Perineal Urethrostomy

Shadow’s PU, Updated

It’s been a little over a month, and I need to update my account of Shadow’s perineal urethrostomy (feline P.U. surgery).  Rather than tack on to the first post I made, I decided to go ahead and begin fresh here in a new entry.  I’ve already gotten a few comments from readers who have gone through the same ordeal (or are going through it right now – good luck, Alli!), so I feel like it’s important to continue keeping an accurate account of the details.

We left off on 3.7.15, when Dr. S pretty much performed a second, larger, p.u.  Our goal was to get Shadow to leave the catheter in for a minimum of two weeks, and for hopefully an entire month.

I began Googling furiously, trying to figure out some way to prevent Shadow from removing the catheter.  I knew of the existence of the “soft, floppy cone,” but when I looked into those I knew it wouldn’t stop him — he’d just crush it and go straight for the cath.  It was when I was reading some threads on Reddit that I became aware of the “doughnut” – an inflatable pillow that wraps around the cat’s neck, immobilizing his head.  Petsmart does not carry them, but fortunately, Petco does!  And we have a new one in town!  I headed over there right away and purchased their XS doughnut, rationalizing that it was the one recommended for cats, plus Shadow is a very small cat.  Wrong.  It was laughably small and did nothing.  I returned it immediately and went for the S.  Honestly, if you have a full size (10lbs+ cat), you may actually want to opt for the M.

Shadow wearing the XS, rolling around in catnip in the bathtub.

Although the S was much better, I still didn’t quite trust it.  I watched Shadow for at least an hour before he finally tried to go for the cath.  He got really, really close – enough to scare me.  So I took the next step, which is what the original Reddit post recommended – combine the cone and the doughnut.  What do you know, that was the winning combination!!!  It took Shadow just a little bit of time to get used to it, but the doughnut prevented him from getting the cone close enough to the catheter to mess with it.  Success!!

Storm giving Shadow some love and support (see how much bigger the S is?)
Storm giving Shadow some love and support (see how much bigger the S is?)

3.11.15 – From my Facebook status, “Shadow is running around like a damn crackhead, eating everything in sight, trying to play with the laser, and repeatedly raising up on the cat trees to sharpen his claws. It feels great to see him acting so well, but I think I need to crate him for his own good!”

When I wasn’t working, I would let Shadow stay out of the crate because at this point, he was urinating through the catheter and it wasn’t dripping incessantly.  I still kept my couches covered with spare blankets just in case, but it wasn’t really a big deal.

CB and I tried to give him as much lap time as possible, wherein we’d remove the cone and doughnut.  While the doughnut seemed to be pretty comfy, the combination of the two definitely was not.  It was important to us that he be allowed to feel “normal” when we could devote 100% attention to him.  He LOVES being swaddled in “The Buddy Blanket,” which is what we call a really fuzzy blanket my mom gave me for Christmas this year.  We often wrap him in it and sit him on our lap, and he’ll cuddle there for a few hours (spoiler alert: we are doing that at this very moment!).

Shadow cuddling with his daddy, who is doing his homework.
Shadow cuddling with his daddy, who is doing his homework.

3.20.15 – The catheter stayed in for two weeks!!!  I took Shadow in for a recheck, and Dr. S went ahead and pulled it because it had gotten so dirty.  I had bought Burt’s Bees cat cleaning wipes, but Shadow would throw a fit any time I’d try to wipe him up.  It was exceedingly hard to keep him clean and Dr. S was worried about hygiene.

Sheer happiness from no cone and no catheter!!!
Sheer happiness from no cone and no catheter!!!

3.23.15 – Alas, things were not to stay perfectly happy.  On this day, I saw Shadow squat 3 times in 15 minutes. He peed each time, but the frequency combined with him licking his crotch a lot worried me. I ultimately decided to be better safe than sorry and ran him back to the vet at about 7pm. I had to work the next day, and I couldn’t fathom leaving him home with a possibly full bladder all day.

Fortunately, his bladder was small, so he was definitely urinating. The opening to his new urethra was all bloody, so the vet (Dr. E this time) ran a basic urinalysis. His urine was clean. The verdict? Overgrooming! Buddy was so ecstatic to be able to clean his crotch that he’d licked it raw. She rubbed some steroid cream on him told me to put the cone back on him again for a few days to discourage him from licking.  I actually put the doughnut on him because I think it’s more comfortable.

3.25.15 – Shadow was still squatting and straining frequently.  I did not feel like things were right.  We went back to the vet, and he saw Dr. S.  Once again, his bladder was small.  Dr. S told me that the frequent urination might be Shadow’s “new normal” because things have been off for so long and he’s kind of forgotten how to urinate regularly.  Although the urinalysis on Monday came back clean, he went ahead and prescribed a liquid antibiotic, Veraflox, in case Shadow had developed a UTI that was causing burning.  He reassured me that Shadow was fine, and told me to bring him back if he starts acting sick… you know, vomiting, not wanting food, etc.

