Which surgery? Please help - male cat

[ohwailywaily]

Hello, this is my first post. I have two cats (and a DH). Earlier in week (Weds) noticed one cat was not acting right, trying to go to loo but couldn't etc. and so Thursday early morning took him to emergency vets where they said his bladder was blocked. They unblocked him, cat was fine, recovering well, but wanted to keep him overnight of course. They said he had a small stone which could probably be dissolved with food once he's back home with us.

Next day his blood test showed a slight rise in creatine, so they wanted to keep him in the next night too (Friday night), fine. He was peeing ok (had removed catheter). But yesterday, noticed he was showing symptoms of being blocked again and so they had to put the catheter back in and keep him overnight.

Today we've heard he has two stones, not one, and they are small - one was in his urethra and one was in his bladder, they are both in his bladder now. Vet talked about two surgeries:

a) bladder (to remove the stones) - seems like a more minor procedure (??) but won't stop him getting blocked again

b) penis (to widen the urethral orifice) - seems like more major surgery (recovery will require cone of doom which he hates) but if he gets stones again he should definitely be able to pass them, however, higher risk of recurring UTIs.

They can't operate until tomorrow, so we have time to make a decision, but honestly don't know what is best?

I'm very upset at the thought of him being in pain and I miss his fluffy face very badly. He's around 11 years old.

Obviously, once he's home we will do whatever we can to help him recover and prevent stones from forming again.

Please could anyone who's been through either surgery before please help us decide!

Thank you.

[thecatneuterer]

I can't make a recommendation - that is something you need to discuss in detail with your vet I think. When you say stones you mean urinary crystals I'm guessing? A few things to bear in mind when deciding which option to go for would be a) if he were to be blocked again would you definitely notice straight away? Does he use a litter tray for example? b) how likely is it that a change of diet would make a big difference? So what where you feeding him before? Cheap dry food (eg Go Cat) is linked to urinary crystals for example. Did he have much dry food and, if so, what was it?

[ohwailywaily]

Ok thank you. Yes they both use litter trays. Now I can recognise the signs and we both WFH so should be able to spot it quickly if it happens again.

The other cat Solomon has ongoing poop issues (diarrhoea, incontinence) which we knew about when we homed him and Alfie. After some trial and error, the best food for Solomon seemed to be Hills i/d dry food so they've both been having that for the past two years (also prednisolone for Solomon).

Last year, we introduced Hills i/d wet food as well, so they have that for lunch but dry food the majority of the time.

In the last month or so, Solomon's issues resurfaced so the vet recommended switching to Hills z/d dry food. This has seemed to sort Solomon out, but we now wonder if the switch has caused these crystals in Alfie. Alfie definitely ate the z/d but not as much as the i/d, and he really goes mad for wet food so we were considering moving him on to having majority wet food anyway.

[Fluffycloudland77]

Bumping for you.

Personally I’d go for option one, try the least invasive op first. But that’s me.

[Want2beme]

Strangely enough, I had a gorgeous tuxedo like your Alfie, (I have a weak spot for them), and he went through a period of getting crystals in his urine. He once had a week's stay at the vet, and I was convinced they were keeping him in because he was so adorable. Anyway, he didn't have surgery, but was flushed out several times, and then put on a renal diet. This seemed to do the trick and the problem disappeared. I used to dread seeing the first signs of this problem - frequent visits to the litter tray, but only a dribble coming out, as you know they're in pain and you have to react quickly. I also had another cat who went through exactly the same thing.

I'd go with option a, and see how that works out. You're always close by, and can keep your eye on him for the obvious signs.

By the way, he's absolutely beautiful😻

[ohwailywaily]

Thank you thank you for bumping and replying! The vet seemed to be more keen on the penis surgery, rather than trying the bladder and then possibly having to do the penis surgery anyway - and I don't want him to have to go through two surgeries, eventually (obviously I don't want him to go through any surgery unless really necessary). I'll ask about the flushing out in any case.

@Want2beme I am the same about tuxedos (Solomon is one too but short-haired) and if Alfie does have surgery tomorrow he'll have been there for five days, basically a week! He is gorgeous, I think the vet is falling for him like we did, he is purring and rubbing up to her, all his usual 'I'm so lovely and fluffy, now give me food yes?' tricks. Really really miss him. I don't want him to think we've abandoned him!

[cupsofcoffee]

My male cat had this - he was in the vets for four days having bladder surgery and the vet said he was one of the worst cases she'd ever seen - we nearly lost him.

But surgery was successful and he's absolutely fine now :) he's never had a reoccurrence (we did switch his dry food) and his perfectly healthy.

[ohwailywaily]

Very glad to hear that @cupsofcoffee thank you, gives me hope.

[cupsofcoffee]

It was really scary at the time but after a few weeks back home, you'd never have known he'd been unwell :)

We switched him to a higher-quality dry food with less fillers (kept the wet food the same) and he was fine. I think it's quite common in male cats but a new diet really helped our boy!

[musicalfrog]

Did they talk to you about long term management for the condition? My boy had a scare and now is on a special urinary diet and we make sure he drinks plenty of water. With that in mind I'd go for the first option, less invasive.

Also I've had the procedure in the second option (not with the penis bit obviously, but a widening of the urethra!) and it hasn't actually made much of a difference.

[ohwailywaily]

Thank you for letting me know @musicalfrog and no, not yet re: long term management, I think we will have that talk tomorrow directly with the surgeon.

V reassuring hearing about others who have recovered. Calming down a bit.

