What is the medical term for the surgical creation of a permanent opening between the urethra and the skin?

A perineal urethrostomy (sometimes referred to as a PU) is a surgical procedure that is most commonly performed on male cats with a urinary obstruction. This procedure removes the narrowest part of the urethra (the tube that transports the urine from the bladder to the exterior of the body), allowing easier urination with a lower risk of reobstruction.

Male cats develop urinary obstructions much more readily than female cats, due to differences in urinary tract anatomy between the two sexes. While the female urethra is relatively short and maintains a consistent diameter as it travels from the bladder to its external opening, the male urethra differs in that it is slightly longer and, more importantly, it narrows as it enters the penis. This narrowing of the urethra predisposes males to urinary obstructions, in which the urethra becomes blocked with stones, blood clots, mucus, or tumors. A perineal urethrostomy creates a new urinary opening that decreases the length of the urethra and allows urine to bypass this narrowed region. This surgery can decrease the likelihood of recurring obstruction.

Less commonly, perineal urethrostomy may also be performed in cats with severe urethral trauma. By allowing urine to exit the body before it reaches the damaged part of the urinary tract (for example, in the case of traumatic injury to the penis), your veterinarian can ensure that complications such as scar tissue or infection do not cause a urinary obstruction for your cat.

When is perineal urethrostomy surgery recommended?

Perineal urethrostomy surgery is most commonly recommended in the following situations.

• A urethral obstruction within the penis that cannot be removed through medical therapy. Typically, urethral obstructions are dislodged by the passage of a urinary catheter. This catheter is advanced through the external opening of the urethra towards the bladder; any stones or mucus that are present within the urethra are flushed into the bladder, where they can be addressed using medication or surgery. In the case of an obstruction that cannot be alleviated with a catheter, perineal urethrostomy may be required to re-establish urine flow and allow the cat to urinate.

• Recurrent urethral obstructions. In some male cats, urinary obstructions may become a frequent occurrence. Even if these cats can be unblocked, cats who frequently reobstruct may benefit from a perineal urethrostomy to decrease the likelihood of future obstructions.

How is a perineal urethrostomy surgery performed?

Your cat will undergo a pre-surgical examination, as well as pre-anesthetic blood testing prior to anesthesia. This pre-surgical evaluation will allow your veterinarian to assess your cat’s health status and ensure that he is a good candidate for anesthesia.

"If your cat is currently obstructed, he will be stabilized prior to surgery."

If your cat is currently obstructed, he will be stabilized prior to surgery. This stabilization will involve administering intravenous fluids to correct dehydration and electrolyte abnormalities. Pre-surgical stabilization will make your cat a better candidate for anesthesia and decrease the likelihood of complications.

Following the pre-surgical evaluation, your cat will be administered medications and placed under general anesthesia. The surgical site will be prepared, shaving the hair from the area and using surgical scrub to remove bacteria from the surface of the skin in order to prevent infection. The surgeon will then perform the perineal urethrostomy by removing the penis and suturing the deeper, larger-diameter region of the urethra to the skin to create a new urinary opening.

What after-care is required following a perineal urethrostomy?

After surgery, your cat will be required to wear an Elizabethan collar (e-collar) to prevent self-trauma to the surgical site. Excessive licking can interfere with healing, leading to infection and scar tissue formation.

Your cat will also need to be kept calm and have his activity restricted. Your veterinarian may recommend confining your cat to a small area, away from other pets, where his activity can be limited and he can be closely monitored.

What are the expected outcomes after a perineal urethrostomy?

With appropriate pre-surgical stabilization, surgical technique, and aftercare, the prognosis for patients with perineal urethrostomy is good. Occasionally, a stone may form that is too large to pass through the urethrostomy opening; however, this is uncommon and most cats do not reobstruct after a perineal urethrostomy.

ASA – Aspirin

BID – twice a day

Bladder Augmentation – is a reconstructive surgery to increase the reservoir capacity of the bladder.

Bladder Instillation – Instilling medication into the bladder through a catheter that is inserted into the urethra to the bladder.