Playing with the feather on a stick!
Playing with the feather on a stick!

Shadow spent the next few weeks alternating between frequently urinating/straining and acting perfectly normal.  He would run and wrestle with Sky, climb on the cat trees, chase the laser, and so forth.  However, he began to urinate inappropriately… on the floor, on the furniture, on a blanket, etc.  I was reassured that urine was coming out, but I still felt like something was off.  It also seemed like the straining became more frequent as time went on, even after he’d finished the course of antibiotics.  I began to worry that he would prolapse his rectum, he was straining so hard.  I put him back on Buprenorpherine for pain, figuring everything might still be irritated.

4.5.15, Easter Sunday – (from my Facebook account) I woke up this morning to find Shadow laying in a pool of his own vomit, crying and very weak. I got CB up and we took him to the emergency vet. He had completely closed up. The opening for him to pee out of was gone. We thought we were going to have to euthanize him, as sick as he was. The evet called his normal surgeon, Dr. S, and they told us that they felt that if they could pass a catheter, he stood a good chance of fully recovering with a different strategy upon catheter removal. The evet, Dr. Amanda, worked at the surgery site with warm, wet gauze and opened it back up – it had scabbed over. Shadow geysered into her face. She came back to update us, and to ask if we wanted to proceed with the procedure. His bladder was still quite large although urine had already escaped.

CB and I debated but ultimately decided to go ahead and try, since the vet thought it was such a good chance.

She and her preceptor (vet student from Auburn, named Amber) worked on him for a long time before she came out to tell us that they could not get the catheter inserted. We were heartbroken. She told us we could take him home to let him pass naturally, or we could euthanize him. We made the decision to euthanize so he would not suffer. She stood up to go to the back to bring him out for us to hold him and say our goodbyes, when just like in a damn soap opera, Amber burst into the waiting room to announce she got the catheter in.

Dr. Amanda rushed back and a few minutes later Amber came out to tell us that he had a good urine flow and Dr. Amanda was stitching the cath into him. It was such a quick turnaround we could barely process it. We had came to the resolution to say our goodbyes and suddenly he was “fine.”

Apparently he has formed something that sounded like a “diverticulum” (it was a Latin word that sounded like “diversion”). Basically, there is a false entrance to his bladder that dead ends. Amber managed to work the catheter around that dead end and down the correct path. The flow is quite good.

Dr. S has been saying the issue is not physical – there is a good pathway. What Dr. Amanda thinks happened is this: she theorizes that Shadow inflames easily. He was quite inflamed the last time Dr. H checked him out. Normally when a cath is pulled, all is well. She thinks the process inflames Shadow, which causes him to close. Then he stresses and strains and clamps and all of that basically just inflames him more. Most cats do not have this issue. Basically EVERYTHING that can go wrong with this PU procedure has gone wrong. Dr. Amanda says that this is incredibly rare and freaky and that most cats recover normally – and that Shadow still can.

I am meeting with Dr. S on Tuesday to develop a game plan. What Dr. Amanda recommended is switching him from Prazosin (the urethra relaxer) to a different kind of urethra relaxer. There are several, and Prazosin is just the most common. We need to find one that works better for Shadow. She also thinks he should be put on an anti-inflammatory. The reason he wasn’t is that they are not at all common in cats and there are like 2 that are approved, and only for limited use. She says she has seen very good effects in using some NSAIDS off-label, and has several patients that do well on them. Since Prazosin and Amitriptyline are off-label anyway, using something else like that doesn’t scare me.

For now, he should be ok – the catheter is back in, and will remain in for at least another two weeks, maybe longer. CB has not let go of him since they brought him out to recover. We brought him home, and he is still resting in his arms, bundled up in his favorite blanket. Once he wakes up, it’s back to the cone and doughnut for our little buddy.

Please rest assured that he is not in pain and we are not torturing him. This morning is the first time his bladder has ever been full and he has shown distress. Yesterday he was even chasing the laser. The day before, he was wrestling vigorously with Sky. If we think that we are at a point where his quality of life is significantly degraded, or that we’re just torturing him, we will make the hard decision we already made once today.

later that day

Shadow did not really wake up. We have been back at the vet since 2:30. Heart rate and temp are normal, but he is severely dehydrated. They think his electrolytes are messed up but he is too dehydrated to get blood out of. We are waiting while he rehydrates. My poor buddy. This has been the worst Easter ever.

late that evening

He was severely dehydrated. The vet has been pushing fluids. She managed to get bloodwork, which revealed kidney issues – but it can also be showing that due to the dehydration. They are keeping him tonight and will recheck his blood work in the morning. I am worried he won’t make it through the night.  Dr. Amanda is clearly worried, also.  She said she may just sit with him all night.  She will call me immediately if anything happens.  My phone will be on and I will be listening for it to ring all night.

