1. What Is Perineal Urethrostomy (PU Surgery)?

Perineal urethrostomy — often called PU surgery or simply “a PU” — is a surgical procedure performed almost exclusively in male cats to create a permanent, wider urinary opening[cite: 8]. The surgery removes the narrowest portion of the urethra (the hollow soft tissue tube which the pet urinates through) and creates a new stoma (opening) at a wider part of the urinary tract, allowing urine to flow more freely and dramatically reducing the risk of life-threatening blockages[cite: 9].

As described in a 2024 surgical reference text (Grimes, Wiley), PU is most frequently performed in male cats to reduce the incidence of urethral obstruction secondary to feline idiopathic cystitis, with the prognosis being excellent — between 89% and 100% of owners report a very good to excellent quality of life for their cat following the procedure[cite: 10].

What exactly is changed during surgery?

2. Why Are Male Cats Prone to Urinary Blockages?

The anatomy of male cats places them at unique and serious risk for urethral obstruction[cite: 12, 13]. The feline penile urethra is extremely narrow — far narrower than in female cats — which means even small accumulations of crystals, inflammatory plugs, mucous, or scar tissue can completely seal off urine flow[cite: 14].

Feline idiopathic cystitis (FIC), also historically called feline lower urinary tract disease (FLUTD), accounts for up to 55–65% of lower urinary tract conditions in cats[cite: 15]. Urethral obstruction occurs with higher frequency in castrated male cats compared to females specifically because of this extremely narrow penile urethra[cite: 16].

Most common causes of obstruction[cite: 17]:

• Inflammatory mucous plugs (most common) [cite: 18]
• Urinary crystals (struvite, calcium oxalate) [cite: 19]
• Bladder stones (uroliths) [cite: 20]
• Urethral strictures from prior trauma or catheterization [cite: 21]
• Idiopathic (no identifiable cause) [cite: 22]
• Rarely, urethral tumors [cite: 23]

Published data show that reobstruction after initial medical management has an overall reported incidence of approximately 36%, with urethral plugs (43%), idiopathic obstruction (36%), and urolithiasis (30%) being the most common reasons[cite: 24]. This high recurrence rate is precisely why PU surgery becomes necessary for many male cats[cite: 25].

4. When Is PU Surgery Recommended? [cite: 37]

PU surgery is considered a salvage procedure, meaning it is reserved for cats who have failed or are poor candidates for medical management alone[cite: 38]. According to peer-reviewed surgical literature, the main indications are[cite: 39]:

• Recurrent urethral obstruction (primary indication): Cats with two or more obstructions, particularly those caused by feline idiopathic cystitis (FIC) that cannot be controlled with dietary changes, stress reduction, and medications alone[cite: 40, 41].
• Urethral stricture: Scar tissue from prior catheterization or trauma that permanently narrows the urethra. These strictures cannot be resolved with medical management and require surgical correction[cite: 42, 43, 44].
• Obstructive urolithiasis that cannot be relieved: When bladder stones or crystals lodged in the urethra cannot be flushed back into the bladder for surgical removal via cystotomy[cite: 45, 46].
• Urethral neoplasia or congenital defect (rare): Tumors of the distal urethra or congenital abnormalities that cause persistent obstruction unresponsive to other treatments[cite: 47, 48].

A comparison of urethrostomy techniques published in the Journal of Feline Medicine and Surgery found that feline idiopathic cystitis was the most common presenting problem in cats undergoing perineal urethrostomy, accounting for approximately 56.7% of PU cases[cite: 49].

5. The Surgical Procedure [cite: 50]

PU surgery is performed under general anesthesia by a veterinary surgeon[cite: 51]. The procedure typically takes 60–90 minutes and involves the following key steps[cite: 52]:

6. Recovery & Aftercare [cite: 54]

The recovery period following PU surgery requires dedicated owner involvement and careful monitoring[cite: 55]. Most cats remain hospitalized for 1–3 days post-surgery for pain management and to ensure the new stoma is functioning well[cite: 56].

