[Very Urgent] Advise on Cystotomy vs PU

My 8 year old cat (male, neutered, American short hair) was diagnosed with bladder stones and underwent a cystotomy in February 2024 to surgically remove the stones from the bladder. Unfortunately, the surgeon left behind 3-4 stones in the urethra during the surgery, which were later pushed back in the bladder. These stones blocked him again in May 2024 – he was unblocked via a catheter and the stones were pushed back into the bladder during catherization. He again got blocked a couple days ago and has been unblocked again via catherization with the stones pushed back in the bladder. The X-rays do not show formation of new stones in the last few months and the urinary analysis do not show any crystals.

We are considering three surgical options to remove the sones now: 1) cystotomy 2) PU 3) Cystotomy + PU. Please see X-rays after the cystotomy in February, the one from May and the one from last night and advise on the best course of treatment

My initial question : https://www.pawbly.com/question/hello-i-live-in-san-jose-california-and-need-urgent-help-with-my-male-7yr-old

Update: My cat went through a cystotomy on Friday, the surgery went well and he was sent home the same day. Unfortunately he was still blocked as the surgeon did not remove the stones in his urethra (He did not take any xrays after the surgery and also discharged my cat without making him pee on his own). I rushed him to the ER as he was very restless and trying to pee, the ER doctor immediately unblocked him with a catheter and while doing so, she was able to push the stones back into the bladder. Xrays (attached) were taken which shows three stones in the bladder. As the cost of ER was adding up and the surgeon who did his surgery was not available over the weekend, I decided to shift him with the catheter on to the hospital where his surgery was done. I would like to add that in the initial surgery, the surgeon successfully removed all the stones in his bladder but the stones in the urethra were left behind even though he said he flushed them. The ER doctor is very certain that she pushed those stones back into the bladder while unblocking him the second time when he landed in the ER post the surgery.

My cat is currently doing well, he is on Ivy and has a catheter on. He is on CD food since two days. The urine color has improved from bloody to fairly clear. Urinalysis results showed struvite (Ammonium Mg Phosphate) crystals . I will be meeting the surgeon tomorrow and need your advice on what should be the next steps for my cat. Which of the following would you advise?

1. Re surgery to remove the remaining three stones from the bladder. After the initial surgery, the surgeon had mentioned that my cats heart is weak and hence he had to adjust the anesthesia to a lower level (1 instead of the usual 2), though the ER doctor does not see why would that be the case as there is no murmur seen in his reports and he has taken the sedation well while he was unblocked twice in the ER.

2. CD food therapy: Urinalysis results showed struvite (Ammonium Mg Phosphate) crystals. Should we remove the catheter, make him pee on his own at the hospital and then get him home. Watch closely for re blockage while continuing his CD diet. What are the chances of his re blockage? Will the bladder have greater chances of rupture if he gets re blocked since he just had surgery?

Please advise.

@KristaMagnifico

Hello, I live in San Jose California and need urgent help with my male 7yr old neutered cat who is blocked. I took him to a vet who referred him to an ER , the ER has given me an estimate of $4500 to $5000. I cannot afford the treatment, they have unblocked him and put a catheter and IV. They plan to keep him for 48hrs in the hospital, the doctor told me that she found stones in his bladder and kidneys. I am really worried, please help me find a vet who can treat him further for less. I want to move my cat in the morning to an affordable clinic. Please guide me on next steps and help me find a vet. The case summary from the vet and estimate from the ER is attached to the post. Please help me this is very urgent.