(from my memory)  Shadow looked terrible.  He was panting, but his heart rate was normal.  His body temperature was on the low end of normal and it took several hours for them to get it up.  He was so severely dehydrated that they couldn’t get blood from him very easily.  They wound up shaving both of his front legs and his jaw in an attempt to draw it from various veins and from his jugular.  He was high on valium during all of this, but he still felt enough to thrash about some when they were poking him.  When Dr. Amanda finally got enough blood, the stupid machine was broken!  A tech had to come in to fix it, and by that time the blood had clotted and they had to go through the whole process again.  Finally, they got an IV cath in him and began giving him fluids intravenously (they had already been giving them subcutaneously).

At one point, they moved him into the “bear hugger,” which was a rather alarming-looking contraption.  It was basically a giant pillowcase with a blowdryer attached… it inflated with circulating warm air, and Shadow was wrapped in the middle of it.   His little head was sticking out and he’d sometimes open his eyes to look at me, but he was not very responsive.  I had to leave him like that and I was terrified it was going to be the last time I would see him.

4.6.15 – (from my Facebook account)  Some blood work is still elevated but it has all dropped significantly.  Dr. Amanda said he was 100x better today – “a totally different cat.”  A few levels are still high, but she “wouldn’t be surprised if they totally dropped” since they already came down so much. Happy day!! Now, time for cuddles because I just brought my boy home!!

Cuddle time!!
Cuddle time!!

Right after I posted that, I wrapped Shadow in the buddy blanket and sat him on my chest.  He began purring like mad, and kept stretching his face up to meet mine to nuzzle me.  He’d also periodically reach out and touch my face with his paws.  It was insanely adorable.  We stayed like that for several hours.

4.7.15 – I had picked Shadow up on Monday, which is Dr. S’s day off, so I made an appointment to see him on Tuesday right after I got off of work.  I brought copies of Shadow’s file from the evet, as well as copies of all the bloodwork.  Dr. S reviewed the files, then surprised me by saying he wanted to pull the cath Dr. Amanda had inserted and “go exploring” to see what the problem was.  He suggested leaving Shadow there that night, since it was quite late in the day, and he’d work on him on Wednesday.  We discussed it for a few moments before deciding that I would drop Shadow off on Wednesday night (because they’re not open by the time I have to leave for work in the morning), and he would work on him on Thursday.

Nothing in the notes told the story of the difficulty cathing Shadow, so I filled Dr. S in on the details.  He became indignant and said “Do not ever put this cat down because a catheter cannot be ran!  He is MY patient and that is MY decision and I AM NOT giving up on him!!  If anyone ever suggests that again, you have them CALL ME IMMEDIATELY!”  It was quite surprising and also quite heartening.  He says that it is a point of pride now for Shadow to recover fully… that this is “the best, most perfect p.u. he’s ever done… and the only one with complications… so he’s going to get it right!!”

4.9.15 – Dr. S called to tell me that he had successfully gone exploring.  He was flabbergasted that Dr. Amanda had such a hard time getting the catheter inserted, because it “slid right on in” for him.  He said he even took a much larger catheter and inserted it with no problems.  He went ahead and made the opening slightly bigger, and stitched the “Slippery Sam” model cath (the flexible, more comfortable one that Shadow had previously kept in for two weeks) in to him.  This time, he said, we were going for the whole month.  He is still trying to determine if the issue is physical (the hole closing) or neurological (Shadow’s bladder and urethra not communicating well with each other).  He wanted to keep Shadow for a few days for observation since he had come so close to death on Easter.  He told me he had an IV catheter in him and was giving him fluids as a precaution since he did not recover very well from the last sedation.

4.10.15 – I visited Shadow!  He was SUPER happy to see me and it was difficult to leave him.  He was still receiving IV fluids.

You can see the red vet wrap that is holding the IV cath in his arm.
You can see the red vet wrap that is holding the IV cath in his arm, and the line of fluids.

4.11.15 – Shadow came home!

4.12.15 – Shadow is still straining.  When I go to wipe his bum down really well, I see that one side of the catheter has come loose.  SHIT!  It’s pretty late at night, and it’s Sunday, so I figure I’ll take him in tomorrow and have them restitch that side.  Dr. S is off Monday’s, but I figure someone else will do it.