The first two weeks at home [cite: 57]

Your veterinarian will provide specific discharge instructions, but standard post-operative care typically includes[cite: 58]:

• E-collar (cone) to prevent licking the surgical site (VERY IMPORTANT!) [cite: 59]
• Exercise restriction and confinement [cite: 60]
• Non-clumping litter to protect the incision [cite: 61]
• Prescribed pain medications and anti-inflammatories [cite: 62]
• Antibiotics if infection risk is present [cite: 63]
• Daily monitoring of urination and the stoma site [cite: 64]

Long-term lifestyle adjustments [cite: 66]

It is critically important to understand that surgery alone does not prevent signs of FLUTD from recurring[cite: 67]. Medical management — including dietary modifications and environmental changes — must be combined with surgery for optimal long-term results[cite: 68].

Long-term recommendations often include transitioning to a urinary-specific prescription diet, increasing water intake (often through wet food or water fountains), reducing environmental stressors, providing adequate enrichment, and attending regular veterinary follow-up appointments[cite: 69].

7. Long-Term Outcomes: What the Research Shows [cite: 70]

The published evidence for long-term quality of life following PU surgery is reassuring[cite: 71]. Multiple peer-reviewed studies have evaluated outcomes over periods ranging from months to more than a decade post-surgery[cite: 72].

A landmark study evaluating 86 cats with follow-up ranging from 1 to 10.4 years concluded that long-term quality of life after PU surgery in cats with obstructive FLUTD is good (as assessed by owners) and that the recurrence rate is low[cite: 74]. A separate welfare study published in the Journal of Feline Medicine and Surgery specifically evaluated quality of life 5–29 months post-PU and similarly found positive long-term outcomes in the majority of cats[cite: 75].

8. Potential Complications [cite: 77]

As with any surgical procedure, PU surgery carries potential risks[cite: 78].

Short-term complications (within 4 weeks)[cite: 79]:

• Temporary dysuria (painful or difficult urination) [cite: 80]
• Hemorrhage (bleeding) or swelling at surgical site [cite: 81]
• Urine leakage around the stoma [cite: 82]
• Wound dehiscence (incision opening) [cite: 83]
• Urinary or fecal incontinence (rare) [cite: 84]
• Anesthetic complications [cite: 85]

Long-term complications[cite: 86]:

• Urethral stricture (stomal stenosis): The most common major complication after PU, reported in up to 17% of cats[cite: 87]. It is most often associated with inadequate dissection during surgery or postoperative inflammation[cite: 88]. The size of the urethral stoma created at surgery appears to be the most critical factor in prevention[cite: 89].
• Recurrent urinary tract infections (UTIs): Because PU shortens the urethra and widens the opening, bacteria have easier access to the bladder[cite: 90]. Recurrent UTIs are reported in a subset of cats, though most resolve with a short course of antibiotic therapy[cite: 91]. One study found that the most common long-term complication was a single UTI recurrence in 33.3% of cats at follow-up, all of which resolved with antibiotics[cite: 92].
• Recurrent FLUTD signs: PU prevents obstruction but does not cure the underlying inflammatory condition[cite: 93]. Cats may still experience episodes of bladder pain, straining, and hematuria — though these are far less dangerous without the risk of complete blockage[cite: 94].

9. Life After PU Surgery [cite: 95]

Most cats adapt remarkably well following perineal urethrostomy. The behavioral and lifestyle changes are minimal from the cat’s perspective, and owners consistently report high satisfaction with their decision to pursue surgery for their chronically obstructed cats[cite: 96].

Will my cat be in pain long-term? [cite: 97]

No. Post-operative discomfort is expected but managed with appropriate pain medications[cite: 98]. Once healed, cats with functional PU stomas typically show no signs of chronic pain related to the surgery itself[cite: 99].

Can my cat still get a urinary blockage? [cite: 100]

The risk is dramatically reduced but not eliminated. The wider stoma makes complete blockage extremely unlikely in most cases[cite: 101]. In the Watson et al. (2020) study, no major complications including re-obstruction were reported in cats at long-term follow-up[cite: 102].

