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.
WHAT ARE THE INDICATIONS FOR PERFORMING A CYSTOTOMY?
Cystotomy is most indicated for treatment of bladder problems including removal of bladder stones, 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.
WHAT PREOPERATIVE EXAMINATIONS OR TESTS ARE NEEDED BEFORE A CYSTOTOMY?
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.
WHAT TYPE OF ANESTHESIA IS NEEDED FOR A CYSTOTOMY?
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.
How Is the Cystotomy Operation Done?
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.
HOW LONG DOES THE CYSTOTOMY TAKE TO PERFORM?
The procedure takes about 45 minutes to 1-1/4 hours to perform in most cases, including the needed time for preparation and anesthesia.
WHAT ARE THE RISKS AND COMPLICATIONS OF A CYSTOTOMY OPERATION?
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 death or the need for additional surgery.
WHAT IS THE TYPICAL POSTOPERATIVE 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.
HOW LONG IS THE 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.