4.13.15 –  I wake up at 6am to see the catheter is completely detached and is protruding about a centimeter.  Shit shit shit!!!  I can’t be late to work because it’s my first day on a new project, so in desperation I call my Mom, who is on her first day of a week of vacation.  She agrees to come get Shadow and take him to the vet right as they open.  I put him in his carrier, confident that he can’t turn his head in there with the doughnut+cone on.  I figure they’ll be able to stitch the catheter back in.

….yeah, no.  By the time Mom got him to the vet’s office 2 hours later, he had already managed to get the damn thing out.  It was laying under him in the carrier!  This time Dr. N takes care of him.  Apparently, she came out into the waiting room and told Mom, “I don’t know how the hell he did that!!!”  Me neither, cuz he was wearing the damn cone and the doughnut just like last time!!!  The stitches were even still knotted!  He must have somehow just ripped them out of his skin.

My mom relays via text messages that they are all out of the Slippery Sam catheters and just have the large, rigid “Tomcat” catheters.  Since it’s going to be in long-term, they don’t want to put one of those in Shadow.  They want to observe him all day and sedate and insert a new Slippery Sam tomorrow.  I am relieved that he is being monitored.

Later that afternoon, I received a call from Dr. N.  She wanted my permission to go ahead and sedate Shadow and insert a Tomcat cath.  He had been straining frequently in the box, and she called Dr. Sykes and they decided that would be the best course of action.  I give my consent, but tell her how Dr. S had the Slippery Sam attached that Shadow managed to keep in for two weeks… he had a piece of surgical tape across it, a hole cut in the tape for the cath to protrude from.  The tape was sutured to Shadow instead of the actual catheter, which was able to protrude slightly.  Dr. N says she will attach it in four different places to make sure he manages to keep it in.

When I get off work, I go visit.  Shadow is coming out of sedation and is adorable.

Sky makes herself at home in Shadow's crate while he's at the vet's. But she's special so she squeezes into the top bunk instead of the bottom!
Sky makes herself at home in Shadow’s crate while he’s at the vet’s. But she’s special so she squeezes into the top bunk instead of the bottom!

4.14.15 – Shadow comes home.  He is wearing a ridiculously giant cone.  Like, it’s so bad he can barely walk in it… it drags on the floor and weighs his head down.  He started off in a size 10, spent the bulk of this time in a size 12.5, and is now wearing a 15!!!  RIDONK!

4.15.15 – I watch Shadow strain in the litter box.  Straining with the cath is futile, because it’s all coming out.  He’s just doing so because it’s irritated.  Poor guy.  I feel so bad for him.  WAIT A MINUTE WHAT THE HELL I notice as he strains and heaves his little butt, the cath pops off!!!

I threw that damn cat in his carrier and floored it to the vet’s office.  I’d just gotten out of the shower, it was 9pm, and I had soaking wet hair and was wearing my pajamas.  Whatever.  He wasn’t getting this sucker out!!

Dr. J was the vet at the clinic tonight.  He explained that luckily, only one side had come undone.  I told him exactly how it had happened.  Apparently my cat has amazing glutes, and he’s been popping those suckers off.  That’s why the only one that stayed with any success was the one that had wiggle room!  Dr. J numbed Shadow up and gave him something to make him a bit woozy (but not full sedation) and stitched the Tomcat cath back to him.  This time, he used half-inch stitches and gave them some slack.  He showed me that the catheter had room to pulse in and out of Shadow while he strains.  He also recommended that after I wipe Shadow’s bum down, that I put some diaper rash ointment on it to help protect it from the urine.  I’m a damn mom and this is my baby.

Oh yeah, and Dr. J also laughingly tells me that they’re all making bets on Shadow… whose cath will stay in him the longest?

I can tell you one thing.  Since we know how he’s getting the caths out now, he’s going back to the smaller cone.  No sense torturing him with this giant monstrosity when the 12.5 is perfectly fine for keeping the cath in (as evidenced by how he kept the slack one Dr. S inserted for 2 weeks without issue).  At least now he can turn around in bed without banging his head on all 4 walls of the crate.

Back home again, luxuriating on my lap in the buddy blanket.
Back home again, luxuriating on my lap in the buddy blanket.

4.19.15 – I dread weekends now.  Do you know why?  Because the vet’s office is closed at noon on Saturday, and doesn’t reopen until Monday morning.  And emergency vet care is not always covered as “continuing care,” unfortunately (Easter was expensive, but worth every penny).  I watched Shadow carefully all weekend, checking the catheter frequently.  He has actually stayed on my lap the entire time I’ve written this post, swaddled in the buddy blanket.  He just jumped down and asked for more food, so I fed him.  He’s voracious!  The vets have all told me to let him eat as many calories as he would like, so I feed him about 4 times a day (morning, when I get home from work, dinner time, and snack right before I go to bed).

