Treatment for a complete urinary obstruction, a life-threatening emergency, should be instituted immediately to prevent permanent damage. The examining veterinarian will have a high suspicion that the animal is obstructed from the history and physical exam. Diagnostic tests usually are postponed until the obstruction is relieved and the cat is stabilized.
Most cats will need to be heavily sedated or anesthetized to allow the veterinarian to correct the obstruction. One method of obstruction relief involves palpating the urethra in the attempt to dislodge any urethral plug that may be present. In most cases, a urinary catheter is inserted into the urethra and sterile saline is injected to flush material back into the bladder. The catheter is then inserted into the bladder to allow the urine to drain completely. In order to remove debris from the bladder and to soothe the irritated bladder lining, the veterinarian will flush out the bladder with cool, sterile saline until the fluid retrieved remains clear. The catheter is then sutured to the outside of the body and left in place for some time so that the bladder size will remain small. The veterinarian will determine when the urinary catheter should be removed.
There is a possibility that the cat will obstruct again soon after the catheter is removed. Thus, most cats with obstructions remain hospitalized to allow for close monitoring. The inability to control urination is considered a warning sign. Due to the amount of stretching that can occur when an animal is completely obstructed, the bladder may be incapable of contracting for some time. Medications can be administered to help this condition once the risk of re-obstructing has decreased.
In order to counteract the toxic effects of urinary tract obstruction, intravenous or subcutaneous fluid therapy will be given to the cat. Fluids help correct any dehydration and electrolyte abnormalities. For the cat that has been obstructed long enough to result in renal compromise, intravenous fluids are continued at fairly high volumes for two to five days. Unfortunately, some patients suffer irreversible kidney damage due to a prolonged obstruction.
Other medications such as antibiotics are used as needed in cats with bacterial infections. If crystals or bladder stones are present, appropriate medications or diets will be recommended.
Surgery sometimes is required for animals that have certain types of bladder stones. A surgical procedure to enlarge the urethral opening at the outside of the body may be required for those cats with an obstruction that can not be relieved by other methods. This procedure also may be performed on cats that have recurrent obstructions despite appropriate medical therapy and preventive measures. This surgical procedure, called a perineal urethrostomy, requires that the cat be neutered to allow access to the urethra. The distal part of the penis is removed and the more expanded section of the urethra then is opened up and sutured to the surrounding skin. A perineal urethrostomy will decrease the likelihood of future obstruction but will not prevent the symptoms of cystitis or lower urinary tract disease that already may be present.
