Cystotomy ( Urinary Bladder surgery)

• A cystotomy is a surgical opening created in the wall of the urinary bladder. This procedure allows the surgeon to look inside the bladder. While abdominal x-rays, ultrasound examination, and cystoscopy (scooping the bladder) are less invasive methods of looking into the bladder, cystoscopy has an important role in treatment of urinary bladder problems.

Indications  of a cystotomy?  

Cystotomy is mostly indicated for treatment of bladder problems including:

• Removal of bladder stones,
• Urinary  bladder tumors, and blood clots. This procedure also can be done
• To obtain a biopsy sample of the urinary bladder.
• Cystotomy is done to repair a rupture or severe trauma to the urinary bladder.
• In cases of abnormal insertion of the ureters into the bladder (these are the thin long tubes that carry urine from the kidneys to the bladder), a cystotomy incision will be needed to correct the problem.

Pre-operative Tests:

• Preoperative tests depend in part on the age and general health of the animal as well as the cause for the cystotomy.
• Radiographs (x-rays) or abdominal ultrasound typically is done to diagnose the underlying illness prior to surgery.
• Often a complete blood count, serum biochemical test, a urinalysis, and possibly an EKG will be performed prior to surgery.

 Type of Anesthesia:

• This is a surgical procedure that involves opening the abdominal cavity. General anesthesia is needed to induce unconsciousness, complete control of pain, and muscle relaxation.
• In the usual case, the pet will receive a pre-anesthetic sedative-analgesic drug to help him relax, a brief intravenous anesthetic to allow placement of a breathing tube in the windpipe, and subsequently inhalation (gas) anesthesia in oxygen during the actual surgery.

Cystotomy  Surgery:

• Following anesthesia, the pet is placed on its back lying on the surgical table.
• The hair is clipped over the lower abdomen, the skin is scrubbed with surgical soap to disinfect the area and a sterile drape is placed over the surgical site.
• The incision is similar to a spay incision (midline). Your veterinarian uses a scalpel to incise the skin of the lower abdomen and to open the abdominal cavity.
• The urinary bladder is isolated with sterile sponges and an incision is made. Any urine is removed from the bladder to prevent abdominal contamination.
• The operation then continues; for example, the surgeon may remove bladder stones, a tumor, or extensive blood clots. Often a urinary catheter is placed at the conclusion of surgery, to allow urine to drain easily from the bladder.
• At the conclusion of the procedure, sutures (stitches) that dissolve over time are placed to close the incision in the urinary bladder.
• The abdominal incision is then closed with one or two layers of self-dissolving sutures (stitches).
• The outer layer of skin is closed with sutures or surgical staples; these need to be removed in about 10 to 14 days.

 Cystotomy Time:

• The procedure takes about 45 minutes to 1-1/2 hours to perform in most cases, including the needed time for preparation and anesthesia.

 Risks and complications of a cystotomy ?

• The overall risk of this surgery is low. The major risks are those of general anesthesia, bleeding (hemorrhage), postoperative infection, urine leakage, and wound breakdown (dehiscence) over the incision.
• Overall complication rate is low, but serious complications can result in anesthetic death or the need for additional surgery.

 Aftercare for a cystotomy?

• Post-operative medication should be given to relieve pain, which is judged in most cases to be mild to moderate and can be effectively eliminated with safe and effective pain medicines.
• Often a urinary catheter will have been placed at surgery. This is typically removed in 24 to 72 hours.
• The home care requires reduced activity until the stitches are removed in 10 to 14 days.
• You should inspect the suture line daily for signs of redness, discharge, swelling, or pain and monitor your pet’s urinary habits.
• Some blood-tinged urine is expected for the first few days, but obvious pain, straining or a lack of urination is not normal and should prompt a call to your veterinarian.

Hospital stay following a Cystotomy:

• The typical stay following a cystotomy is 2-3 days but will vary depending on the overall health of the pet and the underlying reason for the surgery.