I hesitate to type this because I may jinx myself, but so far, so good.  I think we’ve finally realized how the caths are coming out and we’ve got a strategy to prevent it.

Still, I think I am going to take him back to the vet tomorrow evening when I get off work.  Dr. S is off tomorrow, but I want him to check Shadow out on Tuesday.  I don’t think he should still be straining like this.  Also, it’s normal for urine to be bloody after having a cath inserted… but Shadow’s went from bloody to yellow to back to bloody again.  He’s also squatting more frequently.  I suspect he has finally gotten a UTI (and no wonder, after having 3 caths inserted in less than two weeks).  I know the game plan is to leave the cath in for a month and then culture it to see if he needs to be on a specific antibiotic, but I fear he’s in some discomfort now.  And I don’t want him to feel pain while he pees for the next 3 weeks.  I am hoping he’ll be put on an antibiotic that will alleviate that.

Also, it’s exceedingly hard to keep his bum clean, especially right underneath the cath and around the stitches.  He screams and fights and CB has difficulty restraining him while I wipe him down.  And frankly, I’m afraid to be aggressive in doing so because I’m afraid I’ll pop the cath myself when he thrashes.  I’m going to ask if they can give his bum a good cleaning while he’s there.  I feel kind of guilty about that (like I’m being a terrible mom because I can’t keep it super clean), but I think it’s better for me to ask for help now before it gets too dirty.  Hopefully it won’t be a problem.  I don’t want to treat them like groomers when they are medical professionals, but I don’t really know what else to do.

My mom’s been perfecting a dog biscuit recipe and she just bought a set of cute dog cookie cutters.  She’s offered to make a batch for me to deliver, and I think I’m going to use the cutters to bake some sugar cookies or shortbread cookies and take the whole lot to the vet’s office.  If I’m going to be a pain in the ass (or a neurotic cat mom that is constantly there), maybe cookies will help soften the blow.

Click here for part 3 of Shadow’s PU story


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  1. I came across your blog searching for advice on cat food for post PU cats and just had to read it. I went through a very similar experience with my cat last year, and completely feel your pain. It felt like it was never going to end with the constant back and forth to the vets (often out of hours), obsession over what my cat was/wasn’t peeing, catheters (in and out and being unable to insert). I too dreaded weekends. Like you I don’t want to jinx anything but my cat does seem to have recovered so I really hope your story will have a happy ending. It sounds as if Shadow is in good hands with your vet. Mine was similar in treating it as a personal challenge/responsibility to succeed and that really helped. My cat’s problems started from him being run over and his urethra being completely torn in two. God knows how he even survived. After a failed attempt to stitch it back together (it strictured) the vet ended up doing a PU – thankfully they had just enough tissue up to the point of the tear to perform it. But there were many times when I was waiting for a call during surgery to hear whether or not the surgery they were attempting was even viable. And so I was very much having to prepare for the worst. On many occasions I got him home seemingly OK, and then he would begin straining again. And many times when I had to take him back in, when in himself he was fine – eating well, even catching voles – he just could not pee. After the PU he was incontinent for some time, which was a real challenge. I thought he may never get beyond that as it was possible that the bladder had also been badly damaged when he was run over. But the vet persevered with drugs – relaxants and stimulants to get the bladder and urethra talking to one another again and it seems they did. Now I just keep my fingers crossed that we don’t get another stricture/blockage. My cat will be three next month. I hope my story shows that it is possible to get through this and offers some encouragement. Fingers crossed for you. I’ll look out for your next update.

    1. Sarah,

      You have no idea how good it felt to read your comment today. Thank you SO MUCH for sharing! It sounds like your boy went through quite a horrible experience. Could you provide more information about the drugs your vet treated him with? I am very curious about what may lay in Shadow’s future. I know there are different drugs that stimulate the bladder, and cause it to contract, along with a variety of urethra relaxers. I have the sinking suspicion that we are going to have to go down that road once the physical problem is solved.

      Approximately how long did it take for your cat to return to “normal” after the accident and surgery?

      For what it’s worth, I am now feeding Shadow wet food twice a day (Publix brand… he loves it and it’s got a surprisingly short ingredients list with real foods first!) and dry food twice a day (Blue Buffalo). He will occasionally graze on Storm’s c/d but usually turns his nose up at it. He was also turning his nose up at all wet food I offered him, until I tried the Publix brand. For awhile I was pouring water on top of the dry food, but he eventually refused to eat that, too. I’m keeping my fingers crossed that he will stay with the Publix wet, because I have noticed a marked increase in his urine production in the past few days he’s been eating it.

