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I have two cats: Bob and Linda, a bonded pair I adopted in 2017. While Linda has experienced very few health issues, Bob has had no shortage of them, including multiple episodes of stress-induced conjunctivitis and two complete urinary blockages.

Bob’s urinary blockages were caused by bladder stones, which form when there’s a buildup of urinary crystals in the bladder. This can happen because of stress or whenever he doesn’t drink enough water. As most cat owners know, it’s not at all unusual for cats to experience anxiety or fail to drink enough fluids. But what you might not be aware of is just how dangerous a urinary blockage can be.

Because of his medical history, Bob’s vet recommended perineal urethrostomy (or PU) surgery, an operation that would decrease his likelihood of developing future obstructions. Now, nearly 1.5 years post-op, Bob is doing well and has yet to experience another painful blockage.

Urinary obstructions in cats

Urinary blockages are fairly common in male cats, whose narrow urethras predispose them to obstructions. A urinary blockage is a life-threatening condition that occurs when bladder stones or a mucus plug blocks off a cat’s urethra, leaving them unable to urinate. When cats lose the ability to pass urine, toxins build up in their kidneys and vital organs. This condition progresses extremely rapidly and can be fatal in as little as 24 to 48 hours.

Signs of urinary blockages in cats

Though urinary blockages are quite painful, they can be difficult to spot because of how adept kitties are at hiding their pain. That said, when my own cat experienced a blockage, there were a few subtle signs that alerted me to the fact that something was wrong.

For starters, I noticed that Bob began to meow and yowl quite loudly while standing next to his litter box. He also began to pace and kept moving back and forth between the two litter boxes in the room.

Eventually, he attempted to use the bathroom in one of the boxes but failed to produce any urine. This was the most obvious sign that something was wrong, and if you notice your cat engaging in similar behavior, you’ll need to get them help right away.

Luckily, I was able to catch both of Bob’s urinary obstructions fairly early on, allowing him to experience a full recovery.

A few of the telltale signs that alerted me to Bob’s obstructions included the following:

  • Yowling (distressed meows next to his litter box)
  • Alternating between litter boxes every few minutes
  • Posturing and straining
  • Failing to produce any urine

Other common signs of urinary blockages in cats include:

  • Blood in the urine 
  • Frequent small urinations
  • Inappropriate urination (somewhere other than their litter box)
  • Loss of appetite
  • Vomiting
  • Lethargy

👉 If you notice your cat is straining to urinate, take them to the vet right away. Urinary obstructions are extremely dangerous and can be fatal in as little as 24 hours. 

It’s worth noting that Bob ate and drank, willingly accepted cuddles, and allowed me to touch and pet his stomach — all while blocked. This is in large part because cats are skilled at hiding pain. Some cats, like my own, are also highly motivated by food, meaning they won’t turn down a meal, even when they’re in extreme discomfort. Keep in mind that even if your cat looks fine, they might not be.

Treating urinary blockages in cats

To clear an obstruction, your vet will insert a catheter into your pet’s urethra that will be left in place for 24-48 hours. Once the catheter is removed, the blockage should be cleared. After your cat successfully urinates, they’ll be permitted to head home, usually with instructions to increase fluid intake and switch to a prescription urinary diet, like one from Royal Canin or Purina. Our vet Dr. Michelle Diener also recommends the Royal Canin Veterinary Diet Calm Formula, which helps decrease anxiety and prevent the formation of urinary crystals.

In addition, I was instructed to ensure there were at least two clean litter boxes at Bob’s disposal at any time and decrease his stress with the use of a calming spray or diffuser. (I like this one by Comfort Zone.) I also elected to separate my cats to better monitor their individual litter box usage and prevent them from fighting — an unfortunate but common occurrence in my household.

Once a cat experiences a blockage, they’ll also need to be closely monitored to ensure it doesn’t happen again, which is somewhat likely, especially in the days and weeks following their initial blockage. In fact, Bob suffered his first and second full urinary obstructions within the span of one (incredibly stressful) week.

What’s PU surgery

Other than neutering, perineal urethrostomy surgery is one of the most common surgeries performed on male cats. The procedure is fairly straightforward and tends to have good outcomes for most kitties, including my own.

Perineal urethrostomy is a procedure that removes the narrowest part of a male cat’s urethra, the tiny tube that allows them to expel urine. As betterpet vet Dr. Diener explains, “The cat’s penis is basically removed, and a new urinary opening is created.”

Because of their narrow urethras, male cats are particularly predisposed to life-threatening blockages and urinary events. As my cat’s surgeon explained to me, it’s a sort of flaw in the anatomy of boy cats.

There are two primary reasons why a cat owner might opt for PU surgery. The first is when the procedure to remedy a blocked cat fails. The second reason a cat might have PU surgery is because of recurring blockages — as was the case with my own cat.

Preparing for PU surgery

Once you’ve decided to move forward with PU surgery, there are a few things you should know. The first is the time required to properly care for a pet undergoing the procedure.

As I discovered, the recovery process was not necessarily linear, and it was several weeks before Bob was back to his old self. As he healed, we had to make time for follow-ups at the vet and check on him almost hourly. A lot of TLC went into restoring his health, which is something pet owners should be aware of and properly plan for.

