Despite advances in the medical management of feline lower urinary tract disease, Perineal urethrostomy (PU) remains the treatment of choice for patients with repeated obstruction, urethral tears or stenosis, and unsuccessful urethral catheterization. The cat is placed in either dorsal or ventral recumbency. A 3Fr catheter is placed in the urethra. An elliptical incision is made around the penile body and scrotum. The tissue is dissected ventrally to the ischiatic arch and both the ventral penile ligament and the ischiocavernosus muscle are transected. Minimal dissection is carried out dorsally until the bulbourethral glands. The urethra is incised on the dorsal midline with iris scissor to the level of bulbourethral glands to achieve placement of a 10Fr catheter. The mucosa is sutured to the skin with 4-0 rapidly absorbable suture with either interrupted or continuous pattern and the distal end of the penis is amputated. The complication rate is about 20% and includes wound hemorrhage, re-obstruction, dehiscence, urine scalding, stricture, and recurrent bacterial cystitis that is the most common late complication. The overall prognosis following PU is good, with around 90% of clients reporting a satisfactory long-term quality of life.