  2. I read your recount of Shadow’s ordeal because my cat has been at the ER since last night (yay 3 day weekend >.<) and will be getting a PU surgery on Tuesday. I am now absolutely, completely terrified!

    Wishing you and Shadow all the best. Although Shadow's story is heartbreaking, I feel like I am more mentally prepared for what may come. And to think I felt like my baby's issue had been going on forever because he's been in and out of the vet since Tuesday… Wow! You're a good mama to Shadow, he's lucky to have you.

    1. Val,

      Hang in there. I am in the process of writing Update 3 – The Finale. Spoiler alert: Two weeks ago, Shadow had his catheter removed after successfully keeping it in for a month. He has been perfectly normal ever since!!! It seems like everything has FINALLY settled and has worked out well!! Last night I heard a really loud hissing sound… both my husband and I were like “wtf is that?” We realized we were hearing Shadow in the box, pissing really long and hard, LOL. What a glorious sound!!

      I wish you and your baby the best. It was a difficult path to take but I know it was necessary to save his life. I would do it again in a heartbeat. Please keep me updated on how things go for you!

      1. Britt,

        I am so, so relieved to hear that Shadow’s been doing good, what a rough patch you all went through!

        Aren’t large puddles of pee wonderful? Hah!

        Thank you for the kind words and support, I will definitely keep you updated. By the way, I’ll be shopping for a doughnut to go with the cone. I’ll be prepared!

        Cheers to you and the Canadian husband, from the Canadian chick who married a damn American dude ;)

        1. So, as promised – here’s an update on the feline.Gambit had his PU surgery, but the surgeon used a new technique that doesn’t completely remove the penis. He said that it’s more forgiving in the off-chance of relapse, that the urethra is still long enough to perform a regular PU if need be.

          Gambit had to keep his catheter in for two whole weeks, and we had numerous trips to the ER during said two weeks – bleeding, pee leaking outside of his catheter line, and two broken nails (poor baby did NOT like the inflatable collar and wrecked his own paw trying to get it off, nearly choking himself to death in the process).

          We had the catheter and the external stitches removed two days ago, and we’re on the look out for pee! He is still in his recovery crate as he’s not cleared to have his collar removed for two more days.

          This is where we stand – never wished for pee so much in my life!

          1. Val,

            Thank you for updating me!!

            Sounds like you’re in the midst of your own PeeWatch2015!! I will be hoping that Gambit lets it out soon. I used to dance around Shadow singing “Let it flow” to the tune of Elsa’s “Let it Go” … I don’t think that really helped, though.

            That new technique your surgeon used sounds interesting. How does the PU work if the penis isn’t removed and the urethra rerouted? Was the urethra rerouted at all? I can’t quite picture this. I’ll see if I can find anything on the web about it to help me get a clearer understanding.

            Try to stay positive throughout this ordeal. It took Shadow from mid-January until mid-May to truly settle down. As of right now, things are back to normal, though I confess that every time I hear him in the litter box or see him licking his crotch I have to suppress feelings of panic.

            Let us know when Gambit finally “lets it flow!” Fingers crossed and sending good vibes his way!

  3. Hey girl, spent an hour yesterday reading of your travails with the Shadow and his PU. Your experience and outcome have me terrified…..BUT so glad to hear he may be over the hump and is peeing with gusto!
    My cat, Rocky (a rescue three years ago at the end of his 3 month expiration date) had his second episode of crystal accumulation and blocking over Memorial weekend. The first was last November. Of course that was over a week-end too, so let’s say not a stranger to emergency veterinary medicine and the cost. Given two episodes in a 6 month period at a cost of roughly more or less a thousand per, and anticipating that this was not an issue likely to just go away, I opted to do the PU with the hope of nipping it in the bud (so to speak). That was performed Tuesday two weeks ago. He did NOT come home with a cath at all. Now I’m really concerned as to why. Should he have had one? Especially since others have commented the same. Urination varies daily. Sometimes two to three times, sometimes smaller amounts with growling, but he is passing urine and that appears to be the only standard they care about. This past Sunday he pissed like a sailor just off leave. Good right? To me that just meant he was accumulating and not peeing like he should. His stitches came out Monday, advised to leave cone on for another 4 or 5 days. So all is just swell, except for the growling and moaning and continuous effort to ditch the cone to “get at it”. So I decided to get a good look at what was going on Tuesday. Got the magnifying glass and discovered he had a retained stitch with no give when I tweezed it to see if it was maybe just a stray. He’s really simply the best, most easygoing cat I have ever had so this was totally not like him to be so vocally agitated. Called the ER center and they were too busy to see him until today. I’m a RN. A retained stitch is a cardinal sin. You count the stitches in and you count the stitches when they come out. The two numbers should match, and if they don’t, you keep looking. There was only about an eighth of an inch of pink suture visible when I saw it yesterday.
    Now today when we returned to the ER, perhaps I was a bit overwrought with the bouncy tech who told me “we’ll get that out for you and bring him back in a few minutes”, but when a Doc returned him and said “OK, he’s all set now”, I lost it, and was flabbergasted to find out they don’t have a protocol for suture removal…in that the numbers have to match. They don’t count the damn sutures they put in. I think I said something about sloppy practice and discounting the seriousness of this and what if I hadn’t found it and the PU failed due to the inflammatory response from the stitch still being there that would create scar tissue……etc. at least I’m pretty sure I said all of that. To which she responded “He should be fine.”
    So let’s add to that the fact he didn’t have a cath when he came home (it makes sense to have one) I’m just worried sick that they simply clipped the visible part of the suture and didn’t get the knot because there’s a hard place under the skin right where the suture was and he is still growling.
    Do I trust he’ll be “fine”, or get a second opinion from someone else….frankly, I think the sooner the better probably. His regular vet was closed this afternoon, so will check in the morning.
    Sincerely hope your Shadow continues the long fraught upward trajectory and you are rewarded for the perseverance it took to get this result.

