Slater MR, Pailler S, Gayle JM, Cohen I, Galloway EL, Frank KA, DeClementi C. Welfare of cats 5-29 months after perineal urethrostomy: 74 cases (2015-2017). J Feline Med Surg. 2019 Aug 19;:1098612X19867777. doi: 10.1177/1098612X19867777
Perineal urethrostomy is a procedure performed in male cats to shorten and widen the urethra with amputation of the penis. It is generally performed as a “last-line” or salvage procedure to manage recurrent or severe lower urinary tract obstructions in cats. Perineal Urethrostomy (PU) is controversial, as it does not fix the underlying cause of urinary obstructions and has many reported complications including infection, stricture, incontinence, and continued lower urinary signs. Despite these and other drawbacks, it dramatically reduces the risk of lower urinary obstruction. The purpose of this study was the determine the long term health and welfare, quality of life, and retention in the home of cats after PU surgery.
The study was designed as a survey-based study evaluating the opinions of owners of cats after PU surgery performed in an ASPCA hospital in New York City over an ~2y period. Surveys were performed by a combination of phone calls, emails, and texts and involved a combination of open and closed ended questions. These consisted of questions of whether the cat was alive and still in the same home, litter box and urination issues, food and water, veterinary history, and quality of life.
All surgeries were performed according to a standard protocol, however aftercare was not standardized. All cats in the study were male. The mean age was 4y and mean weight 5.3kg. Only 22% of cats had a urinalysis with culture performed. Of the 86% of cats where the reason for PU was recorded, 73% had failed medical management, 16% were for financial reasons, and 11% were a combination of both. Mean time in hospital was 6 days.
122 cats had surgery performed in this time period. Five of these had no contact information available and 4 died or were euthanized during or soon after surgery (3.3%). Nine owners were unable to be contacted, leaving 104 owners enrolled, of which 74 completed the survey (71%).
The following data were determined:
- 90% of cats were still in the same home, with 8% rehomed due to reasons unrelated to PU and 1% dying of unrelated reasons
- 27% of cats had post operative litter box issues, of which 22% persisted longer than 2 weeks
- 83% of owners continued to feed a special or canned only diet
- 93% of owners completed the quality of life score. All of these owners ranked QoL as 7/10 or higher, and 75% scored 10/10
- 48% of owners said their cat’s lives were better and 52% the same as before surgery
Overall, the authors concluded that the long term outcomes of PU surgery in this cohort of cats were excellent, and the PU may be recommended earlier in management than previously thought.
It is crucial to note that these PU surgeries were performed by experienced (99% of them board certified) surgeons with excellent technique. Given the degree of finesse needed for this procedure, these data are not likely generalizable to less experienced surgeons.
Several drawbacks to this study exist. Among these are the retrospective survey based design, introducing possible response bias and error through the unvalidated QoL survey. The study also relied on owner opinions of outcomes and did not involve evaluation by veterinary professionals. The short follow up time is also a concern (median 7 months) as many lower urinary signs are intermittent or seasonal in nature and may not have had time to recur.
Despite these possible limitations, this study demonstrates that when performed by experienced surgeons, PU surgery may have a positive outcome in a large majority of cats, leading to a good quality of life and low risk of surrender, though urinary issues persisted in 27% of cats (possibly due to lack of control of the underlying issues).