Clinical outcomes of 28 cats 12–24 months after urethrostomy

Abstract

Objectives The aim of this study was to evaluate and compare the long-term clinical outcomes and quality of life of cats having undergone perineal urethrostomy (PU) or prepubic urethrostomy (PPU). Methods This clinical study followed 28 cats (PU, n = 22; PPU, n = 6) that underwent a urethrostomy, with a minimum of 1 year postoperative follow-up. Medical records, pet owner surveys and urologic laboratory tests were used for assessment. Urologic laboratory tests included serum symmetric dimethylarginine (SDMA), serum creatinine, urinalysis, urine specific gravity (USG), urine protein:creatinine (UPC) ratio and urine culture. Results The main indications for urethrostomy were multiple catheterizations and PU stricture. The overall complication rates of PU and PPU were 31.8% and 83.3%, respectively. Recurrent urinary tract infection (UTI) and urine scald dermatitis was less frequent in PU than in PPU cats (UTI 22.7% vs 66.6%; dermatitis 4.5% vs 83.3%). Bacteriuria was present in 77.2% and 100% of PU and PPU cats, respectively. Owner satisfaction rates were excellent in 81.8% of PU and 33.3% of PPU cases. Conclusions and relevance A proportion of cats that underwent urethrostomy showed bacteriuria, recurrent UTIs and increased levels of SDMA. PPU is important as a salvage procedure; however, it should be limited to cases in which standard techniques for PU cannot be performed, owing to the potential for recurrent complications and lower owner satisfaction.

Comparison of surgical indications and short- and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy

“…This is in contrast to a recent study of 28 cats which reported a higher incidence of UTIs in cats undergoing PPU compared to PU (66.7% vs 22.7%). 5 Urethrostomy stricture has been reported in up to 11% of cats in early reports of PU 11 but does not feature in all case series. This may be due to early reports identifying the primary cause for stricture as inadequate release of the penile urethra from the pelvis , which could then have been avoided in later studies.…”

“…Two previous studies have reported no stricture formation following PPU. 4,5 Similarly, only 1 out of 9 cats undergoing TPU showed evidence of stricture but showed no associated clinical signs. 6 In our study, stoma stricture was noted in one PPU cat and one TPU cat within 4 weeks of surgery and in another PPU cat 9 months after surgery.…”

“…5 This difference in PPU satisfaction may be due to indication for urethrostomy, rather than surgical technique. In the study by Sousa-Filho et al 5 , primary indication for PPU was feline lower urinary tract disease plus failed PU, but the primary indication for PPU in the current study was pelvic urethra trauma.…”

“…5 This difference in PPU satisfaction may be due to indication for urethrostomy, rather than surgical technique. In the study by Sousa-Filho et al, 5 the primary indication for PPU was feline lower urinary tract disease plus failed PU, but the primary indication for PPU in the current study was pelvic urethra trauma. Urethrostomy does not correct the underlying problem in feline lower urinary tract disease, but cats presenting with urethral trauma (excluding iatrogenic causes) have no underlying urinary tract disease.…”

“…3 Complication rates of up to 83.3% and mortality rates of up to 38% are reported, which appear to exceed those of PU. 4,5 Due to the apparently high complication rate associated with PPU compared to PU, transpelvic urethrostomy (TPU) has been described as an alternative technique for cats with failed PU. 6 In this procedure the caudal intrapelvic urethra is accessed by making a window in the pubis.…”