EXPRESS: Clinical Evaluation of a Modified Perineal Urethrostomy Technique in 30 Cats: A Retrospective Observational Study

Objectives: To evaluate the clinical efficacy of a modified perineal urethrostomy (PU) technique using preputial mucosa in male cats with recurrent urethral obstruction, and to assess the associated learning curve based on surgical proficiency and complication trends. Methods: Thirty male cats with recurrent urethral obstruction treated between 2019 and 2024 were retrospectively reviewed. The modified PU involved reconstruction of the urethral stoma using preputial mucosa with partial dorsal skin anastomosis to enhance tissue stability. Postoperative urinary function and complications were assessed at 10, 21, and 60 days, and up to 3 years in selected cases. Surgical proficiency was analysed through a cumulative sum (CUSUM) analysis of operative time and complication incidence. Results: All cats resumed voluntary urination within 48 hours of surgery, and none exhibited persistent dysuria or urinary incontinence. Minor wound dehiscence occurred in two cats (6.7%), and one cat (3.3%) developed a stomal stricture that resolved with balloon dilation; however, no revision surgeries were required. No cases of peristomal dermatitis or increased bacterial cystitis were detected. The median surgical time decreased from 71 minutes in early cases to 54 minutes in later procedures, and the CUSUM curve demonstrated a consistent decline in complication frequency, indicating progressive procedural mastery. Compared with previously reported stricture rates of 7%–9% for conventional Wilson-type PU techniques, our findings suggest that this modified technique results in lower complication rates and enhanced reproducibility, even in primary care settings. Conclusions and Relevance: This modified PU technique incorporating preputial mucosa provides stable urinary patency, low complication rates, and favourable cosmetic results. By minimising direct mucocutaneous tension and preserving mucosal integrity, this approach may reduce the risk of stomal stenosis and postoperative infection. The procedure demonstrates a short learning curve and appears to be a reliable, anatomically sound alternative for managing recurrent urethral obstruction in cats.