By Erica Tramuta-Drobnis, VMD, MPH, CPH

Urethral obstructions (UOs) are common in male cats. Recognizing obstruction, prompt treatment, appropriate antimicrobial stewardship practices, good pain and anxiety management, addressing stressors at home, and working within the pet parent's budget, expectations, and needs remain paramount. Ensuring we remain up to date with current evidence-based recommendations for the treatment and management of UOs in cats improves health outcomes. Proper client education about the risks of recurrence, treatment costs, treatment plans, outcomes, and possible complications improves compliance and preserves the human-animal bond (HAB).

Best practices: Feline UOs

When I started in veterinary medicine more than 20 years ago, the standard treatments were phenoxybenzamine and buprenorphine for managing feline interstitial cystitis (FIC) and UOs. However, we soon learned from evidence-based research that phenoxybenzamine was not effective in the feline urethra, so we switched to prazosin. Nevertheless, that, too, has fallen out of favor, and research suggests it may actually increase the risk of UO recurrence when used.^1–5

My points are a few: using the best available evidence-based practices is crucial to improving health outcomes; our understanding and management of feline UO has improved over time; proper antimicrobial stewardship is paramount; multiple treatment options are available for UO management in the general practice and 24/7 care hospital settings; managing pain and anxiety remain crucial to treatment during obstruction, immediately after, and for long-term prevention.

UO management

We all understand how cats with UO can rapidly decline, and yet this life-threatening condition can be treated, and most cats do well. Treatment, in a nutshell, consists of pain management and relief of the obstruction (paramount). Note, I didn't say antibiotics. Remember that less than 1 percent of cats with FIC and UOs have bacterial infection upon presentation.^6–8 Please stop giving cefovocin (and other antibiotics) to all your blocked cats. Culture the urine and give antibiotics if the culture is positive; otherwise, the odds of infection are very low, thus, careful watching is advised. (See: "The contraindication of cefovecin"). Clinically, cats managed with unblocking and an indwelling catheter (12-48 hours depending on various parameters, including level of azotemia, degree of hematuria, patient's stress level, post-obstructive diuresis, and client financial constraints) and IV fluid therapy have the best prognosis and are less likely to reblock than those that are unblocked and sent home.^9,10

Unblocking a cat

We all know how to pass a urinary catheter to unblock a cat. However, this article offers some useful tips from an emergency vet:

1.  Pain management and sedation/anesthesia. Ensure adequate sedation, pain management, and urethral relaxation for your patient. This means not using sedatives alone with minimal pain control (e.g., just butorphanol), and, in some cases, means adding a benzodiazepine to help with urethral relaxation. For some, propofol or gas anesthesia may be necessary to relax the patient fully. Do not fight against the cat. That only makes your job harder and increases the risk of urethral tears or bladder ruptures.
2. An IV catheter should always be placed for safety and emergency access, regardless of the sedation protocol you use.
3. To unblock: A long catheter with the stylet removed, such as an 18-22 g 1.5-in., has more rigidity to it than an open Tom Cat catheter and may permit that initial unblocking with pulse flushing to relieve the obstruction. The downside is it does not fully reach the bladder, which may make fully evacuating the bladder more challenging, but a longer catheter can always be placed once the obstruction is relieved. Unblocking a cat is often an exercise in patience. Gentle back-and-forth movements with pulse flushing can help relieve most obstructions.
4. Coccygeal epidural: Some practitioners perform a local block of the penis and urethra and feel it provides an improved outcome. It provides pain management and may make catheterization and obstruction relief easier. This is a skill, however, that requires practice; learning on a UO where time is of the essence is not recommended. Consider adding it to your protocol once it is well-practiced and see if you notice a difference. This is often clinician-dependent.^9,11,12 More recent, larger-scale studies are warranted.
5. Always be sure to take radiographs. Some may choose to take radiographs before sedation/before unblocking to evaluate if stones are in the urethra and may pose a challenge. Others take them during the unblocking. The presence of bladder/urethral stones affects the prognosis, care required, and costs for clients. Regardless of when you choose to take rads, make sure you do and include the distal urethra.
6. Indwelling catheters. For cats that will be hospitalized, these include most commonly 3.5-in. to -5-in. red rubber catheters and Slippery Sams. Whichever you use, if you are hospitalizing a patient for any period, always put a closed collection set on your catheter to prevent contamination and bacteria from wicking up the catheter and creating an infection. Some research suggests that using a 3.5 French over a 5 French lessens the risk of re-obstruction, but additional research is warranted.^5,7,9
7. Fluid therapy. Even with normal renal values, these cats are often dehydrated and benefit from having their kidneys flushed. Ideally, IV fluid therapy is recommended even in cats that will be going home after unblocking.^9,10,13,14
8. Management of hyperkalemia. The key is to unblock them, perform diuresis, and protect the heart. Unblock these cats sooner rather than later, administer a dose of calcium gluconate to stabilize the heart before sedation, and perform diuresis. While additional therapies may be used (e.g., insulin/dextrose), hyperkalemia is often managed without them and, when promptly treated, doesn't negatively impact survival rates. Generally, no significant differences are observed across protocols. The key is to unblock and diurese.^15,16
9. Post-unblocking care: Pain management, anti-anxiety management, and minimizing stress are key. Most of these cats have either a history of FIC or are at high risk for FIC and related clinical signs. Further, these cats are at risk of reblocking, which generally occurs within the first  six to 48 hours after pulling a urinary catheter (unblocking a cat), but it can happen at any time. For the first seven days, cats should be closely monitored for recurrence.^4,9,17 Minimizing stress in the hospital includes administering gabapentin and/or trazodone +/- a benzodiazepine (e.g., lorazepam),¹⁸ placing them in a quiet space (e.g., cat ward), playing soothing music (e.g., classical), and handling minimally. At home, ensuring proper pain management and anti-anxiety care, along with patient-specific multimodal environmental modification (MEMO), are all crucial to minimizing recurrence of obstruction.^10,13,14,19 
   

