Marty is an unusual cat. Rescued from Dubai, he is an Arabian Mau. I love it that the Arabians call their cats Mau. Makes sense. But Marty no longer has a penis. I had to amputate it 10 days ago.
Nearly three weeks before Marty had presented off his food, sore and unwell. The previous morning he had eaten well and was playing with the other cats. In the afternoon he was seen straining to pee several times in his sister’s litter tray. Now he was really miserable.
This is such a classic presentation I had already made the diagnosis before I felt the really distended bladder in Marty’s abdomen. I’m sure many of you reading this had too.
In male cats the urethra (the tube that drains urine from the bladder) becomes very narrow as it passes through the penis. This makes male cats susceptible to urethral blockage if there are crystals or small stones in the bladder or if the urethral lining becomes inflamed and swollen.
This was an epidemic problem 30 – 40 years ago. Medical management was often unsuccessful so we often had to perform surgery. This involved amputating the penis and dissecting 3-4 cm up the urethra to where it widens. This was then stitched to the body wall to create a new and wider opening.
About the time I graduated it was found that there was a strong association of urethral blockage with diets high in magnesium. Because the dietary association meant lots of funding the problem has been extensively researched. There are now diets that dissolve the crystals and prevent new ones forming. The research has also shown that bladder conditions in cats have a wide range of causes and there is a complex interplay between diet, drinking habits, obesity, stress and domestic environmental factors. This better understanding has meant that we can nearly always solve this problem medically and prevent most recurrence.
First we do have to unblock the bladder and this is a medical emergency. We do this by sedating the cat and very gently flushing out the last part of the urethra with sterile saline using a small bore intravenous catheter and lots of lubrication. Most of the time that removes the plug of crystals and protein sludge and urine can flow freely again. That urine is often dark red with blood because the bladder has been so severely stretched. Sometimes the back pressure from the bladder causes kidney damage and even kidney failure.
Once we have unblocked the bladder we try to flush out remaining crystals in the bladder. There may be a half-teaspoon or more. We don’t want them to cause another blockage before we can use diet to dissolve them and prevent more.
Poor Marty ended up getting every complication in the book. His penis promptly reblocked so we had to insert an indwelling urinary catheter and stitch it place. That nearly always results in a bladder infection. Marty was no exception but he developed a raging fever. As soon as he could pass urine around the catheter we removed it. We could now get control of the infection but he reblocked again. Another catheterisation episode.
His bladder wall had been severely stretched so the muscles didn’t work to empty it properly. The urethral lining was inflamed causing spasm. He was on special drugs to help this but he needed manual help to empty his bladder. We saw Marty twice a day over the next three weeks and he was uncommonly gentle and cooperative throughout the uncomfortable process of helping him pee. Marty’s bladder muscles got stronger and stronger but his urethra wasscarring up and getting narrower. When it became clear we could not win this battle we took Marty to surgery and for the first time in perhaps 15 years I performed the operation called perineal urethrostomy.
Marty is now home with the other cats and doing well.