What to Do with a Failed Perineal Urethrostomy

Feline perineal urethrostomy is most often performed because of unresolvable or recurrent urethral obstructions. The most common etiology of feline urethral obstruction in the United States is urolithiasis, although mucoid plugs still occasionally occur. Feline uroliths often consist of calcium oxalate, and concurrent cystotomy may be necessary to remove cystic calculi in cats undergoing perineal urethrostomy.

Complications of feline perineal urethrostomy include hemorrhage, urinary tract infection, stricture, subcutaneous urine leakage, wound dehiscence, and recurrent obstruction from calculi. Stricture rates in recent reports varied from 0% to 13.5%  Strictures of the urethrostomy site have been blamed on a variety of causes, including postoperative catheterization or lack of Elizabethan collar use, but it is likely that poor surgical technique plays an important role in their development.

In the largest study to date, revision of perineal urethrostomy was reported in 11 cats. Eight cats had evidence of inadequate dissection: pelvic muscular and ligamentous attachments remained intact, and the urethrostomy did not extend up to the level of the bulbourethral glands. Three cats had evidence of extravasation of urine into subcutaneous tissues. This can occur with poor mucosal to skin apposition, self- trauma, or in cases where the perineal urethrostomy is very proximal and is therefore under tension. With high perineal urethrostomies in cats, I prefer to place a Foley catheter for 1 to 3 days after the surgery until any gap in the mucocutaneous junction is sealed. Stricture formation does not seem to be associated with suture material or pattern: in one study, use of a simple continuous, absorbable suture pattern for mucocutaneous apposition did not result in strictures in cats, despite the fact that the suture was not removed later by the veterinarian. Removal likely occurring by the cat after removal of the Elizabethan collar 2 weeks later.  [...]