Orby Perineal Urethrostomy
Meet Orby
The Problem
Over the course of a few weeks, Orby developed repeated episodes of urethral obstruction, where the urethra—the tube carrying urine from the bladder to the outside—became blocked.
Despite treatment with urinary catheterisation and medication, the problem continued to recur and Orby was increasingly unable to urinate, even with his owner’s help.
Urethral obstruction is an emergency in male cats. If urine cannot leave the bladder, pressure builds within the urinary system and potentially dangerous changes to kidney function and blood electrolyte levels can develop.
Signs of urethral obstruction can include:
- Repeated attempts to urinate while passing little or no urine
- Straining or crying when trying to urinate
- Frequent visits to the litter tray
- Urinating outside the litter tray
- Blood in the urine
- Increased agitation or restlessness
- Excessive licking around the genital area
- Reduced appetite or becoming quiet and withdrawn
- Vomiting
A cat that is repeatedly straining but unable to pass urine requires urgent veterinary attention.
Surgical Treatment
As Orby’s obstruction continued to recur despite urinary catheterisation and medical management, the decision was made to perform a perineal urethrostomy (PU).
The aim of this procedure is to remove the very narrow terminal portion of the male urethra and create a new, permanently wider opening through which urine can pass.
Under general anaesthesia, Orby was positioned to allow careful access to the perineal region. A urinary catheter was placed before surgery to help identify and manipulate the urethra during the procedure. Because the surgical site lies very close to the anus, meticulous clipping, preparation and isolation of the area were particularly important to minimise contamination.
During surgery, the penis was carefully dissected from the surrounding tissues. The muscles attaching it within the pelvis were released, allowing access to the wider pelvic portion of the urethra.
The urethra was then carefully opened along its length until a sufficiently wide section was reached. The edges of this wider urethra were meticulously sutured directly to the surrounding skin, creating a new urinary opening (urethrostomy).
The remaining penis and narrow terminal urethra were then removed.
Particular care is required during this procedure to minimise tissue trauma and create a wide, tension-free opening. Accurate placement of the very small sutures is important to encourage good healing and reduce the risk of postoperative narrowing (stricture formation).
After the surgery
Following surgery, Orby had a new, considerably wider urethral opening and did not require an indwelling urinary catheter.
The surgical site requires careful management during the initial healing period. Some swelling and inflammation are expected, and the new opening will naturally reduce slightly in size as healing progresses over the following couple of weeks.
Long-term management of any underlying urinary tract disease remains important, as a PU does not prevent bladder inflammation, urinary crystals or stones from developing. However, by removing the narrowest portion of the male urethra, the procedure can dramatically reduce the risk of these causing another life-threatening obstruction.
Summary
Orby’s case was particularly challenging because of the lasting effects of his previous road traffic accident and his pre-existing difficulties with normal urination.
His owner had successfully supported him for several years, but when recurrent urethral obstruction could no longer be controlled with medication and catheterisation alone, surgery offered a more permanent solution.
A perineal urethrostomy can be a life-changing procedure for appropriately selected cats with recurrent or unmanageable urethral obstruction—allowing them to urinate through a wider opening and reducing the risk of another potentially life-threatening blockage. 🐾
Advanced Surgical support for Veterinary Practices in Durham, Stockton on Tees, Northallerton, and Darlington.
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