    1. First off – good on you for rescuing Rocky!! Rescue pets are the best!!

      I have no idea why Rocky did not come home with a catheter. I have never known a PU to not have one, because from what I understand, everything “heals around” the catheter. In fact, what seems like the problem with Shadow (I’m still not 100% certain) was that he was healing super quickly, and the opening kept trying to seal shut. The catheter prevented that from happening, and once we managed to keep one in him for a full month, he’s been fine *knocks on wood*

      I also have no idea about the retained stitch thing. I am not a medical professional, as you are, but it seems logical to me that you make sure you remove the same number of stitches that you put in…

      What concerns me is that Rocky is still crying and growling when he is passing urine. That should NOT be the case. Urination should not be painful, and that is a huge sign that something is wrong. Sure, it’s great that he’s passing urine, but it shouldn’t be painful. I would be questioning why, and if my vet could not give me a good answer, I would definitely seek out a second opinion.

      Please keep me updated on how your boy is doing. I will keep him in my thoughts!!

      1. Am absolutely happy to report Rocky is doing well, no problems. Peeing, pooing great.! Have found him snacking on the dog food which is a real no-no as it could lead to crystal formation, but so far so good. I would say however though, that passing a cath every so often would help to prevent future strictures from forming. The inclination of the body to heal itself won’t necessarily just end with initial healing, it may take a greater period of time. Just something to consider for all of our furry loved ones.
        Hope all remains and continues to remain well with Shadow. No one would want to go through this again. If that is even possible come to think of it.
        Best to all and thanks for your blog!

        1. Oh, I am so glad things are going well for Rocky!! Thank you so much for updating me and for putting your story out here for others to read. Please come back to update if anything else happens (and I’ll be keeping my fingers crossed for Rocky’s continuing health!).

  4. I just stumbled across this with the same issue. I have taken my cat to the vet for emergency care 3 times now in the last few months. It breaks my heart when I wake up to him meowing in pain and realize I have to get him in stat. The worst part was this time it came on so sudden- at midnight I was playing with him and he was his cheerful self and then not even four hours later was laying the floor heavy breathing and clenching his stomach. I thought he was going to die right then and there. And its worst when the vet hours are not 24hr care. But thank God I got him in right when they opened and they said I caught it early. The thing is my cat when hes in pain will come to my husband and me and meow continually until we fix it. From his ears hurting to infections. Hes a smart one. But we are recently married and the vet bills are overwhelming. And I dont know what to do. I am going to talk to the doctor today when I pick up my cat from being there for 3 days now. Just from your stories I am worried what might go wrong with the surgery. I just want my cat to not have to keep having these life or death situations. Does the surgery mostly stop the crystals from blocking? Your doctor seems pretty smart. Im not so certain about my vet atm. Sorry for all the questions, Im just stressed to the top with this. I miss my cat and I feel so bad this keeps happening.
    Prayers for you and furry friend. I hope he is doing well! Your an awesome owner! Its encouraging that your taking such good care of him! (:

    1. Tamara, I apologize for the brief reply (I’m at work but I wanted to hurry up and get back to you). I posted an update a few days ago about Shadow – he seems to be completely recovered, whew!! Especially now that he’s come through this, I have to say, I do recommend the pu surgery if you have a reputable vet that you trust.

      Blocking three times in a few months seems to indicate a pretty severe problem. I would definitely make sure I explored all options first though. Is your cat on a prescription urinary diet? Does he eat wet or dry food? Do you have him a water fountain? Is he on any mood-stabilizing medicine, like amitriptyline? Have you used different antibiotics to try to clear him up? Maybe he’s keeping the same infection because whatever the vet is prescribing is not going away.

