Clinical Outcome of Cats Following Perineal or Prepubic Urethrostomy

Jacqui Scott, BVSc, DVSc, DACVS-SA, University of Illinois

ArticleLast Updated September 20203 min read
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In the literature

Sousa-Filho RP, Nunes-Pinheiro DC, Sampaio KO, da Silva EC, Cavalcanti GA, Mori da Cunha MGM. Clinical outcomes of 28 cats 12-24 months after urethrostomy. J Feline Med Surg. doi: 10.1177/1098612X19888808


The Research …

Perineal urethrostomy (PU) is a salvage procedure performed in cases of recurrent distal urethral obstruction, which most commonly occurs secondary to feline lower urinary tract disease (FLUTD).1 PU involves amputation of the penis and creation of a urethral stoma in the perineal region.2 When the obstruction is further proximal, a more cranial urethral diversion, such as a prepubic urethrostomy (PPU), may be required.2 Urethrostomy procedures can result in complications, including urinary incontinence, UTIs, peristomal dermatitis, SC urine leakage, and stenosis.3

This retrospective study reports on the long-term outcomes and quality of life in cats following a perineal or prepubic urethrostomy. The most common indication for PU was recurrent FLUTD (54.5%), and the most common indication for PPU was stricture of the PU site (83.3%). Median age was 3.38 years for cats undergoing PU and 2.5 years for those undergoing PPU. A high proportion of cats were neutered and had an increased BCS. Multiple urethral catheterizations were reported in 90.9% and 83.4% of PU and PPU cases, respectively.

The overall complication rate was 31.8% for PU and 83.3% for PPU. Complications included hematuria, edema, signs of recurrent FLUTD, UTI, peristomal dermatitis, urinary incontinence, and SC urine leakage. The main transient postoperative complication for both PU and PPU cases was transient hematuria (72.7% and 83.3%, respectively). Recurrent FLUTD was less common in cats that underwent PU as compared with cats that underwent PPU (22.7% vs 66.7%). Similarly, recurrent UTIs were less frequent following PU than PPU (22.7% vs 66.6%). Peristomal dermatitis was also encountered significantly less in cats that underwent PU as compared with cats that underwent PPU (4.5% vs 83.3%). Urinary incontinence was observed in a single case following PPU. Owner satisfaction was excellent in 81.8% of PU and 33.3% of PPU cases.

Laboratory analysis showed elevations in SDMA in 22.7% and 16.6% of PU and PPU cases, respectively; creatinine levels were elevated in 27.2% of PU patients, and additional testing revealing chronic kidney disease (CKD) in 5 out of 8 (62.5%) of these cases. Bacteriuria was present in 77.3% of PU and 100% of PPU cases, with Staphylococcus spp being the most common isolate.

These findings suggest that long-term follow-up is important in cats that have undergone urethrostomy to monitor for recurrent FLUTD clinical signs, UTIs, and CKD. Although both PU and PPU are important salvage procedures, PU is associated with higher owner satisfaction and fewer complications as compared with PPU. PPU should therefore be limited to cases in which PU or other more distal urethrostomies cannot be performed.


… The Takeaways

Key pearls to put into practice:

  • Urethrostomy reduces the risk for reobstruction but does not always resolve clinical signs of FLUTD.

  • PU is associated less frequently with complications (eg, recurrent FLUTD, UTIs, peristomal dermatitis) and has higher pet owner satisfaction than does PPU.

  • PPU should be limited to cases in which PU or other more distal urethrostomies cannot be performed.