My Cat’s Journey with Feline PU Surgery (Perineal Urethrostomy)

My 5-year-old cat Botak has been in and out of the hospital to treat his mouth ulcer since February 2019. His first visit to the vet in 2019 was to check for his red and slightly swollen penis and his lack of appetite to eat. But the vet noticed his mouth ulcer had gotten really bad. That’s why he couldn’t eat.

Let me warn you, though, this is gonna be one hell of a long read. 🙂

Botak Feline PU Surgery Perineal Urethrostomy

Botak’s Care History in 2019

The vet wanted to focus on the mouth ulcer so for a week, we’ve been going to the vet daily for his medications and subcutaneous fluid with hope it would reduce his mouth ulcer and also the swelling on his penis.

A week later, nothing happened.

His mouth was still red and raw, and his penis was still red and swollen. The doctor was baffled.

Doc decided to do urinalysis. She said Botak’s showing sign of kidney problem.

Botak Feline PU Surgery Perineal Urethrostomy

I changed to k/d diet but didn’t return to the clinic for his weekly sub-q fluids. Doc also said if he could still urinate with no problem, we should leave the swelling alone. So, I did. For a month-ish.

But then, sometime in April, Botak returned to the clinic because he wasn’t eating at all. He had lost his appetite again. His mouth ulcer was getting painful again. Nobody could give him pills because it’s too painful for him to open his mouth. After discussing with the doctor, I decided to ward him for a few days so he could get daily sub-q fluids and meds by injection.

After a week at the clinic, it managed to reduce his mouth ulcer pain and he got his appetite back so he could go home, yay. The night he went home, he started vomiting. Took him back to the clinic the next day. He had a slight fever but he didn’t puke again.

For a week, everything seemed to be okay. Took him back for a follow-up and the doctor was happy with his progress. However, I noticed he was peeing a bit too frequently than usual and in small amounts. But the doctor said if the urine still came out a lot, there’s nothing to worry. Leave it be. His swelling had also gone down a bit and no longer red.

Botak Feline PU Surgery Perineal Urethrostomy

Everything seemed to be going okay…

…until 3 days later.

Despite having a very swollen penis for 3 months, he’s been peeing ok until 3 days later on a Sunday afternoon when I noticed no urine came out. Not a single drop. He had been peeing fine then all of a sudden nothing at all. He was straining so hard that he’d poop instead.

I rushed him back to the vet the next day.


Botak Feline PU Surgery Perineal Urethrostomy

➡️ MONDAY May 13th

Rushed Botak to the vet in the afternoon. Doc wanted to ward him for a few days and flush his bladder. She tried but unfortunately, the catheter couldn’t even go in because the tip of the penis was so damaged and scarred, they couldn’t find the way to insert it. His penis didn’t look like a penis anymore.

This could be the reason why Botak couldn’t urinate. He wasn’t blocked by something, but I’m guessing because the swelling on his penis started to go down and shrink, it eventually ‘shriveled’ and close up the tip of the penis so no urine could come out. That’s why they couldn’t even find it to insert the tube.

So, they just drew the urine out a different way and gave him some muscle relaxer, hoping it would work. Doc gave some choices for me to make when I go home –

  • To take him to another specialist vet who could fix this problem
  • To do PU surgery (Perineal Urethrostomy) at a university veterinary hospital in Kuala Lumpur (3+ hours away by car)
  • Or to put him down (PTS)

I swear I thought my heart stopped for a second. My world went dark upon hearing the word ‘PTS’. That’s NOT an option for me. NEVER.

But at the same time, even if I disagree to it, he would still die if nothing is done. He couldn’t urinate. He didn’t have much time. I didn’t even have much time to think of a plan or to prepare anything. It was all too sudden.

A week ago, both the doctor and I were happy with his progress. And now I had to consider to put him down or let him die?

I was bawling my eyes out in the car. And all night long. After everything that we’ve been through for a few months, this is the ending for him?

Hell no. I refused to give up on him. I just knew it wasn’t his time to go yet. It wasn’t my decision to make to end his life. I wasn’t gonna give up without a fight.

Botak Feline PU Surgery Perineal Urethrostomy

What is PU Surgery (Perineal Urethrostomy)?

PU stands for perineal urethrostomy. Perineal urethrostomy is a surgical method for alleviating urethral obstruction in cats with complicated or recurrent obstructive feline lower urinary tract disease. It involves removing the penis and creating a permanent opening in the urethra, subcutaneous tissues, and skin above the site of the blockage.

If you want to learn in depth about perineal urethrostomy and how the surgery is done, you can check

Botak Feline PU Surgery Perineal Urethrostomy

➡️ TUESDAY May 14th

Took my mom for her hospital appointment early in the morning (she broke her toe a month before) but I guess I was so stressed from everything that I had a panic attack and my asthma flared up that I ended up in the emergency room myself.

