Piglet, a nine-year-old tabby cat, looked me right in the eye. It was midnight. I don’t usually offer nighttime care, but Piglet had arrived on emergency 24 hours earlier for a urinary tract blockage and I’d been checking his bladder repeatedly ever since. Feline Lower Urinary Tract Disease is a common syndrome encountered in veterinary medicine, a catchall name encompassing a multitude of problems that all result in inflammation of the bladder and/or urethra.
We call it FLUTD (pronounced fluted) for short. Although it occurs in both sexes, in tomcats FLUTD can be life-threatening. It’s all about anatomy. In female cats, the urethra (the tube which carries urine from the bladder out of the body) is short, ending in a relatively wide opening inside the vulva. In male cats, the urethra travels farther. The last inch becomes very narrow and makes an “S” shaped curve before reaching the tip of the penis.
In FLUTD, urine from the inflamed bladder may contain mucous, crystals, red and white blood cells, bladder epithelial cells, even tiny bladder stones. This material can get stuck in that narrow male urethra causing an obstruction. With the urethra blocked, urine backs up. The bladder becomes excessively distended and tense. Clinical signs can include non-productive straining to urinate, abdominal pain, licking the genitals, loss of appetite, vomiting, acute kidney failure, severe electrolyte imbalances, possible bladder rupture, and eventually collapse, and death.
When Piglet arrived, the first thing we needed to do was relieve the obstruction by putting in a urinary catheter. Easier said than done. Sedation or even general anesthesia is often needed. My friend, Piglet, was feeling pretty badly, however, leaving him sufficiently apathetic that I was able to start placing the urinary catheter without knocking him out. As expected, within a centimeter from the tip of his penis, the catheter encountered resistance — the obstruction. What we do then is simple. We try to flush the junk out of the way by pulsing blasts of sterile saline through the catheter with a syringe, then advance the catheter farther and farther until it reaches the bladder.
Piglet’s case was tough, requiring multiple flushes but we eventually got the catheter in and were able to empty out the urine. Once the catheter is in place, sometimes we just flush the bladder, then pull out the catheter. Other times we sew it in place for a day or two, allowing time to treat the FLUTD without having to worry about our patient reblocking. Ah, there’s the rub. Cats with urethral obstruction have a high risk of blocking again in the first few days to weeks after the initial episode.
Piglet was one of those cats. In fact, Piglet seemed to have almost every complication possible. The night he first presented, he was in kidney failure due to the length of time he was blocked. Luckily, relieving the obstruction, followed by several days of intravenous fluid, returned his renal function to nearly normal. Then there was the issue that his bladder had been distended so long it had lost its ability to contract well. I knew by keeping his bladder emptied and using medication to stimulate muscle contraction, it would most likely regain contractility.
That’s where things stood that Saturday night. I had pulled the catheter earlier, hoping he could now pee on his own. But he couldn’t. With no one around to hold him for me, I had worked on developing a rapport with him. I petted him. I talked to him. “Let me help you,” I said soothingly, placing one hand on either side of his belly and gently squeezing out the urine. It hadn’t been coming in a good stream, but at least it was coming out, and he was letting me do it every few hours.
Then, at midnight, I squeezed him and nothing came out. His bladder was tense and distended again. Now I pride myself on being good with cats. Piglet and I understood each other, right? Such hubris. Piglet suddenly had enough. He turned without warning and sank his fangs deep into my arm. I think it hurt my feelings almost as much as my arm. So there we were. I had to sedate him and relieved the blockage. Again. Sew the catheter in place. Again. And add an Elizabethan collar to keep him from chewing it all out.Over the next few days Piglet proved to be a Houdini, pulling out every catheter I put in, despite sutures, despite the E-collar. I put on a bigger collar. He managed to get it off overnight. And he kept reblocking. Each time he needed sedation to replace the catheter. Urine culture showed a bacterial infection, resistant to all the usual antibiotics. Radiographs revealed multiple small bladder stones. By the end of a week it was apparent Piglet needed a perineal urethrostomy, often simply referred to by vets as a P.U.
Perineal urethrostomy is surgery intended to prevent the recurrence of obstruction by creating a wider outlet for the urine flow. The surgeon actually removes the penis, which contains that narrow S-shaped portion of the urethra, and makes a new opening, more like a female cat’s. Sounds bad, I know, but without that P.U. surgery, Piglet can’t pee. If he can’t pee, he can’t survive. As many as a third of all cats presented for urethral obstruction are eventually euthanized due to repeated blockage. Cats with P.U.s are still susceptible to FLUTD, but it is no longer life-threatening.
Piglet’s surgery went well. The stones were removed. The specialists were not overly concerned about the bacterial infection. Now we just have to hope he heals well, his bladder contracts normally, and that there is not too much residual kidney dysfunction.
Me? When my arm started to swell up and turn bright red, I saw the doctor and got some antibiotics. But I don’t hold a grudge. I’m one of Piglet’s biggest fans, despite that momentary lapse when he forgot how good I am with cats.