Cystotomy Surgery

 

     Can you imagine the feeling of having to urinate, but physically not being able to?  Supposedly passing a kidney stone is one of the most painful things a person can go through.  I am sure that not being able to pee is just as painful.  I recently had a little patient who had cystic calculi (stones) blocking her urethra and bladder causing her much discomfort to the point that the little amount of urine she was able to pass was gross hematuria (straight bloody urine).  Whenever a pet presents with a problem of this magnitude, you have to run diagnostic tests.  The tests begin with a simple urinalysis and progress to radiographs looking for radiopaque objects located within the bladder/urinary outflow tract and often-times even include bloodwork to evaluate renal function/electrolyte imbalances as well.  My 7 pound patient had stones the size of raspberries in her tiny little bladder.  Sometimes you can dissolve them with specific therapeutic diets, but sometimes you end up resorting to surgery.  Complete obstruction is a medical emergency that can be life-threatening and therapy should be initiated immediately.  Partial obstruction is not necessarily an emergency but these patients are at risk for developing complete obstruction which may cause irreversible urinary tract damage if not treated promptly.  Blocked canines have a little more time, but blocked felines are always an emergency.  First and foremost you must stabilize the patient at the time before even contemplating surgical therapy.  Treatment has three major components: combating the metabolic abnormalities associated with postrenal uremia (dehydration, hypothermia, acidosis, hyperkalemia, azotemia, etc); restoring and maintaining a patent pathway for urine outflow; and implementing specific treatment for the underlying cause of the urinary retention.  Long-term management and prognosis depend on the cause of the obstruction.

The cystotomy was performed to remove cystic and urethral calculi.  A ventral midline incision using a #10 blade was made through the linea alba from the umbilicus caudal to the pubis to identify the bladder.  The bladder was isolated from the rest of the abdominal cavity by placing moistened laparotomy sponges beneath it.  Stay sutures were placed on the bladder apex to facilitate manipulation.  Urine was removed from the bladder.  An incision with a #10 blade was made on the ventral aspect of the bladder, away from the ureters and urethra and in-between the major blood vessels.  Urine was removed from the bladder.  The bladder apex was checked for a diverticulum.  The mucosa was examined for defects, and a catheter was passed down the urethra for patency.  The urethra was flushed until certain that the urethra was free of cystic calculi.  The bladder was closed in a single layer absorbable suture simple continuous pattern using 3-0 PDS taper-point needle.  The goal of the closure was to obtain a watertight seal that would not promote the formation of future calculi.  The bladder patency was checked.  The abdomen was then flushed with sterile saline and suctioned out.  The external rectus sheath was closed using 2-0 PDS in a simple continuous pattern.  The subcutaneous and skin layers were closed using 2-0 PDS in a subcuticular intradermal pattern.  Compared with other organs, the urinary bladder heals quickly, regaining 100% of its normal tissue strength in 14-21 days with appropriate post-operative exercise restriction.

One happy little dog that could pee, free from pain...extremely satisfying.