Which Should I Choose? ...Prepubic / Subpubic / Transpubic Urethrostomies

Introduction
Urethrostomy is indicated for permanent relief of urethral obstruction in male cats. Obvious, although uncommon, indications are irreversible trauma and neoplasia. Obstructive lower urinary tract disease (OLUTD) from matrix crystallin plugs or uroliths that cannot be managed conservatively, is the major indication for urethrostomy, made to circumvent the life-threatening consequences of urethral obstruction.

OLUTD occurs predominantly in the narrow distal portion of the urethra. Irrespective of cause, initial treatment must focus on the restoration of urethral patency and urine flow. Non-surgical techniques, including penile massage and retrograde urethral flushing, can be very effective, or not, in dislodging intraluminal plugs and uroliths. Further medical management may include treatment of urinary tract infection (UTI), dietary recommendations for the dissolution of urocystoliths and/or crystals, and prevention of their reformation, and use of relaxing medical agents. Cats suffering from non-relievable obstructive urethral conditions, urethral strictures, trauma or neoplasia, can benefit from surgical urethrostomy procedures designed to create a permanent opening of the urethra, above the level of the obstruction, to restore the urine outflow.

To date, 4 types of urethrostomy techniques have been described in cats, depending on their location on the urethral length. Historically, the pre-pubic urethrostomy (PPU), also termed ante-pubic, was the first to be described in the fifties. The perineal urethrostomy (PU) and the subpubic urethrostomy (SPU) were described later. The transpelvic urethrostomy (TPU) was documented 10 years ago. [...]