Brachytherapy – the placement of radioactive sources (SEEDS) in contact with or implanted into tumor tissues to be treated for a period of time.

Circumcision – removal of foreskin for penis

Contigen injections – injecting collagen into the urethra to help treat urinary incontinence or leakage.

Cryotherapy – using cold as a destructive medium

Cystectomy – surgical removal of the bladder

Cystoscopy – fiberoptic scope used to look into the bladder

DaVinci Robotic Prostatectomy – robotic assisted surgical procedure that removes the prostate when cancer is present.

Diverticulectomy – Surgical removal of a pouch-like herniation in the bladder.

Deflux – a treatment option for a Vesicoureteral Reflux (VUR)

Dysuria – pain with urination

Endopylotomy – endoscopic procedure done when there is an obstruction of the ureter

Epididymis – a coiled tube behind each testicle

Epididymitis – inflammation of the epididymis

Epididymectomy – Surgical removal of the epididymis

Green Light Laser (GLL) – a treatment option for an enlarged prostate. It uses laser energy to remove enlarged prostate tissue.

Hematuria – blood in the urine

Hydrocele/Inguinal Hernia Repair – (pediatric) repair the hernia in the groin area

Hydrocelectomy – (Adult) removal of fluid around the testicle

Hydrodistention – surgery that expands the bladder with sterile water to diagnose and treat interstitial cystitis.

HS – bedtime

Hypospadius Repair – surgical correction of the placement of the urethral opening

 – am implanted electrical device for urgency, frequency, incontinence, and pain.

Kidney Stone – stone that forms in the kidney, and can drop down into the ureter and eventually down to the bladder.

Lithotripsy (ESWL) – shock wave lithotripsy for kidney stones, uses sound waves to break up kidney stones.

Meatotomy – surgery that dilates the meatus (opening to the urine channel) to help improve urination

Microwave Therapy – used in treating BPH (enlarged prostate) with exposure to high temperatures.

Neo Bladder – a surgical procedure done to create a new bladder from the large intestine, once a cystectomy is done.

Nephrectomy – surgical removal of the kidney

NKA – no known allergies

NKDA – no known drug allergies

NKMA – no known medical allergies

Nocturnal Enuresis – night time incontinence, or bed wetting.

NPO – nothing by mouth

Orchiectomy – surgical removal of testicle

Orchiopexy – bringing testicle down into the scrotum

Orchitis – inflammation of the testicle

Paraphimosis – the foreskin is retracted for so long that it is unable to be pulled back over the head of the penis.

Partial Cystectomy – surgical removal of part of the bladder

Partial Nephrectomy – surgical removal of part of the kidney

Partial Penectomy – surgical removal of part of the penis

Penectomy – surgical removal of the penis

Penile Prosthesis – a device surgically implanted in the penis to treat erectile dysfunction

Perineal Prostatectomy – surgical removal of the prostate through an incision between the scrotum and the anus.

Pessary – a device inserted into the vagina to function as a supportive device for the uterus.

Phalloplasty – repairative or plastic surgery to the penis.

Pyelolithotomy – removal of a stone from the pelvis of the kidney through an incision.

Pyeloplasty – repairative surgery on the pelvis of the kidney.

Radical Prostatectomy – surgical removal of prostate gland and some surrounding tissue.

Retropubic Prostatectomy – surgical removal of the prostate through an incision in the abdomen.

Sacral Neuromodulation – am implanted electrical device for urgency, frequency, incontinence, and pain.

Stone Extraction – surgical removal of kidney, bladder, ureteral stone.

Suprapubic Tube Placement – procedure where a catheter is placed in the bladder through an incision in the lower abdomen, above the pubic bone.

Ureteral Reimplantation – surgery that changes the way an abnormally positioned ureter connects to the bladder.

Ureteral Stent – a small tube placed in the ureter to allow the kidney to drain fluid to the bladder.

Urethroplasty – surgical procedure done to reconstruct the urethra.

Ureteroscopy – a small scope is inserted into the bladder and then into the ureter.

Urinary Diversion – procedure done to reroute urine flow from its normal pathway, once the bladder has been surgically removed.