Went to visit Botak in the late afternoon. I was hoping to receive good news but I didn’t. I received the bad news that he still couldn’t urinate. So I had to make the choice on what to do right at that moment. It was the most stressful moment ever.

After taking some of the positive comments I’ve received about PU surgery in a few Facebook’s cat groups I’m in into consideration, I decided that’s the best for him for long term. I told them I want them to do it. But if they failed, I will do whatever I can to go to KL.

They said they will try in the morning. I went back home praying everything will go smoothly and that they could do it because I seriously didn’t know how to go to KL without transportation or money.

Botak Feline PU Surgery Perineal Urethrostomy

➡️ WEDNESDAY May 15th

Doc called me in the morning telling me they’re not confident with the surgery because it’s a complicated case and told me to take him to KL. I had a panic attack because I was really hoping they could do it and it wouldn’t have to travel so far with Botak. It would stress him out even more.

Not only I didn’t have any money, but what if in KL, they couldn’t do the PU surgery? A lot of ‘what ifs‘ came to mind. I also couldn’t visit him. Obviously, I couldn’t stay there either. I decided to try another specialist vet.

At the 2nd vet, we did a blood test and turns out his kidney is not bad. His white blood cell was very high, though. The vet thought maybe he’s fighting infection so he gave Botak an antibiotic injection. We did the FIP/FeLV test and he’s negative for both.

But the doc did so much to him and was very rough that I cried when I got home! He even inserted his fingers into Botak’s anus and wiggled them around to feel for his penis. Botak was crying while currently under sedation. It hurt me so bad. I questioned myself if I was wrong to put him through all of that pain and stress. But I wasn’t gonna give up on him that easily. No way. I could only hope it was just a necessary but temporary pain.

Botak Feline PU Surgery Perineal Urethrostomy

The doc said he could do the surgery but he needed over $1000 and at least $400 deposit to proceed. I didn’t have enough money. I begged and begged for him to proceed and I will raise the amount needed when I get home. He refused. He told me to take him to KL instead. 😭 He insisted on half of the payment first before he would do anything. He withdrew the urine out by needle. He checked his urine and said Botak has some stones as well.

I was SO LOST at this time. It was a race against time. The more I delay, the sicker Botak gets. I went to another vet near my house. She couldn’t do it but she recommended another vet and asked me to go there. So I did. The 4th vet told me she could do it. She has done PU surgery before. I was so happy to hear it! She told me to bring Botak the next morning.

Botak Feline PU Surgery Perineal Urethrostomy

➡️ THURSDAY May 16th

Botak slept with me on my pillow the whole night. I felt so guilty for putting him through all the horrors and pain at the 2nd vet. Early in the morning, I took him to the 4th vet. I was tired, Botak was tired, we just needed some good news. I wanted to avoid the long distance travel so badly so I don’t stress Botak. He’s been through so much already.

The vet said she could do the surgery the next day and Botak needed to be warded. I was happy until she told me I needed to pay a deposit of roughly $440 to proceed with the surgery. I said I only had $120 and will find more. She wouldn’t even ward him until I get the money. Told me to take him home and to come back when I have enough.

I begged and begged but they still said no. I couldn’t hold back my tears. I cried at the clinic. The assistant was so sad he couldn’t help me. He tried, though. I was so upset and disappointed. I was so lost. I didn’t know where to find that huge amount of money in such a short amount of time. I didn’t want more delays. Even if I took him to KL, they would still reject me for not having money for the deposit. The long trip would’ve been for nothing.

I had no choice but to take him home. As soon as I got home I posted a cry for help on my facebook. I was so surprised and so touched that within a couple of hours I managed to get the needed amount for the deposit. 😭😭 So I rushed him back to the clinic before they close and got him warded.

Surgery was scheduled at 7am the next morning.

Botak Feline PU Surgery Perineal Urethrostomy

➡️ FRIDAY May 17th

I couldn’t even get proper sleep. I was panicking in the morning because I was so scared. Finally, at 10 am the doc called. The surgery went well! Omg it was such a relief to hear that! She said I could visit him later that evening.

He was still groggy when I visited him but alert. I worry about his recovery process but he seemed to be doing fine so I could finally take a breather. He looked so stupid and so cute being high on the meds haha.

Botak Feline PU Surgery Perineal Urethrostomy

➡️ SATURDAY May 18th

I visited Botak in the morning. I wasn’t happy. I heard he vomited in the morning and wasn’t eating much. When I visited him, he was drenched in his urine, very cold and shivering. He was also acting very weird and looking traumatized from the sound of dogs barking nonstop in the next room.