   Tips for unblocking If you work at a non-24/7 clinic and offer unblocking and hospitalization, ensure: Owners know the clinic isn't staffed overnight and that this could lead to re-blocking and severe complications. Owners understand that referral to a 24/7 practice is always an option. You never transfer a patient with a urinary catheter without a closed collection system.7 A closed collection system protects against bacterial contamination and wicking up the catheter. Remember, these cats usually have sterile cystitis. We do not need to cause iatrogenic infection, nor do we need to give antibiotics "just to prevent infection." You do not need anything fancy, though they sell actual collection sets. However, IV tubing and an IV bag with a Christmas tree do fine. You provide proper pain/anti-anxiety management.

When finances dictate therapy

We don't discuss the gold standard of care anymore but instead offer a spectrum of care. With UOs, unblocking is still the best option. Unblocking and hospitalization vs. unblocking and going generally are what most people offer. Sadly, all too often, young cats are euthanized because of financial constraints, recurrent obstructions, lack of MEMO management at home, and recurring FIC signs. More proactive client education about early detection, risks, anxiety management in the home, multi-cat household environmental strategies, and the option of a perineal urethrostomy upon reblocking remains essential. Working with clients within their financial means and expectations is crucial. Our goal is to minimize pain and suffering and preserve the HAB. However, owners need a clear understanding of the treatment path they choose, the risks, and the options.

Meds to go home

We need more evidence-based studies with larger sample sizes to better understand the needs of our feline patients with UO and their risk of recurrence. Current research shows the rate of UO recurrence is equivocal regardless of whether meloxicam (NSAID) or steroids (higher risk of infection with administration or heart disease unmasking) are utilized.^20,21

Steroids fell out of favor years ago and are not clinically recommended. No studies on using robenocoxib have been completed. Since current evidence is lacking and NSAIDs can pose renal concerns, especially in compromised patients, the use of NSAIDs in the acute stages of UO is not recommended. Until research suggests benefits, their use post-obstruction is not advocated.

Anti-anxiety and pain management may not lessen the risk of recurrence of obstruction but may help keep the patient comfortable and minimize stress. Generally, my choice includes gabapentin (minimum 10-15 mg/kg) q 8 hours for 7-10 days or longer depending on the situation at home. I will usually do 5-7 days of buprenorphine PO q8, as well. Some clients appreciate the long-acting topical buprenorphine preparation; however, I have seen very dysphoric cats on that, that fail to eat, cause concern for owners, and cannot be fully reversed. Thus, use careful patient and owner selection when choosing a longer-acting therapy. Regardless, send home pain meds and ensure proper client education about MEMO and monitoring for recurrence.

Recurrence happens

Always educate clients that even though a cat does well with their unblocking, any cat can re-block, and we have no way of knowing which ones. Thus, ensure owners understand the clinical signs, make modifications in the home to lessen inter-cat aggression, minimize stressors, increase water intake, ensure ideal body condition, and know when to return urgently if recurrence occurs.

With prompt management, most cats survive this condition, save for iatrogenic euthanasia due to client constraints (e.g., financial, logistical). Remember, this condition is not generally bacterial in origin, and antibiotics are not warranted unless directed by a positive urine culture. Practicing proper antimicrobial stewardship is crucial to lessening our impact on AMR. Send home pain medication and anti-anxiety medications as dictated by the patient and caution owners that signs of feline lower urinary tract disease may continue for up to seven days.

While the ideal is to hospitalize with an indwelling catheter and IV fluids, this is not realistic for all owners, geographical areas, or even patients, and unblocking and sending a patient home is a viable option. However, owners need to be aware of the risk of recurrence, which is higher without hospitalization. Still, to preserve the HAB, lessen financial euthanasia, and improve outcomes, unblock-and-gos offer a viable option when hospitalization is not feasible.

Erica Tramuta-Drobnis, VMD, CPH, is the CEO and founder of ELTD One Health Consulting, LLC. She works as a public health professional, an emergency veterinarian, a freelance writer, a consultant, and a researcher. Dr. Tramuta-Drobnis is passionate about One Health issues and is a strong advocate of evidence-based veterinary medicine. She is the president-elect of the Evidence-Based Veterinary Medical Association (EBVMA).