[Lonecatwithkitten]

@ohwailywaily make sure you fully understand the two different surgeries if 2 is what I think they are suggesting this is a massive surgery involving to be blunt chopping off the penis - perineal urethotomy - I would only put my cat through this if there was no other option.
As a vet I would always try dissolution and/or cystotomy ( removing stones from bladder) before I would consider the urethotomy.

[ohwailywaily]

Yes @Lonecatwithkitten she said perineal urethrostomy as the second option (she was also blunt like you and said 'removing the penis') - she said she has seen lots of cats going on a diet to dissolve the crystals but come back to the vets and have the surgery anyway, in the end, because the crystals come back. She didn't really talk about the bladder surgery apart from saying it's the other option. However, she's not the actual surgeon who will be operating - we are talking to him/her tomorrow I think.

[ohwailywaily]

Quick update - hadn't heard from hospital so called them at 12.30pm and the receptionist was like, oh yeah Alfie's scheduled in for surgery this afternoon and we were like WHAT?! because we had not consented! but it turns out they just book the slots way in advance. Just had call from them (a different vet to the one yesterday) now to confirm it will definitely be the bladder surgery, cystotomy, today as both stones are in the bladder and not in the urethra. And they'll send off the stones for analysis to see what type they are and so we will try to prevent them through diet etc. Thank you everyone for your experiences/advice.

[Fluffycloudland77]

WTAF?

[musicalfrog]

Surely you have to sign a consent form before surgery? Are these vets well known /recommended to you?

[Want2beme]

How's Alfie? Did it go well?

[ohwailywaily]

Sorry - been hectic here. Alfie actually had the cystotomy surgery yesterday, Tuesday, at 1pm. He was scheduled for Monday, but we had another call in the evening from them saying they'd had too many emergencies that day so they would operate on Tuesday instead. He is home now, but I'm very freaked out because he's so lethargic, doesn't want food, doesn't want water, and he keeps shaking a bit - on and off. Apparently this should all wear off tomorrow (48 hours after surgery).

The vets put him in a little onesie but when he got home he peed with it on and got it very wet, then had diarrhoea as well (although the vets said he was doing normal poos there). We've put him in a material cone though we have the plastic one as backup - first time wearing the soft cone and he doesn't seem to mind it as much (yet).

He is slumping in random spots on the tiled floor, probably because it's nice and cool. We've enclosed the living room for him, he has easy access to a small amount of food, water and litter trays and all his blankets and beds but he seems to want to stick to the floor.

He is on Hypovase (anti-spasm), Cystophan (bladder support) and Temgesic (pain relief).

@Lonecatwithkitten if you're still around, or anyone really! I'd appreciate some advice on how to look at his wound - they said we should check it if it bleeds or oozes, but it's covered with a white bit of gauze, I don't think we should be taking the gauze off?

We will go back to vets on Saturday for the first post-op check.

[ohwailywaily]

PS the vets are trusted, we normally go to the local branch but this hospital is a bit further away and open 24hrs. Normally they are v good but it seems they are incredibly busy so the communication/handovers internally have been a bit rushed it seems. When we went to collect him there were at least seven other people waiting for meds/to collect their pets/dropping off their pets.

[Fluffycloudland77]

Good lord you’ve both been through it haven’t you?.

[Want2beme]

Hope he has a good night and you all manage to get some sleep. He'll be a good as new very soon

[Lonecatwithkitten]

@ohwailywaily if there is bleeding or discharge you will see coloured strike through on the dressing. There maybe a small amount this okay, large amount or foul smell straight back to the vets.
Are you in the UK? Just surprised you have temgesic the human product rather than one of the veterinary products.

[ohwailywaily]

Yes in UK @Lonecatwithkitten, thank you, the temgesic is a small pill, half of it given every 8 hours. On Weds he was very very tired and out of it, but peed quite a bit, then on Thursday the amount of his pee got smaller and smaller so around 11pm we went back to the vets - thankfully bladder was fine, not blocked, but very empty, but vet said he was most likely in pain from inflammation from his surgery, but they couldn't give him any anti-inflammatories because his creatine was too high. So now we have another painkiller and an antibiotic to give him, and she also gave him an appetite stimulant.

He then very much came back to his old self overnight and has since had small amounts of wet food (with added water) but still doesn't seem to want to drink (will have tuna water occasionally but not a normal 'drink' by far, has been to the water fountain only once in 24 hours). It's been really lovely to see him stretching out and walking around, but he is mad that he's wearing a doughnut cone, mad that we won't let him upstairs (not sure he should be running/walking up the stairs), and I think still in pain despite all the meds - hunches over while sitting (but then will go back to loafing/lying around, but kind of trembling lightly while doing so). And sometimes he just sits there and stares into space and looks really monged out. But in between these moments, he seems normal and loving being home. He has only peed once today, although a good amount. Waiting to speak to vets.

To add to all this, my period came early and I'm having the worst ongoing cramps I've ever had, usually it's only the first day but it's been three days of constant aching and I've obviously not really slept so I am really, really fucking grumpy and just want him to be ok, it's like I can't feel better until he feels better.

[Fluffycloudland77]

Well he sounds better doesn’t he? It’s very early days.

I’m sorry your in pain too.

[Lonecatwithkitten]

@ohwailywaily the tablet explains it there is no licenced oral med, most commonly the specialty compounded liquid is used, but temgesic is also possible.

[wheresmymojo]

Hi OP...

We are going through something similar with our boy cat at the moment, how is yours now?