Perineal Urethrostomy, Incontinence, and Bladder Atony

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Wendy posted the following question as a comment on my blog post about perineal urethrostomy, which I thought was worthy of a blog post all of its own:

Question:

Has anyone else had issues with incontinence after the surgery? My cat Henry had the procedure done almost one year ago. Everything was going great until this last month...No matter where he sits or lies, he leaks urine. I love my cat and I am heartbroken that this is happening to him. I have heard that in rare cases there can be permanent nerve damage during the procedure, but why would it have just started? Any advice?

Veterinarian Response:

You can see incontinence in this situation occasionally but it probably is not nerve damage from the surgery; more likely a result of bladder atony. The sphincter of the urethra is at the base of the bladder, not at the end of the urethra. When cats get "blocked" he is not able to urinate and the bladder gets distended. The muscles in the bladder wall that are responsible for constricting the bladder are stretched and are not able to work as well. This is called bladder atony. When the bladder becomes full enough, the pressure within the bladder overcomes the urethra and he dribbles.

Have Wendy ask her vet about two drugs that can help in some cases, phenoxybenzamine and bethanechol. The phenoxybenzamine will help decrease the urethral tone and the bethanechol helps the bladder muscle contract. I would also look to see if there are no strictures in the urethra.

Lastly, bladder infections are common after PU surgeries since the urethra is wider and bacteria can get in the bladder easier. This is the same reason bladder infection is more common is female cats as compared to males. So I would check a urinalysis and do a culture of the urine.