References

1. Conway DS, Rozanski EA, Wayne AS. Prazosin administration increases the rate of recurrent urethral obstruction in cats: 388 cases. J Am Vet Med Assoc. 2022;260(S2):S7-S11. doi:10.2460/javma.21.10.0469
2. Hanson KR, Rudloff E, Yuan L, Mochel JP, Linklater AK. Effect of prazosin on feline recurrent urethral obstruction. J Feline Med Surg. 2021;23(12):1176-1182. doi:10.1177/1098612X211001283
3. Reineke EL, Thomas EK, Syring RS, Savini J, Drobatz KJ. The effect of prazosin on outcome in feline urethral obstruction. J Vet Emerg Crit Care. 2017;27(4):387-396. doi:10.1111/vec.12611
4. Beeston D, Humm K, Church DB, Brodbelt D, O'Neill DG. Occurrence and clinical management of urethral obstruction in male cats under primary veterinary care in the United Kingdom in 2016. J Vet Intern Med. 2022;36(2):599-608. doi:10.1111/jvim.16389
5. 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(4):512-519. doi:10.2460/javma.243.4.512
6. Cooper ES, Lasley E, Daniels JB, Chew DJ. Incidence of bacteriuria at presentation and resulting from urinary catheterization in feline urethral obstruction. J Vet Emerg Crit Care. 2019;29(5):472-477. doi:10.1111/vec.12870
7. Weese JS, Blondeau J, Boothe D, et al. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J. 2019;247:8-25. doi:10.1016/j.tvjl.2019.02.008
8. Balboni A, Franzo G, Bano L, et al. No viable bacterial communities reside in the urinary bladder of cats with feline idiopathic cystitis. Res Vet Sci. 2024;168:105137. doi:10.1016/j.rvsc.2024.105137
9. Cosford KL, Koo ST. In-hospital medical management of feline urethral obstruction: A review of recent clinical research. Can Vet J. 2020;61(6):595-604.
10. Taylor S, Boysen S, Buffington T, et al. 2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats. J Feline Med Surg. 2025;27(2):1098612X241309176. doi:10.1177/1098612X241309176
11. O'Hearn AK, Wright BD. Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction. J Vet Emerg Crit Care. 2011;21(1):50-52. doi:10.1111/j.1476-4431.2010.00609.x
12. Local Anesthetic Techniques For Perineal Procedures. AAHA. February 12, 2020. Accessed August 4, 2026. https://www.aaha.org/resources/2020-aaha-anesthesia-and-monitoring-guidelines-for-dogs-and-cats/local-anesthetic-techniques/for-perineal-procedures/
13. Macleod B, Laven LJ, Laven RA, Hill KE. Understanding the current evidence base for the commonly recommended management strategies for recurrent feline idiopathic cystitis: a systematic review. N Z Vet J. 2025;73(4):233-245. doi:10.1080/00480169.2025.2477542
14. de Moraes RS, Ferreira JF, Maia SR, et al. Managing urethral obstruction in male cats: a practical guide and literature review. N Z Vet J. 2025;73(6):381-396. doi:10.1080/00480169.2025.2527114
15. Jones JM, Burkitt-Creedon JM, Epstein SE. Treatment strategies for hyperkalemia secondary to urethral obstruction in 50 male cats: 2002–2017. J Feline Med Surg. 2022;24(12):e580-e587. doi:10.1177/1098612X221127234
16. Maciorowski S, Rozanski EA, DeStefano I, Verschoor-Kirss M. Pharmacological therapy for hyperkalemia in feline urethral obstruction has no additional benefit over intravenous fluid and calcium gluconate therapy and prompt unobstruction. J Am Vet Med Assoc. 2025;263(10):1268-1272. doi:10.2460/javma.25.04.0258
17. Seitz MA, Burkitt-Creedon JM, Drobatz KJ. Evaluation for association between indwelling urethral catheter placement and risk of recurrent urethral obstruction in cats. J Am Vet Med Assoc. 2018;252(12):1509-1520. doi:10.2460/javma.252.12.1509
18. Splittstoesser A, Kerley J, Lulich J, Randall A, Tart K. Lorazepam reduces recurrence of urethral obstruction in male cats: a prospective, randomized, double-blinded, placebo-controlled study. J Am Vet Med Assoc. Published online May 6, 2026:1-9. doi:10.2460/javma.26.01.0045
19. Buffington CAT, Westropp JL, Chew DJ, Bolus RR. Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis. J Feline Med Surg. 2006;8(4):261-268. doi:10.1016/j.jfms.2006.02.002
20. Dorsch R, Zellner F, Schulz B, Sauter-Louis C, Hartmann K. Evaluation of meloxicam for the treatment of obstructive feline idiopathic cystitis. J Feline Med Surg. 2016;18(11):925-933. doi:10.1177/1098612X15621603
21. Smith-Uchotski T. In cats which treatment, meloxicam or prednisolone, most quickly reduces clinical signs of feline interstitial cystitis? Vet Evid. 2022;7(1):vetevid-7-1-346. doi:10.18849/ve.v7i1.346