Help... my cat can’t pee! Feline Urethral Obstruction: Be Prepared... What to do

    help-my-cat-cant-pee-feline-urethral-obstructionIn the article Feline Urethral Obstruction: Be Aware I covered the ‘what’ of urethral obstruction. In this artcile I’ll be detailing the things you should know to be prepared for in the event of a urethral obstruction. Hopefully you’ll never need this information, but as with most things in life, it's best to have it and know it's here if you do. After all, when it comes to feline urethral obstruction, your cat’s life is truly at stake.

    If you’ve ever had a cat that has suffered a urethral obstruction you can help me help others by taking a minute or two to fill out an online survey about pet owner experiences with this condition. It's completely anonymous and only takes a minute or two to complete. Thank you in advance.

    What should I do if I suspect that my cat has a urethral obstruction?

    As I started out with and highlighted in the first post of this seriesA cat that cannot pee is a cat that’s going to die, unless appropriate veterinary medical care is obtained immediately. Urethral obstruction is a very severe, very acute, very critical medical emergency.
    This is an important enough point to highlight here again, and it nicely answers the first question here in this blog post too. If you think your cat has a urethral obstruction, or if there isany question of it, you should bring them immediately for veterinary evaluation.

    This is not a condition to trifle with, and it is certainly not one to ‘wait until your vet’s office opens in the morning or after the weekend’… doing so will certainly result in greater treatment and hospitalization costs, and this is the ‘best case’ scenario. The more likely result of such delay will be a dead cat, and one that has died a painful and unpleasant death.

    Along those same lines, its important to understand that there are no safe and effective first aid steps which you can, or should, perform at home for a blocked cat. Aside from the fact that it isn’t likely to be effective, if you try to express their bladder yourself there is also a good chance that you may actually cause it to rupture. Additionally, you will almost certainly wind up with cat teeth firmly embedded in your hands or arm if you attempt expression at home too (the distended bladder is very painful). So please, for their sake and for yours, don’t even bother trying, just take them immediately for proper veterinary evaluation.
    Similarly, you may be inclined, after all the mention of the pain associated with this condition, to give your cat some pain medication. However, it is important to note that there are very few pain medications that can be safely used in cats even under the best of circumstances - and a cat with a urethral obstruction is far from the ‘best of’ circumstances. By giving your cat a pain medication from your medicine cabinet you will compound their problem and wind up costing yourself more money in the long run, as well as greatly increasing your cat’s chances of death too. Again, don’t do it.

    How much time do I have to act if my cat has a urethral obstruction?

    The short answer to this one is… not very much time at all. Cats can die from being obstructed for as short a period of time as 24 hours, and potentially less. Further compounding the problem and adding to the need for immediate veterinary attention is the fact that many cats have already been obstructed for several hours, and maybe even days, before their owners recognize a problem. (Of course this won’t happen with your cat, because you’re reading this article series and you’ll know what to look for and do :-)

    Point being that any delay increases your cat’s risk of death, and your risk of increased costs. The best thing you can do, for your pet and for your pocketbook, is to bring your cat for veterinary evaluation immediately upon even the slightest suspicion that they may have a urethral obstruction.

    *This is just one of the reasons why it's important to monitor your cat’s activity level, appetite, and eliminations on a daily basis. And don’t forget to have someone checking in on your cat(s) at least once daily any time you’re traveling too… this is a very common time for urethral obstructions (and a variety of other stress-related cat emergencies) to occur.

    What does treatment for urethral obstruction involve?

    Of primary importance when treating a cat with a urethral obstruction is ensuring that their heart isn’t at risk of failure due to the toxic metabolic imbalances created by the obstruction, and stabilizing the situation if it is. This is accomplished through the administration of certain drugs under the guidance of close monitoring of their EKG trace and heart rate, as well as evaluation of a STAT blood sample in most cases. As you might imagine, this is a vitally important step if a cat is to survive their obstruction and its one of the reasons why ‘blocked’ cats are rushed straight back to the treatment area if they’re deemed unstable on initial triage. It is at this point too that an iv catheter will be placed, initial blood samples collected and EKG monitoring initiated.

    Once your cat’s cardiac function is protected (or restored), the work to correct their metabolic imbalances and relieve their urethral obstruction can begin in ernest. This usually involves the administration of intravenous fluids and sedation or anesthesia to facilitate the placement of a urethral catheter to restore the flow of urine and allow for flushing of the urinary bladder.

