Surgical management of urethral obstruction in tomcats using percutaneous pigtail catheter cystostomy

Introduction

Feline urethral obstruction (UO) accounts for approximately 4.6% of all feline emergency presentations (Hetrick & Davidow, 2013) [1] . It occurs with markedly greater frequency in male cats due to their long, narrow, and anatomically complex urethra, which predisposes them to obstruction by urethral plugs, crystals, or uroliths (Lekcharoensuk et al., 2001) [3] . Young to middle-aged tomcats maintained predominantly on dry commercial diets and housed indoors with limited physical activity are considered at increased risk (Gerber et al., 2005; Lew-Kojrys et al., 2017) [5,4] . Obstruction may arise secondary to urolithiasis, urethral plugs, strictures, or neoplasia, and these conditions are collectively classified under Feline Lower Urinary Tract Disease (FLUTD) (Gerber et al., 2005) [5] . Clinically, affected cats typically present with oliguria or anuria and require immediate intervention. Urinary diversion is critical to prevent life-threatening metabolic disturbances and preserve renal function. Several interventional options are available, such as cystocentesis, transurethral catheterisation, tube cystostomy, and perineal urethrostomy, with advantages and disadvantages (Nurra et al., 2022) [6] . Percutaneous cystostomy using a pigtail catheter has emerged as a minimally invasive and effective alternative for temporary urinary diversion in cats with UO, when retrograde catheterisation is unsuccessful or contraindicated (Nurra et al., 2022) [6] .

Materials and Methods

The study was conducted on six clinical cases of tomcats presented to the Department of Veterinary Surgery and Radiology, Veterinary College, Bengaluru. Cases of feline urethral obstruction were included irrespective of age or breed. The signalment and anamnesis of the cases under study are presented in Tables 1 and2.

Instrumentation

The materials used for percutaneous cystostomy were a Pigtail catheter kit, which include Pigtail catheter (6 Fr, 22 cm), trocar and sharp stylet (Fig 1&2)

Pre-operative preparation of the patient

Selected cats were fasted for 12 hours for food and 6 hours for water before surgery. The ventral abdomen was clipped and aseptically prepared using 7.5% povidone iodine scrub, followed by surgical spirit and a final application of 5% povidone iodine, and covered with sterile surgical drapes. Premedication was administered with atropine sulphate at 0.04 mg/kg intramuscularly, 15 minutes before induction. Anaesthesia was induced and maintained with tiletaminezolazepam (Zoletil®) at 10 mg/kg intramuscularly.

Surgical Procedure

The animals were positioned in dorsal recumbency with the hind limbs extended caudally. The distended urinary bladder was palpated and gently stabilised against the abdominal wall along the median raphe. A small stab incision was made at the midline of the caudal abdomen using a No. 11 BP blade, sufficient to permit insertion of a 6 Fr pigtail catheter. The catheter assembly with trocar and stylet was advanced percutaneously into the bladder using gentle pressure. Entry into the bladder was confirmed by urine flow upon withdrawal of the stylet. The catheter was further advanced until the fenestrated pigtail segment was fully positioned within the bladder lumen, after which the locking mechanism was activated by removing the trocar. The skin incision was closed with nylon in a single cross-mattress pattern. The catheter was secured to the skin using a Chinese finger-trap suture with additional stay sutures to prevent tension and displacement. The site was protected with an elastic adhesive bandage.

Postoperative care and management

Postoperatively, all cats received ceftriaxone at 25 mg/kg intravenously and buprenorphine at 0.02 mg/kg intravenously, administered twice daily for five days. Fluid therapy with Ringer's lactate was provided at 10 mL/kg twice daily for five days. Subsequently, oral cefpodoxime proxetil was prescribed at 5 mg/kg twice daily. Cats were monitored until restoration of urethral patency on postoperative days 2, 4, 6, 8, 14, and 21, and the time required for the return of normal urine flow through the urethral orifice was recorded.

Results and Discussion

In the selected tom cats, urethral patency was re-established within a mean duration of 8.5±1.9 days. Catheter removal was subsequently undertaken at a mean of 10.4±4.9 days, following confirmation of unobstructed urine flow through the urethra without evidence of straining, even after complete occlusion of the catheter

Conclusion

Percutaneous cystostomy using a pigtail catheter offers a minimally invasive, well-tolerated method for direct bladder access, enabling effective urinary diversion and supporting urethral healing. Urethral patency was typically reestablished within 10 days, with catheter removal followed by uneventful recovery. The technique required minimal use of anaesthetic drugs and proved particularly beneficial in compromised patients. By avoiding more invasive procedures such as conventional tube cystostomy, cystotomy, or perineal urethrostomy, this approach represents a valuable alternative that combines clinical efficacy with reduced patient morbidity.

References

1. Hetrick PF, Davidow EB. Initial treatment factors associated with feline urethral obstruction recurrence rate: 192 cases (2004-2010). J Am Vet Med Assoc. 2013;243:512-519.
2. Holmes ES, Weisse C, Berent AC. Use of fluoroscopically guided percutaneous antegrade urethral catheterization for the treatment of urethral obstruction in male cats: 9 cases (2000-2009). J Am Vet Med Assoc. 2012;241(5):603-607.
3. Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. J Am Vet Med Assoc. 2001;218:1429-1435.
4. Lew-Kojrys S, Mikulska-Skupien E, Snarska A, Krystkiewicz W, Pomianowski A. Evaluation of clinical signs and causes of lower urinary tract disease in Polish cats. Vet Med. 2017;62:386-393.
5. Gerber B, Boretti FS, Kley S, Laluha P, Muller C, Sieber N, et al. Evaluation of clinical signs and causes of lower urinary tract disease in European cats. J Small Anim Pract. 2005;46:571-577.
6. Nurra G, Howes C, Chanoit G, Meakin L, Parsons K, Friend E. Clinical use and complications of percutaneous cystostomy pigtail catheters in 25 cats. J Feline Med Surg. 2022;24(6):e28-e33.