleared up as of the urinalysis they performed yesterday (they're doing a culture, but initial results showed no WBCs or visible infection). This gave us a lot of clarity as to what was going on when I initially posted this thread. For those interested, a summary:

1. Kitty was peeing outside the litterbox, progressing to peeing frank blood in urine. Turns out he had a pretty bad UTI.
2. Aside from the UTI (but perhaps the prioximate cause of the UTI), kitty has two stones in his urethra that are stable. They're allowing him to pee just fine at the moment. They haven't moved in the 10 days between initial x-ray and yesterday's x-ray. This solves the 'mystery' of why he was able to pee whilst having these stones.
3. Aside from *those* stones, kitty has a previously diagnosed ureter stone in his right ureter that had been stable, but now is not. It's blocking his right kidney and that kidney is now sad. It's not an emergency yet, but will be soon.

Thus, he'll be getting a tune-up of his whole urinary tract on Tuesday. Wish him luck and thanks to all that are following his story!

 

[Daisy6]

Good luck and keep everyone posted!