    In most instances, this urinary catheter will be left in place for anywhere from 24-72 hours, with the actual duration depending upon many factors. The catheter is sutured into place and then (ideally) attached to a closed collection system to (1) prevent the ascension of bacteria into the bladder and (2) facilitate measurement of the quantity of urine produced (this helps to determine if the rate at which the iv fluids being administered needs to be adjusted).

    Some combination of radiographs (X-rays), blood tests, and urine testing are frequently part of the work up for blocked cats as well. These tests can help to discover urinary stones, electrolyte abnormalities and kidney damage, and possible infections that may be present. Common treatments include intravenous fluid administration, pain medication, and medications to relax the urethral muscle. Frequent bladder flushing and quantification of urine output should also be done. Additional diagnostics and/or treatments may also be necessary in some cases. Close monitoring of your cat’s hydration, vital signs, appetite, and comfort are also vitally important, as is close monitoring of certain blood parameters.

    When the time comes to pull the indwelling urinary catheter, it is important to appreciate that the period of monitoring that follows is vitally important. During this time its not uncommon for cats to re-obstruct, and this is where the frustration of dealing with urethral obstructions comes in (both for the pet owners and for the attending veterinarians and nurses). If a cat re-obstructs when their catheter is removed, they will need to be sedated again to have another urethral catheter placed, and the clock starts all over again. Sadly, and understandably frustratingly for the cat’s owner, there is no way to predict which cats will re-obstruct, nor is there any way to predict how quickly cats will regain their ability to urinate normally and therefore how quickly they will be able to be discharged from the hospital.

    For cats that block 3 times within a short time span, or those that are discovered to have a stricture (abnormal narrowing) within a certain part of their urethra, a surgical procedure called a ‘perineal urethrostomy’ (PU) may be recommended by the veterinary team. During a PU surgery the penis and its narrow portion of the urethra are removed and the lining of the wider portion of the urethra is sutured to the skin, creating a wider opening and making the cat’s external genitalia more analogous to that of a female cat. If done correctly, and in the right patient population, this procedure can greatly reduce the chances of a future obstructive event. This procedure is not without its complications, and can be expensive, so its not typically recommended until a cat has clearly demonstrated that they would benefit from having it performed. Here's a good description of the PU procedure and necessary aftercare.

    * Special note about cats with indwelling urethral catheters and those on IV fluids…All cats with indwelling urinary catheters and those on intravenous fluids should remain in the hospital for close observation; as many complications can occur with either. If your veterinarian’s office does not have a staff member present overnight to monitor your cat with an indwelling urinary catheter and IV fluids, then you should transfer your cat to a local emergency hospital for overnight monitoring. The importance of this level of monitoring really cannot be stressed enough. If there are no local emergency hospitals for you to transfer to, and your regular veterinarian does not have overnight monitoring, then your cat would be better off having their urinary catheter and IV line pulled and sent home with you for monitoring. Be sure to discuss this carefully with your veterinarian.

    How much does it cost to have a urethral obstruction treated?

    The final costs for treatment of a case of urethral obstruction in a cat will be influenced by many factors, including:

    • how long the cat was blocked and how sick they were on presentation
    • whether or not they require surgery to correct the blockage (such as to remove a stone) or prevent a future blockage (such as the PU surgery discussed above)
    • whether or not they re-obstruct upon removal of the indwelling urethral catheter
    • the diagnostic tests and therapeutic treatments necessary in their care
    • the duration of their hospital stay
    • the type of hospital in which they receive their care (costs at general practices are typically lower than those at specialty or emergency hospitals, though there may be more transferring back and forth for overnight monitoring with the general practice)
    • your geographic location
    • and others

    Typically speaking though, treatment for a non-surgical case of feline urethral obstruction that doesn’t re-obstruct when the catheter is pulled will likely cost you between $750-1,500.

    However, for cats that obstruct multiple times, or those that require surgery as part of their treatment, you should expect the costs to be in excess of $3,000.

    What type of care is necessary following treatment for a case of feline urethral obstruction?

    I’m glad you asked. Read this article on preventing feline urethral obstruction.

    If you’ve ever had a cat that has suffered a urethral obstruction, please take a couple of minutes to fill out the online survey we’ve created to help reinforce the importance of awareness, preparation, and prevention of this common feline emergency. Thanks very much for your time, and for helping other cat owners.
     

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    Topics: Cat Behavior, Cat Health, Cat Safety, Overweight Cat, Urethral Obstruction, Lack of urine in the litter box, Excessive drinking, Traveling with your cat, Feline Urethral Obstruction, Vomiting, My cat can't pee, Frequent trips to the litter box, Male cat, Loss of appetite, Blog

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