ABSTRACT OF THE WEEK

Journal of Small Animal Practice
Volume 53 | Issue 12 (December 2012)

Short- and long-term outcome after perineal urethrostomy in 86 cats with feline lower urinary tract disease.

J Small Anim Pract. December 2012;53(12):693-8.

L Ruda¹, R Heiene

¹ Blue Star Small Animal Hospital of Gothenburg, Gothenburg, Sweden.

Abstract

BACKGROUND:Perineal urethrostomy is a surgical method for alleviating urethral obstruction in cats with complicated or recurrent obstructive feline lower urinary tract disease. However, long-term outcome of perineal urethrostomy in cats with feline lower urinary tract disease has only been described in studies with relatively few cats.

OBJECTIVES:The aim of this study was to evaluate the long-term prognosis, recurrent episodes, quality of life and survival times in cats with feline lower urinary tract disease who underwent perineal urethrostomy.

MATERIALS AND METHODS:Data was collected from 86 cats from medical records, including 75 cats with at least 6 months survival, whose owners responded by questionnaire-based telephone interviews.

RESULTS:Long-term follow-up ranged from 1·0 to 10·4 years. The median survival time for all cats was 3·5 years after surgery. Forty-seven cats were still alive at the time of the study. Five cats (5·8%) did not survive the first 14 days after perineal urethrostomy surgery; another six cats (7·0%) did not survive 6 months. Seventy-five cats (87%) lived longer than 6 months; 45 (60%) of these were asymptomatic after surgery; 8 of 75 cats (10·7%) experienced severe signs of recurrent feline lower urinary tract disease. For 19 cats, data were available for more than 6 years. Among these, 13 cats were still alive at the time of this study. The six non-surviving cats had all been euthanased for diseases unrelated to the urinary tract. Eighty-eight percent of the owners categorised their cat's long-term quality of life as good.

CLINICAL SIGNIFICANCE:This study shows that long-term quality of life after perineal urethrostomy in cats with obstructive feline lower urinary tract disease is good (as assessed by owners) and the recurrence rate is low.

Companion Notes

Retrospective report on the short- and long-term outcome after perineal urethrostomy in 86 cats

Study design

- introduction on urethral obstruction in the cat

- reported in 28.6-58% of cats with feline lower urinary tract disease (LUTD)

- re-obstruction reported in 22-35% within 6 months of obstructive LUTD

- perineal urethrostomy (PU) may prevent urethral obstruction

- surgical treatment however does not eliminate LUTD

- complications of PU include the following:

- urethral strictures

- cystitis

- wound dehiscence

- urinary or fecal incontinence

- urinary tract infection

- several reports show it predisposes to UTIs

- quality of life (QOL) after PU is controversial

- if PU resulted in poor (QOL) many owners would elect euthanasia

- survival times may indirectly indicate quality of life

- study population:

- 86 neutered cats seen in Gothenburg, Sweden over past 10 years

- PU as modified by Wilson and Harrison (1971)

(Wilson, G. R & Harrison, W. (1971) Perineal urethrostomy in cats.

Journal of the American Veterinary Medical Association 159, 1789)

- performed by 19 different vets with variable specialization and experience

- postop therapy: IV crystalloid fluids, opiate analgesics and E-collar

- antibiotic if urinary tract infection present

- non-steroidal anti-inflammatory drug (NSAID), most cats

- therapeutic diet if indicated for struvite or oxalate uroliths

- canned food recommended to increase water intake

- methods to increase water intake recommended

- minimum followup time: 1 year (mean followup: 4.2 years)

- median age at surgery: 5.0 years of age with a range of 1-11 years

- median weight at surgery: 5.1 kg with a range of 2.5-9.3 kg

- 14 cats had simultaneous cystostomies to remove material from bladder

- owners responded to questionnaire-based telephone interviews

- 75 cats had at least 6 months survival

- procedure: records retrospectively reviewed

Results (long-term followup from 1.0-10.4 years)

- median survival time for all cats: 3.5 years postop (47 still alive at study end)

- 5 cats (5.8%) did not survive the first 14 days postop

- re-obstruction, 3 cats

- sepsis, 1

- multi-systemic disease, 1

- 6 cats (7.0%) did not survive 6 months

- stricture, 2 cats

- stricture and chronic cystitis, 1 cat

- re-obstruction, 1

- recurrence of hematuria/dysuria (LUTD)

- 75 cats (87%) lived over 6 months

- 45 (60%) of these were asymptomatic postop

- 22 (29.3%) had 1-2 mild episodes of recurrent LUTD

- recurrence indicated by the development of lower urinary tract signs

- hematuria, dysuria, pollakiuria, stranguria, periuria etc

- 8 (10.7%) of these had severe signs of recurrent LUTD

- among 19 cats with a followup of more than 6 years

- 13 cats still alive at study end

- 6 had been euthanized for diseases unrelated to the urinary tract

- 88% of owners felt their cat's long-term quality of life was good

“Most cats in this study became asymptomatic after surgery or experienced few relapses, which could be managed medically. The majority of the owners considered their cat to have a good quality of life after PU.”

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