Transpelvic urethrostomy in 11 cats using an ischial ostectomy

To investigate the feasibility and long-term outcome of a modified subpubic urethrostomy technique termed transpelvic urethrostomy (TPU) in cats.

Prospective clinical study.

Eleven male cats with obstructive lower urinary tract disease that could not be relieved, and requiring a surgical urinary diversion, were selected for TPU.

With the cat in dorsal recumbency, the penis was exposed and the ventral pelvis was denuded by median adductor muscle elevation. An approximately 12 mm x 15 mm area of ischium was removed. The pelvic urethra, 8-20 mm cranial to the bulbourethral glands, was incised longitudinally and sutured to the skin to create a urethrostomy.

All cats were neutered males (2-9 years); none were uremic or hyperkalemic at admission. Urine was cultured if there was leukocyturia, nitrituria, and/or bacteriua. Bacteria were isolated from 2 specimens. A patent urethrostomy was created in all cats without operative complications. Except for 1 cat without associated clinical signs, stricture was not evident between 9 and 42 months after urethrostomy. One cat had postoperative urinary incontinence (UI) that resolved within 4 weeks. Two cats each had 1 episode of idiopathic lower urinary tract disease after 6-month follow-up; both responded to medical therapy.

TPU was used as a successful urinary diversion procedure relieving signs of urinary tract obstruction and preventing further obstruction, with few complications. The incidence of UI after TPU remains minimal.

TPU should be considered as a salvage urinary diversion procedure in cats (as an alternative to prepubic and subpubic techniques). TPU may also be considered as a possible primary urinary diversion solution (an alternative to perineal urethrostomy) for obstructive lower urinary tract disease in cats.