Urethral obstruction in male cats, commonly caused by urolithiasis or FLUTD, can be life-threatening. Modified perineal urethrostomy (MPU), connecting the proximal urethra to the preputial mucosa, was performed in three male cats. Two cases with urolithiasis underwent concurrent cystotomy, and one FLUTD case received MPU alone. Two cats recovered uneventfully, while one developed re-obstruction from urinary sludge requiring revision. MPU achieved stable urinary patency and good cosmetic results in most cases, suggesting it as an effective alternative to conventional PU; however, recurrence associated with inflammatory or metabolic causes in FLUTD indicates the need for careful postoperative medical management.