I should also mention that, especially without pet insurance, PU surgery can be extremely expensive since it can typically only be performed by a board-certified surgeon. On top of that is the expense brought about by recurring urinary blockages, one of the primary reasons a vet might recommend your cat for the procedure. And, if a pet blocks, they need immediate care regardless of what time it is, so it’s safe to assume that most male cats with urinary issues will require costly after-hours veterinary care at some point.

Pet owners of boy cats should not only be aware of the signs and risk factors of obstructions but also how costly they can be to deal with. Overall, the cost is one of the biggest inhibitors among pet owners who elect not to move forward with the surgery.

Some clients can’t afford the surgery and unfortunately have no choice but to pursue euthanasia."

Dr. Michelle Diener


Post-op care 

I was told that Bob’s post-operative care would be somewhat extensive, but until I went through it myself, I’m not sure I was entirely prepared. If your cat is about to have surgery, I hope some of the tips and tricks I learned along the way might save you some of the stress and hassle I experienced.

First off, you should be aware that you’ll need to separate your cat from any other animals in the house. Other cats could be tempted to “help” by licking or cleaning your pet’s surgical area, causing them to remove your cat’s sutures with their rough tongues. While dogs don’t have barbs on their tongues and aren’t as much of a risk in that regard, they could cause your cat unnecessary stress.

If you happen to have a bathroom you can keep your cat in, that’s probably your best option. I’d recommend draping the area in fresh blankets and towels to ensure your pet is comfortable. You’ll also want to limit your cat’s access to stairs, so keep that in mind when preparing a space for your cat to recover in. Dr. Diener also suggests investing in a large dog crate, like this one from Frisco, to help keep your cat confined and limit their activity as they recover.

Secondly, you’ll need to ensure you have a good e-collar on hand. I quickly realized that Bob was able to get his vet-provided e-collar off by rubbing the back of his head against the bottom edge of the bathroom cabinets. Finding an e-collar he couldn’t remove was a long process of trial and error and ultimately set Bob back by about a week since he was able to lick at his stitches and reopen his wound.

👉 If your pet removes their e-collar, you’ll need to alert your vet right away and find one that works for them. Our vet’s favorite is the Calm Paws Cat Wearing Collar

I also highly recommend a cat water fountain to ensure your pet remains hydrated throughout their recovery. At least in the initial days after surgery, Bob wasn’t super interested in food or water, but the novelty of a new fountain did help encourage him to drink.

You’ll also need to use pellet-style litter as your cat recovers since clumping litter can stick to their incision. My vet recommended Yesterday’s News and even gave me some to take home, but it wasn’t nearly enough; I ended up changing the litter out about twice a day to prevent infection and ensure everything was clean.

When your cat does use the bathroom, blood may be in their urine for a few days after surgery. I was told to watch out for this with Bob, though it ended up not being an issue for him.

Lastly, you’ll need to monitor your cat’s incision carefully. Check multiple times a day to make sure the incision has not opened and the stitches are still in place. It should look better every day, and in most circumstances, kitties can have their sutures removed and return to normal life after about two weeks. That said, if you notice swelling, redness, or discharge, you’ll need to get in contact with the vet hospital where your cat’s operation was performed.

Bob the cat sleeping on a bed

Bob slept comfortably the day after getting the all-clear to remove his cone.


The majority of the cats that undergo PU surgery end up making a full recovery. That said, there are a few things to keep in mind and look out for.

Since PU surgery removes a cat’s urethra, which serves as a barrier to bacteria, your cat will be at increased risk for bladder infections following their surgery. (Luckily, Bob hasn’t experienced any issues.) In general, blockages also increase a cat’s risk of kidney failure since toxins that would normally be released via urine end up building up in the kidneys. If you catch your kitty’s blockage as early as possible, you should be able to prevent some of that damage.

Final thoughts

I feel confident that having the operation was the right decision for Bob, and I know his quality of life has improved because of it.

Overall, I don’t have any regrets about my cat’s surgery. I feel confident that having the operation was the right decision for Bob, and I know his quality of life has improved because of it.

While Bob still has issues with stress that I help to manage with calming diffusers (and plenty of snuggles), he hasn’t experienced any urinary issues since his surgery. Thanks to the operation, I’m much less stressed knowing Bob’s risk of developing another full urinary blockage has decreased significantly. His kidneys and urinary function will need to be monitored for the rest of his life, but for now, he’s happy and healthy, which is all a pet parent could want.

Frequently asked questions

How long do cats live after perineal urethrostomy surgery?

With the right preventative care, cats have the same life expectancy after this surgery as they would in any other situation. The surgery doesn’t negatively impact a cat’s lifespan at all.

How much is perineal urethrostomy surgery in cats?

Pet parents should expect to pay between $3,000 to $4,500 for the surgery. While this seems expensive, the cost of treating frequent blockages can exceed that, making the surgery not only a better option for cats, but finances as well.

How long does it take for a cat to recover from PU surgery?

Typically it takes two or three weeks for cats to heal from their PU surgery. During this time an e-collar or bodysuit will have to be worn to stop your cat from licking the area and risking damage or infection.