I guess it reminded him of the crappy vet in 2017 where he got so traumatized he even got nightmares. He would howl in his sleep. It was that vet that probably did the extensive damage to his penis until he needed the surgery now.

I was so scared he’d get so terrified that it’ll affect his recovery process. Plus, I couldn’t visit him for 2 days because of the public holiday in Malaysia so that’s definitely not good. I had to make a quick decision and decided to transfer him to the first hospital where he’s more familiar of.

I requested for him to be discharged. At the other clinic, it took me 3 hours to try to calm him down. He wouldn’t let me touch him. He ignored my voice. Definitely not good. But once he was warded he was slowly back to his normal self but still acting weird. His paw where they put the IV was also VERY swollen.

Botak Feline PU Surgery Perineal Urethrostomy

➡️ SUNDAY May 19th

It was a public holiday but I made an appointment to see Botak in the morning. He seemed sad and scared but he did respond when I called his name. He was still shivering uncontrollably. I opened the cage door to pet him but he forced himself out and onto my lap. I could feel how hard he was shaking.

But after a minute, his shaking slowed down and he started grooming himself. Then he fell asleep on my lap. He stopped shaking after a while. Poor baby was probably cold, scared and in so much discomfort. But he seemed slightly better than the day before.

Botak Feline PU Surgery Perineal Urethrostomy

➡️ TUESDAY May 21st

Botak could go home!

I thought it would be a happy thing. I thought it would be a good thing to monitor him at home and have him by my side because I miss him. But oh no, it was more stressful than I thought it would be!

His behavior had changed. He was more cranky, more grumpy and still shivering like he’s paranoid of things. The worst thing is that I saw him licking the surgery site and I ended up being paranoid that he would disturb the area and make it worse.

Everybody started suggesting cone. Oh no. Botak is not the kind that would wear a cone. He will fight you and the cone and destroy it. Believe me, I’ve tried. Everybody has tried. Not even the vet could put it on him without him acting like Linda Blair needing an exorcism.

I messaged the 4th vet but she said the wound seems okay and healing alright so phew, I stopped panicking. I tried my very best to prevent him from licking the wound.

His behavior changed a lot the next week. He’s now easily paranoid of things. He’s now afraid of the rain, the lightning, he’s quieter and spaced out and ignoring me most of the time. He would also give me angry meows.

Botak Feline PU Surgery Perineal Urethrostomy

➡️ SATURDAY June 1st

It has been two weeks so it was time to take his stitches out! He got so scared at the clinic. Yep, he’s now traumatized of the vet as well when before this he didn’t care. It didn’t help that at the clinic, there were loud and big dogs as well.

His wound has been healing well and the doctor is happy and so am I. The doc took out the blue stitches but left the transparent stitches that will dissolve on its own.

Finally, he would sleep in his carrier after the stitches are out. I guess he was feeling a bit more comfortable now.

The doc also mentioned that his urine test came back and he didn’t have bacteria infection but it was alkaline so he’s now on strict urinary diet.

Botak Feline PU Surgery Perineal Urethrostomy
June 7th, 2019

At the time I published this, it has been exactly a month since we began this horrifying journey but so far, the PU surgery has been a success and Botak could urinate again without problems.

I hope he will continue to heal without any problems. The doc also said that I still need to keep an eye on any abnormalities because he’s more prone to infection now. Also, there could be the formation of scar tissue after the surgery which could possibly obstruct the flow of the urine.

I am glad I didn’t give up and chose PTS. I can’t imagine what it would be like without him after everything we’ve been through this year. I’m also extremely glad that the surgery could be done in my town without needing to travel far where I wouldn’t be able to visit him. Who knows what could’ve happened.

Now, we just need to focus on his mouth ulcer. He also has some weird crusty dried up blood that wouldn’t heal on his ear and I’m scared it could be skin cancer. Crossing my fingers that it’s not. But I need to get it checked soon.


I have set up a fundraiser for Botak to get some help with his remaining unpaid bills from his previous hospital stays. The fundraiser will remain up indefinitely. Any excess donation will be used towards his special food (urinary s/o wet and dry) or his mouth ulcer treatment or any required vet visits.

Any donation will be a huge help and greatly appreciated. Even if you can’t donate, I’d be so grateful if you could help share the fundraiser.



Local Malaysian Bank:

Bank: Maybank
Account: 508177682216
Name: Intan Fazliana

Thank you for reading EVERYTHING. I hope this post in some ways has given some helpful information for those who are looking to learn about PU surgery or having a similar problem like Botak.

If you’d like to personally ask any questions about my experience with PU surgery or Botak or anything else, feel free to email me!

Botak Feline PU Surgery Perineal Urethrostomy
January 5th, 2019

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