PU Surgery in Cats: What You Need to Know

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If your cat repeatedly has problems urinating, your veterinarian may recommend your cat get a perineal urethrostomy. Here's everything you need to know about PU surgery in cats and how it could help get their urinary system back on track.

Why Would My Cat Need a Perineal Urethrostomy?

Urinary blockages are a fairly common problem in cats, especially among male cats. A blockage can be caused by a lower urinary tract disease that leads to inflammation and swelling in the urethra, the tube that allow urine to pass from the bladder to outside the body. Stones, mucus plugs or tumors in the urethra can also cause blockages. If a cat can't urinate, their bladder swells up with urine. Not only is this extremely painful, but cats with urinary blockages are at risk of life-threatening damage to their bladder, kidneys and the rest of the body.

Most times, urinary blockages can be managed through a combination of a balanced meal plan, medicine, stress reduction, increased water consumption and/or the insertion of an emergency catheter. If your cat consistently has urinary blockages that can't be managed medically, however, they may be a candidate for PU surgery.

What Is PU Surgery in Cats?

PU surgery involves surgically opening the urethra and making a new, wider opening for the cat to pee from. It's a fairly simple procedure that has been performed for many years and has a good success rate. The surgery is done under general anesthesia, usually with a local nerve block, meaning your cat will be completely asleep during the surgery and pain-free during and after the procedure.

Potential Complications

Even though PU surgery in cats is successfully performed every day, complications can happen. Potential complications after surgery include the narrowing of the urethrostomy site, urine leakage under the skin, bleeding, urinary tract infections and incontinence, which is why it is so important to have this procedure done by an experienced surgeon and properly care for your cat after the surgery.

Another important fact to consider is that your cat's urinary problems can be due to an underlying disease, such as feline lower urinary tract disease. If the underlying condition isn't addressed, your cat may continue to strain while urinating, have bloody urine and/or pee outside the litter box — even after PU surgery.

A Maine coon using litter tray.

Alternative Treatments

Transpelvic urethrostomy (TPU) is an alternative to PU. However, because PU is so successful, TPU is less common.

Nonsurgical treatment requires you to work closely with your vet to try and resolve the underlying cause of your cat's urinary blockages and to monitor your cat closely for signs of urinary obstruction. Unless you're watching your cat 24 hours a day, however, this is nearly impossible. There are few alternatives for cats who repeatedly develop blockages.


Caring for a Cat After PU Surgery

To ensure your cat heals properly after their operation, follow these steps:

  • Keep them indoors for several weeks following surgery.
  • Monitor their surgical site daily for signs of infection. Mild swelling is normal, but major swelling, odor, heat, pain and colored discharge are all signs of infection and require a vet's attention.
  • Make sure your cat urinates at least once daily. If they don't, call your vet.
  • Have them wear an Elizabethan collar at all times until your vet says you can remove it. If your cat chews out the sutures, they may have to return to surgery.
  • Give your cat all medicines as prescribed.
  • Feed your cat canned food in addition to dry food to increase their water consumption. Your veterinarian may also recommend feeding your cat a therapeutic food that helps with your cats urinary health.
  • If your vet sends you home with special litter, use it. Otherwise, if litter gets stuck to the surgical site, wipe it off with a moistened washcloth.

Most cats are fully recovered by the time they have their sutures removed — generally 10 to 14 days after the procedure. Sedation may be required to remove the sutures, so don't feed your cat before the appointment.

Most cats do very well with PU and go on to live long, healthy lives free of pain and obstruction. If PU is recommended for your cat, get all the facts you can and make sure you feel comfortable with your surgeon. Don't hesitate to ask questions — remember that you are your cat's main health advocate!

Contributor Bio

Dr. Sarah Wooten

Dr. Sarah Wooten

A 2002 graduate of UC Davis School of Veterinary Medicine, Dr. Sarah Wooten is a well-known international speaker in the veterinary and animal health spaces. She has 10 years experience in public speaking, media work, and writing for a large number of online and print animal health publications. Dr. Wooten is on the FearFreeTM Advisory board and the Prized PalsTM Advisory board. Dr. Wooten is also a certified veterinary journalist, a member in good standing of the AVMA, and has 16 years experience in small animal veterinary practice. In addition to being a speaker, author, veterinarian, and co-creator of the wildly popular card game 'Vets Against Insanity', she co-owns Elevated Eateries Restaurant group in Greeley with her husband of 21 years, and together they are raising 3 slightly feral mini-humans. When it is time to play, she can be found skiing in Colorado, diving with sharks in the Caribbean, or training kenpo karate in her local dojo. Go big...or go home.