Expert: Jessica - 1/27/2010

Question
My cat had a urethra blockage and he has been in the hospital for a couple of days. they keep telling me he can't come back home because he is not peeing by himself, but they are putting a new catheter every couple of hours. I don't get it, he won't pee some ofter, even when he was healthy.
Should I just go pick him up and take him to another vet in the morning?

Answer
Hi Diana.  They are putting in a new urinary catheter every couple of hours?  I don't understand this.  Changing catheters is extremely irritating to your kitty's penis, and the resulting swelling can worsen his chances for reblockage when he comes home.  Cats also must generally be anesthetized every time they have to be catheterized, and anesthesia carries its own risks (and expenses!).  A catheter should only be changed when ABSOLUTELY necessary, i.e. if the catheter becomes clogged with grit.  If they are changing his urinary catheter every couple of hours, I would definitely get him to another vet, no doubt about it.  

Generally, they will keep a cat for a day or so after removing his catheter.  They will keep him on intravenous fluids to encourage urination, so it shouldn't be long before he should have to empty his bladder.  When he doesn't empty his bladder, the vet will suspect it's full and do an exam to see if a.) it's full and b.) the cat appears to be straining to urinate when they squeeze his bladder.  If both of these are true, then it's reasonable to assume the cat is blocked and put a catheter back in rather than sending him home.  It's quite certain the cat will be back at the hospital within the next day, and in worse shape.  I can see removing his catheter after a day or two of clear urine and then replacing it if he's still unable to urinate on his own, but no way should they be trying this every couple of hours.

If your cat's urinary catheter and collection bag are running clear - free of urinary crystals, mucus plugs and blood clots - and they're removing the catheter believing he'll urinate freely, but he is not urinating freely, something else may be going on.  He could have certain types of stones or a urethral stricture.  I'm assuming your kitty had x-rays done to check for stones.  There are some types of stones, such as urate stones, that do not show up on an x-ray.  Ultrasounds would be required to diagnosed these and other radiotranslucent stones, as they are called when they cannot be detected by x-ray.  So if your cat has not had an ultrasound of the bladder, bladder stones are a possible reason why he's unable to urinate once the urinary catheter is removed.  

Urethral strictures are anatomical abnormalities which are a narrowing of the urethra.  The cat becomes unable to urinate because the urethra grows narrower and narrower.  These need to be resolved through surgery, generally what's called a perineal urethrostomy, or P.U. surgery.  In this procedure, the veterinarian shortens the urethra, cutting out the narrowest part and typically removing the external penis and scrotum in the process.  This is the best fix for urethral strictures and is also highly recommended for cats who suffer continued blockages due to blood clots, mucus plugs, stones or crystals.

I would call the vet and ask a lot of questions.  Why are they replacing the catheter so often?  Have they done x-rays and ultrasounds, and what have they shown?  Does a P.U. surgery need to be considered since he's not seeming to recover?  If they don't answer the questions to your satisfaction, certainly, getting him to another vet is reasonable.  Be aware that his catheter may need to be removed and replaced by the new vet once again (some vets will agree to leave the cather in place if you are transporting directly to another vet, but others will not).

I know this past fall, I spent $3000 unblocking one of my cats 4 times, and in the end, he had to have a P.U. surgery.  That only cost $800.  If I'd known what I know now, I would have done that to begin with!

Best of luck!

Jessica