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Today, I’m excited to be able to offer you a guest post written by Dr. Jonathan Mitelman and Barbara Kelly which details the true story of a very sick cat that was in pain and in danger of losing his life and the surgery which was able to save his life.
Shadow’s Malformed Anatomy and His Life-Saving Surgery
By Dr. Jonathan Mitelman, DVM and Barbara Kelly
When Shadow, a nine month old male cat, began urinating inappropriately and refused to eat for two to three days, his owner brought him to VETS Toronto at the Kingston Road Animal Hospital for emergency treatment.
On presentation, Shadow was quiet and uncomfortable. When Dr. Jonathan Mitelman performed a physical examination, he found the cat had an abnormally turgid (large and firm) bladder. He was so painful when touched he was foaming at the mouth.
Dr. Mitelman’s first suspicion was a blockage. However, when lifting the cat’s tail for further assessment, he found Shadow’s anatomy was malformed. The penis was misshapen, curled up and directed towards the anus. (See photos below.)
Shadow's abnormal anatomy. Compare this to the normal feline anatomy pictured below.
Normal male feline anatomy
It normally would be pointing down and away from it. There was no opening at the tip of the penis. He had a bifid scrotum (two halves of the scrotum are abnormally separated) and the anogenital area was closer than it should be.
The owner said a previous vet had described Shadow as a hermaphrodite (having both male and female genitalia). As the cat was using the litter box and seemed in good health she thought nothing of the assessment until Shadow began urinating on her bed a couple of week’s ago.
It was impossible for staff to put a catheter in as there was no way of accessing the urethra. Although Shadow had been urinating up until recently, the malformation in his anatomy made it difficult to determine exactly how.
He had been leaking inside his body and the urine was making its way out.
Dr. Mitelman searched for relevant cases online and did consults with specialists, only to discover how rare this situation was.
The failure of Shadow’s external genitalia to complete development (also known as incomplete virilization), was caused by insufficient production of testosterone, or incomplete response to testosterone by the target tissues.
Most mammals, including humans, are created females by default, but “tainted” by testosterone to develop male reproductive organs.
The doctor explained to the owner that it was necessary to relieve the pressure on the cat’s bladder immediately by safely extracting urine across the bladder and abdominal wall through a small needle called cystocentesis and then proceed to surgery to perform a perineal urethrostomy.
This would involve creating a urethral opening or stoma at the level of the pelvic floor, with enough distance between it and the anus.
Shadow was given antibiotics and pain medications and attached to slow drip IV fluids.
Approximately one cup of urine was extracted from his bladder by needle and syringe. The lab work showed blood in his urine, but not crystals. Any sediment was sitting heavily in his bladder.
Dr. Mitelman advised the owner that there were risks involved as the location of the urethra was unknown. The hope was to perform a perineal urethrostomy despite the anatomical malformations.
It was possible a pubic urethrostomy or opening of the pubic symphysis and creating the stoma between the hind legs would be necessary. Or perhaps even a pre-pubic urethrostomy where the stoma is in front of the pelvis from the abdomen would be required.
These are fortunately rarely needed as long as the urethra from the bladder is intact and useable. In all cases, complications can include constant dribbling from incontinence and infection when the protective barrier of the penis is removed.
Once inside, Dr. Mitelman had his associate lightly squeeze the bladder in an attempt to locate the urethra. He was able to trace it to its location, 1/2 an inch (1.27 centimetres) inside the body, hidden beneath tissue at the level of the prostate.
The squeeze on the bladder also dislodged a blockage that splashed Dr. Mitelman’s surgical gown with crystalline urine of a tooth paste-like consistency.
The urethra was dissected away from the sphincter muscle and brought towards the anal opening. It was necessary to bring skin together to form a bridge, thus maintaining sufficient distance from the anus.
Once the urethra was visible and functional, a large catheter was inserted and the sediment in the bladder removed.
Shadow was given medications to help his bladder squeeze and was evacuating on his own shortly after surgery. His back end now looks similar to any other cat that has had a perineal urethrosotomy.
Post-surgery appearance
Shadow’s owner has his sibling from the same litter at home and is hoping the two will spend their lives together.
A week after surgery, the owner reported Shadow recovering well. He will be monitored and is eating food to help prevent future crystals. Wet food is included to help with his fluid intake.
There are still some outstanding questions because Shadow’s incomplete virilization prevented the full development of his outer male organs.
It is still uncertain whether Shadow might have female reproductive organs hiding on the inside and if there is a non-functional uterus within, it remains to be seen if this will become a problem.
About the authors:
Dr. Jonathan Mitelman, DVM, graduated in 2002 from the Ontario Veterinary College in Guelph, Ontario, Canada. He is the medical supervisor and managing partner at VETS Toronto (Veterinary Emergency Trauma Service) and the Kingston Road Animal Hospital. Dr. Mitelman’s special interests include: ophthalmology, ultrasonography, cardiology, orthopedic surgery and emergency and critical care medicine.
VETS Toronto and the Kingston Road Animal Hospital operate as two separate entities that share facilities to provide regular day services and after hours, emergency, critical care, overnight patient monitoring and referral services. This full-service animal hospital, located in Toronto, Ontario, has a doctor on site 24/7/365.
To learn more, please visit the following:
Vets Toronto
Vets Toronto on Twitter
Vets Toronto on Facebook
Vets Toronto Blog
About Lorie Huston, DVM
Lorie Huston is a veterinarian, pet health and pet care expert, professional writer, blogger, social media and blogging consultant, and SEO strategist.
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{ 3 comments… read them below or add one }
I’m feeling Shadow’s pain just looking at the photos. He must have been in agony for days now. I do hope he recovers soon and eat well again.
Thank you, Julianne. We all do!
Thank you for working with us on a medically challenging case. We acknowledge how important Shadow is to you and your family.