Feline lower urinary tract disease (FLUTD) is a group of conditions that affect a cat's bladder and urethra. There are several possible causes of FLUTD, including feline idiopathic cystitis (FIC), urinary crystals or stones, and urethral plugs. FLUTD is something we see relatively commonly in cats. It can cause frequent trips to the litter tray, blood in urine, painful straining, and in male cats, a potentially life-threatening urinary obstruction.

While some cats only experience a single episode in their lifetime, others develop recurrent urinary problems that significantly impact their quality of life. My own cat Ash’s story is an example of how challenging recurrent FLUTD can be, and how treatment sometimes needs to progress beyond managing individual episodes to consider longer-term solutions.

When one blockage became three

Ash's first urinary obstruction was frightening. He was constantly moving from one corner of the house to another, repeatedly squatting and straining to urinate, but unable to pass any urine. He required emergency treatment, including placement of a urinary catheter to relieve the obstruction.

I hoped that this would be an isolated event and that, with appropriate management, we could prevent it from happening again.

Unfortunately, this was not the case.

Ash went on to become blocked three separate times. Each time, he required hospitalisation and placement of a urinary catheter to relieve the obstruction. After each episode, I hoped that treatment, hydration and ongoing management could keep him comfortable and prevent it from happening again.

But what became increasingly concerning was the amount of time between each obstruction.

The intervals were getting shorter.

I was spending more and more time worrying about whether he would obstruct again. Every trip to the litter tray brought a little anxiety – was he actually urinating or was this the beginning of another emergency?

The turning point

When we eventually removed the catheter for the third time, I hoped it would be the final time. Instead, he re-obstructed almost immediately.

This was the point when I had to step back and look at the bigger picture. It was no longer about simply treating occasional, isolated episodes of urinary obstruction. I had to consider a different approach.

Perineal urethrostomy

A perineal urethrostomy (PU) is a surgical procedure performed in male cats that are experiencing recurrent urethral obstructions. The surgery involves removing the narrower portion of a cat's urethra and suturing the wider portion directly to the skin to create a new, larger urinary opening.

A PU does not cure the underlying cause of FLUTD. Cats can still develop cystitis, urinary crystals, stones, or other urinary issues after surgery. However, by creating a wider urinary opening, the procedure significantly reduces the risk of another life-threatening obstruction occurring at the narrow part of the urethra.

Taking the next step

Deciding to put my own cat through surgery wasn't easy.

There are risks associated with PU, including bleeding, infection, urinary tract infections, and narrowing of the new opening (stricture). There was also the possibility that Ash could continue to experience signs of FLUTD after surgery.

But I had to weigh those risks against what I already knew.

Three obstructions.

Three urinary catheterizations.

And increasingly shorter periods between episodes.

At that point, continuing to treat each obstruction as it happened no longer felt like the best long-term option for him.

I ultimately decided to go ahead with perineal urethrostomy.

Life after surgery

Thankfully, Ash's surgery went incredibly smoothly, and before long, he was back to his usual self – eating, playing, and doing all the other things that make him Ash. He is happier than ever now, and seeing him comfortable and enjoying life again has made the decision to proceed with surgery feel completely worthwhile.

As a veterinarian, I knew how serious FLUTD and urethral obstruction could be, but experiencing it with my own cat gave me a very different perspective on just how stressful, frightening and exhausting recurrent urinary disease can be.

For Ash, a perineal urethrostomy wasn't the end of his urinary disease, but a way of breaking the cycle of repeated obstruction and giving him a happier, more comfortable life.