Does my cat still need a special diet? [cite: 103]

Yes. Dietary management remains an important part of long-term care[cite: 104]. Many cats benefit from prescription urinary diets that promote proper urinary pH, reduce crystal formation, and increase water intake[cite: 105]. Your veterinarian at TLC Animal Hospital can recommend the most appropriate diet for your cat’s specific situation[cite: 106].

What about urinary tract infections? [cite: 107]

Regular urinalysis monitoring is recommended, as PU cats have a modestly increased risk for UTIs[cite: 108]. Annual or biannual urine checks allow for early detection and treatment before infections become serious[cite: 109].

10. Care at TLC Animal Hospital, El Paso, TX [cite: 110]

If your male cat has experienced a urinary blockage — or if you’re concerned about urinary symptoms — the veterinary team at TLC Animal Hospital in El Paso, Texas is here to help[cite: 111]. We provide comprehensive feline urinary care, from initial diagnosis and medical management to surgical consultation for cats who may benefit from perineal urethrostomy[cite: 112].

We understand how frightening it can be to see your cat in pain and unable to urinate[cite: 113]. Our team will walk you through every step — from the initial evaluation to post-operative recovery — with clear communication, compassionate care, and the latest evidence-based treatment approaches[cite: 114].

El Paso families trust TLC Animal Hospital for expert feline care[cite: 115]. We are here for your cat when it matters most[cite: 116].

Peer-Reviewed References [cite: 118]

[1] Grimes JA. Feline Perineal Urethrostomy. In: Coleman KA, ed. Techniques in Small Animal Soft Tissue, Orthopedic, and Ophthalmic Surgery. Wiley; 2024. doi:10.1002/9781394159970.ch32 [cite: 119, 120]

[2] Clinicians Brief. Perineal urethrostomy in cats: veterinary step-by-step guide. Updated September 2025. [cite: 121]

[3] Dorsch R, et al. A prospective randomized study of efficacy of 2 treatment protocols in preventing recurrence of clinical signs in 51 male cats with obstructive idiopathic cystitis. J Vet Intern Med. 2019. doi:10.1111/jvim.15594 [cite: 122, 123]

[4] Papazoglou LG, et al. Prevalence, risk factors, pathophysiology, potential biomarkers and management of feline idiopathic cystitis: An update review. Front Vet Sci. 2022. doi:10.3389/fvets.2022.893100 [cite: 124, 125]

[5] Nye AK, Luther JK. Feline perineal urethrostomy: a review of past and present literature. Topics Companion Anim Med. 2018;33(3):77-82. doi:10.1053/j.tcam.2018.07.001 [cite: 126]

[6] Seneviratne M, Stamenova P, Lee K. Comparison of surgical indications and short- and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy. J Feline Med Surg. 2021;23(6):477-486. doi:10.1177/1098612X20959032 [cite: 127, 128]

[7] Hankins K, Zacher-Coy L. The use of 6-0 glycomer 631 for perineal urethrostomy in male cats: 314 cases (2013-2023). Front Vet Sci. 2025. doi:10.3389/fvets.2025.1515477 [cite: 129, 130]

[8] Watson MT, Roca RY, Breiteneicher AH, Kalis RH. Evaluation of postoperative complication rates in cats undergoing perineal urethrostomy performed in dorsal recumbency. J Feline Med Surg. 2020;22(3). doi:10.1177/1098612X19838286 [cite: 131, 132]

[9] Ruda L, et al. Short- and long-term outcome after perineal urethrostomy in 86 cats with feline lower urinary tract disease. J Small Anim Pract. 2012;53(12):693-698. doi:10.1111/j.1748-5827.2012.01310.x [cite: 133, 134]

[10] Slater MR, Pailler S, Gayle JM, et al. Welfare of cats 5-29 months after perineal urethrostomy: 74 cases (2015-2017). J Feline Med Surg. 2020;22(7). doi:10.1177/1098612X19867777 [cite: 135, 136]

[11] Calfon-Perelman TM, et al. Outcomes and postoperative complications after transpelvic urethrostomy used as first-line surgery in 38 male cats. J Feline Med Surg. 2022. doi:10.1177/1098612X221084879 [cite: 138, 139]