      The pu surgery does not cure utis, which are usually the underlying problem (but not always -have you had a urinalysis to see what kind of crystals your boy is forming?). What it does is widen the urethra so crystals can pass, preventing blockage and death.

      Good luck to you, and please keep me updated!

  5. Apologies I have only just seen your reply to my post, but good to hear things are much improved for you and Shadow :-)

  6. Thank you so much for all of this info. I have always had male cats and never had a problem until Oreo this past weekend. Emergency vet on last Saturday afternoon, and she had a terrible time trying to release his obstruction. She said his urine was like sand because of so many crystals. HE then went to my regular vet Monday morning and was doing Ok thef irst couple days then re-obstructed and had to be re-cathed. They left that cath in 3 days and took it out Friday morning. I finally was able to pick him up and bring him home this morning. He is peeing OK, but like Shadow, is peeing outside of the box. We know if he obstructs again we are looking at PU surgery so I am so thankful to have found this site and all the info you provided. We are keeping him quarantined from the other 2 cats for now to make sure he is peeing etc. Once again, thanks for all the info!

    1. Make sure you are taking appropriate steps to control the crystals before you go for a PU (unless he’s blocked completely) – is he on an antibiotic for infection? Is he eating food formulated for fighting crystals? How about therapeutic drugs, like amitriptyline for anxiety/stress relief (plus cotton mouth for more water intake, and an anti-inflammatory!), buprenorpherine for pain, or prazosin to relax the urethra? I’m so glad that I can be a resource for you, and I will be thinking of Oreo and hoping he comes through this UTI without a sex change! Please keep me updated on his situation!!

  7. Oh my gosh. I came across this while researching PU because my little dude is set for one tomorrow and this all sounds nothing like what I understand it to be! I have a surgical consult in the morning but so far, as I understand, my guy will not be sent home with any catheter. Did your vet use an older procedure perhaps? I’m sorry you had to go through all of that. I can imagine the stress and trauma. This is my definition of nightmare and I’m now praying to all that is holy that what I understand from my feline surgeon is correct. The thought of having to go through an ordeal like this is making me nervous!

    1. Elizabeth, how did your little dude’s surgery go? From what I understand, a catheter is not always used, so that in and of itself wouldn’t alarm me. However, with everything Shadow went through, I am very glad the vet went with a catheter! (all of our problems had to deal with him stricturing and healing shut).

      PUs are fairly common, although major surgeries, and apparently what I went through is not “normal.” In Shadow’s case, we suffered “every complication in the book,” which was not a result of bad surgery or veterinary skill, just our unique situation. Please update us with news on your kitty’s surgery and post-op care! The more information on here to help other worried cat parents, the better!

      1. It went really well, thanks for asking! I brought him home Friday, the day after surgery, and he’s doing well. I find that he is way less active without the cone on and in the crate, so I’ve just been camping out in a room with him and being super vigilant about watching him closely. His incision site looks really good and he gets sutures out in another week and a half. The only thing we’re really battling now is diarrhea from the clavamox, then baytil. So, we’re on metro to clear that up. It’s tough being confined to a room and I’m sleeping in here with him too, so I feel like I’m abandoning my other two kitties but my husband is taking care of them.

        I wouldn’t recommend being off-cone aside from eat/drink/pee breaks for most. They can get to their sutures in the blink of an eye and have the entire thing undone in less than three minutes but I’m devoting my time to solely watch over him and that’s the only way off-cone works. When he’s in the cone, he’s much more active and stressed. We put the cone back on when I need to devote time to something else (like emailing, preparing his food, leaving the room for a bathroom break, etc – anything that takes my attention away from him for even a moment). Then he’s in the cone and crated when I need a sleep break at night and he’s knocked out from his buprenex by then. It’s actually pretty exhausting for me and I feel like a captive but it’s temporary and I’ll do anything to give him the best recovery possible.

        The new diameter of his urethra still isn’t the ultimate ideal the surgeon would have liked it to be, but there’s only so much they can do there. It seems to be fine though. I’m going to switch over to a urinary diet even though diet played no part in his blockage. With the increased risk of UTI now, I just want to be conservative and cautious for the future.

        I’ve been through a great deal of medical stuff with kitties and am even a meds tech at a local kitty shelter so I have a good deal of understanding around meds but surgeries for my kids are new to me. I’ve only ever had one other boy kitty before bathed no trouble with him and this is really why I’ve always gravitated toward girl kitties but I’m thankful that Baxter is getting his sass back and doing well. His little sister, Lucy, is REALLY missing him!

        I hope your Shadow is doing well!

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