About six weeks ago I neutered a nice little black kitten named Jaws. In and of itself this isn’t unusual. On average, especially in the spring (I’ll get back to the ‘spring’ part later), I’ll neuter six or eight kittens in a week.

About a week after his surgery I got a phone message from Jaws’ mom. Jaws was acting cranky, he was hissing at his brother Moose, he wouldn’t play, and he was dribbling urine around the house.
Erm.
Well any report of ANY male cat dribbling urine around the house makes me anxious, regardless of whether or not I’ve recently had anything to do, however indirectly, with his plumbing.
I didn’t have any space in my schedule for that day so I had the receptionist call Jaws’ mom and instruct her to take Jaws directly to the ER so he could be evaluated.

Presently I got notification over the fax machine that Jaws had been admitted to the ER with a urethral (the urethra is that bit that hooks the urinary bladder to the outside world for those of you not in the know) obstruction. The obstruction had been relieved and Jaws was currently resting comfortably with a urinary catheter in place. Jaws would be discharged in a few days.

A brief pause to delve into the medicine part:
1. The urethra of the male cat is quite narrow and makes some very remarkable twists and turns on its path to the outside.
2. Male cat urine can tend to be very concentrated and occasionally, for a laundry list of reasons, they will start to form microscopic mineral crystals in their urine.
3. When the correct conditions are met (plenty of crystals, cat unable or unwilling to urinate for a period of time, under the correct phase of the moon the cat walked under a ladder while a black cat crossed his path etc. {these last two conditions are facetious by the way}) the crystals will form a plug, usually at one of the more tortuous turns in the urethra, and the cat will be unable to urinate. This, if you hadn’t guessed, is BAD NEWS.
4. The way we want treatment to go in these guys is as follows. With a moderate amount (depending on the size, location, and duration of the plug) of bad language a urinary catheter is placed and the bladder emptied and flushed. The urinary catheter is left in place for 48 hours or so to allow the bladder to rest after having been stretched out. After 48 hours the urinary catheter is removed and the cat is monitored for another 12-24 hours to be sure he can pee normally. Occasionally what will happen is that we remove the urinary catheter and start to monitor the cat’s urinations only to find that the urethra has been so irritated by the combination of the plug, the relief of same, and the urinary catheter, that it swells and the cat is unable to pee again. This results in further bad language.

And unfortunately this is what happened with Jaws. We got a tearful call from Jaws’ mom on the Wednesday of the week he had been admitted to the ER. Jaws’ urinary catheter had been removed, he had re-obstructed, and he either needed immediate surgery or he needed to be euthanized. She couldn’t afford the surgery and he is only a baby and she didn’t want to put him down and, and, and, and, and…..
There is a third option.
Sometimes, not often, but sometimes, you can replace the urinary catheter, keep it in place for another 48 hours or so, blast the bejeesus out of the cat with anti-inflammatory medications then remove it to find everything hunky dory. We offered her that option, she accepted.
Unfortunately it didn’t work.
We re-admitted Jaws on Wednesday afternoon and I replaced the urinary catheter. We blasted the bejeesus out of Jaws with IV fluids and anti-inflammatory medications for 48 hours and by Friday evening he could only sort of pee. Sort of.
I got a call on Friday evening from our office manager on behalf of my boss. The surgery the cat needed wasn’t, she knew, something that I’d done before, but would I be willing to give it a try? I’ve rather a reputation at my current hospital as a rather experienced surgeon and I’ve performed surgical procedures that the other two doctors wouldn’t come close to attempting. I like surgery, I like the cat, and honestly I felt sorry for the owner so I agreed.

The surgical procedure is called a perineal urethrostomy. You create a permanent opening (a stoma) in the urethra and have it exit the body in the perineal space, thus a perineal urethrostomy. It is technically a simple surgery, really. All you’re doing is basic deconstruction and so long as you know what bits of anatomy you’re dealing with and so long as you can sew it’s simple. I’ve read the procedure several times, I did a whole bunch of research into possible complications. There are a large number of potential complications and the bottom line is that when something like this goes wrong, it goes wrong in really ugly ways.
I must have done the surgery in my sleep dozens of times overnight on Sunday so that by Monday morning I was completely keyed up and, from having read afresh the rafts of “oh my god it all went pear shaped” posts regarding PU surgeries on my online vet site, was thoroughly convinced that there was no way that this wasn’t going to make me absolutely miserable. BUT I’d agreed to do it, I’d put my reputation on the line, and really there was no other option but euthanasia for the cat so……

So I re-plumbed the cat. I won’t go into details because it’d gross too many people out, but whatever I did seemed to work. Jaws was up and about that afternoon not only able to control his urination, but able to empty his bladder completely. Jaws was making happy feet (I believe in STURDY postoperative pain control) and eating by the time I left that evening.
And he came back to have his few remaining sutures removed about a week ago. Happy, purring, peeing like a champ, and growing the hair back along his shaved little baboon butt.

Veterinary medicine is so cool.