Hi, I’m looking for guidance on possible causes and what diagnostics I should ask my vet for.

Species: Cat
Age: almost 11 years
Sex/neuter status: Male, neutered (around 6–7 years old)
Location: France
Indoor-only: Yes

History

Urinary obstruction once when he was young (~1.5 years old). No urinary issues for ~10 years after that.
September 2025: new urinary obstruction. Treated with urinary catheterization (“sondage”) and bladder emptying, hospitalized for 1 day. No perineal urethrostomy at that time. The vet said the obstruction was caused by urinary “sand”/grit (sediment), not a single large stone.
Post-op meds (as prescribed): Kesium (amoxicillin/clavulanate), Meloxidyl (meloxicam), Xatral (alfuzosin).
After ~2 weeks, urination seemed normal again.
Bloodwork was done at the time of the obstruction/intervention and kidney values were normal.
No urinalysis or urine culture has been done since these symptoms started.

Current problem (started ~1–1.5 months after Sept 2025 obstruction)

For about 7 months (early May 2026 now), he has had persistent urine leakage/dribbling:

It feels like he “always has a drop”: he licks his genital area often to clean it.
I find small urine drops wherever he lies down (floor, couch, bed). Usually small amounts, but sometimes larger stains if he sleeps a long time in one spot, or especially when he comes to the bed (he seems like he can’t fully hold it even though he tries).
He also urinates outside the litter box sometimes: mainly right in front of the box, sometimes on the bed, rarely on the couch (not random places).

Litter box behavior

He goes to the litter box about 10–15 times per day.
Each time he urinates roughly 1–2 teaspoons (estimate).
The urine often comes out in drops, not a strong stream/jet like before. He doesn’t seem to strain hard; more like he sits and “waits” and it comes out in drops.
He often licks after urinating or after noticing a drop.

General condition

Otherwise he seems well: playful, social, affectionate, no vocalizing, no obvious pain on abdominal touch, no vomiting/diarrhea/constipation.
Urine looks normal to me: no visible blood, no pink color, no strong odor, no visible “sand” deposits.
He may drink a bit more, but I recently bought a new fountain he likes (mineral bottle water).
Appetite: overall he eats normally, weight seems stable (he was overweight before and looks more “normal” now). He sometimes eats the dry food less. Wet food appetite is always good.
Possible mild redness at the tip of the penis, which could also be from frequent licking.

Diet

Dry: Royal Canin Veterinary Urinary S/O Moderate Calorie via automatic feeder.
Wet (not often): Royal Canin Veterinary Urinary S/O in gravy (always eats it well).
No real diet cheating (rare tiny bits of cooked meat < once/week).

Vet follow-up

When leakage started, the vet re-tried Xatral (alfuzosin) in case of partial urethral blockage. No clear improvement (maybe mild tiredness).
At the second visit, the vet did an ultrasound and reported no crystals/stones and no obvious bladder abnormality.

Personal note

I understand you can’t diagnose online; I mainly want a second opinion on what to investigate. The last months have been difficult financially and personally, which is partly why this has been going on for so long, but I love my cat deeply and I want to address this properly now. On the second visit, my vet mentioned perineal urethrostomy as a possibility because they suspected recurrent stones/obstruction. That really scared me given what he already went through and how stressful vet visits are for him.

However, since this has been ongoing for many months, he has been on a strict urinary prescription diet, and imaging did not show stones, I’m wondering if recurrent stones are less likely as the main explanation and whether other causes (UTI/inflammation, urethral stricture, bladder dysfunction, etc.) should be ruled out first.

Thanks. I’m happy to provide any additional information if needed.

u/Barber-ours