Stones In The Urethra?

[greytabby]

Update:

Kitty made it through surgery today! Early in the day they heard a slight intermittent heart murmur that caused them to strongly recommend an echocardiogram to ensure that they wouldn't be overloading his heart with the amount of fluid flushing they'd be doing. Turned out to be nothing of concern, thankfully.

The surgeons were then able to flush the stones out of his urethra into his bladder where could be removed. They also installed the SUB (Subcutaneous Ureteral Bypass) and, according to the resident, a lot of cloudy urine drained out immediately. It must have been so uncomfortable for him to carry that around, and they likely saved that kidney today. His BUN and creatinine levels were normal before the surgery, so he was really starting from a good place.

They'll update us in the morning as they start feeding him through the feeding tube. Apparently they'll also start weaning him off of the opiates, though I'll press them on this. Give kitty opiates as long as is practical, I say

I do want to advocate for a moment for the type of advanced vet hospital we took him to. While it's too early to give this particular hospital an endorsement here, I will say that, already, it's a level of care that we only came to expect from going to a world-class teaching hospital like UC Davis. They go deep; they open cans of worms. The other 24/7 surgery center we were considering taking kitty to (the one the diagnosing local vet at the beginning of the thread works with) definitely doesn't have an interventional radiologist on staff capable of performing a SUB for a cat with ureteral blockage. Most places don't. So they would have cleared his stones into his bladder and performed a cystotomy. And then his right kidney would have failed sometime later.

That extra measure of performing an ultrasound on his upper urinary tract, just to check on it, just to be a little annoying, saved us thousands and probably years of our cat's life.

Also: I've noticed if the hospital you're going to has residents taking care of your pet, you're getting double the care. Some facilities even give discounts on surgery performed by residents, but the fact of the matter is that a boarded surgeon is (by law) right there overseeing the procedure -- so you're basically getting two surgeons for the price of one. And, because it's a teaching environment, everybody is even more buttoned-up and meticulous than usual. Residents have something to prove, and so they work even harder to ask every question, run down every lead, and make sure they're advocating for the most optimal treatment plan possible.

There's a long road ahead for kitty, and anything can happen in the coming days and weeks as he recovers. The site could leak urine into his abdomen. The bypass could clog and need replacement. So I'll be cautiously optimistic, especially as longer term we need to figure out how kitty is still forming stones. But I am comforted tonight knowing that he made it through the hardest part and that he's at a place that is going to take care of him no matter what.

Thanks everyone for the support and I'll keep you posted. Here's a pic of the lil guy from last night

 

[greytabby]

Update: Kitty is home and doing well (as well as to be expected, at least). As is protocol for this kind of major abdominal surgery, they placed a feeding tube in his esophagus that we are getting used to working with. It's common for cats who go through this to have very little appetite, hence the feeding tube to keep him well nourished. He is starting to eat a little on his own when we offer him his favorite canned food, though.

He's peeing freely and is well medicated to keep him from feeling too much discomfort. He is deft at outsmarting his e-collar, but I'm getting better at placing it -- and we actually have a baby monitor on the room he's confined to so that I can quickly see if I have to run in there and reset it. It's a lot of work but I can't complain. He's alive, he's on the mend, and he's home.

And thank heavens for buprenorphine! When he was at the hospital, I'm told he didn't really sleep at all. Too scary with all the bright lights of the ICU, the dogs coming out of anesthesia (he's terrified of dogs), and the constant poking and prodding from medical staff. Now, he's almost constantly in a relaxed state of rest, purring happily when we're around him and getting lots and lots of sleep. He gets one dose of buprenorphine in the morning and one dose in the evening, and it's really helping him through these tough days after surgery. In the hour or so in the morning when the drug wears off, he's pretty agitated -- he uses the litterbox more frequently due to the irritation from surgery of his bladder and urethra, and doesn't want to sit still for a 20 minute tube feeding. Once we get him medicated he seems to enjoy the tube feeding and falls asleep halfway through.

We have a follow-up visit in a little over a week to get his incision site checked and the feeding tube removed. In a month, he'll get his first 'flush' of his SUB device and a check to see if it's still functioning properly. For the rest of his life he'll need maintenance: at first every three months to flush it out and then later on every 6 months. But, he now has an access port (quite literally) to his urinary tract that can be painlessly tapped into to flush with fluids, take samples, whatever. In fact, he can't ever have a cystocentesis again to take a urine sample as it could screw up the device pretty bad.

Longer term, we still need to tackle what is causing him to form stones, but for now, we're just happy his current stones are gone and that his right kidney is no longer blocked. His creatinine is lower than it's been in 5 years.

Overall, so grateful. Will keep updating!