What does it involve and when it is indicated?

This surgery involves incising into the urinary bladder, most oftentimes to remove cystoliths (bladder stones). Cystoliths are diagnosed through urine analysis in combination with radiographs (x-rays) and/or ultrasound. Cystotomies are performed when stones are diagnosed to be in the urinary bladder or the urethra (a tube that carries urine from the bladder out of the body) and have the potential to or are blocking the passage of urine (completely or partially). With enough time and pressure, a complete urinary blockage can cause the urinary bladder to rupture and spill urine into the pet’s abdomen (uroabdomen). This painful condition can be fatal and surgical intervention should be pursued as soon as possible.

Clinical Signs

Clinical signs depend on the severity of the blockage:

Partial Obstruction:

• Patient urinates small amounts consistently (for cats, this could mean frequent trips to the litterbox or sleeping/lying in the litterbox)
• Straining when urinating
• Potentially there may be blood in urine
• Urinating small drips instead of a steady stream
• Possible inappropriate urination (urinating in unusual places in the home)

Complete Obstruction:

• Will strain to urinate repeatedly without producing any urine
• Will be in pain and be lethargic, lose their appetite, and could start to vomit

Treatment

While under general anesthesia, all stones are flushed from the urethra into the bladder with the use of an indwelling urinary catheter. After opening the abdominal cavity, the bladder is incised into to remove all stones, blood clots and sludge/sandy debris. Prior to closure the bladder is repeatedly flushed with saline to ensure there are no leftover stones. Repeat imaging (most likely radiographs, depending on the stone type) is done prior to closing the incisions to ensure all stones have been removed from the bladder and urethra.

Complications

• Urethral and/or bladder tears prior or during surgery can result in urine leakage, bladder dysfunction, urinary incontinence or recurrence of the obstruction due to urethral scarring. These symptoms may warrant further surgeries

Post-operative complications:

• Urine leakage at the suture line of the bladder
• Hernia and seroma formation at the abdominal incision
• Infection
• Dehiscence of bladder wall and abdominal incisions

Aftercare

• Patients recovering from a cystotomy surgery will spend on average of one to two days in hospital before being discharged to the care of their owner.
• Restricted activity for 14 days. Short leash walks only to go to the bathroom (if applicable). No running, jumping or rough plays during this time.
• Patient is monitored closely for the first week for reduced appetite, abdominal pain and swelling, lethargy, fever and vomiting
• Pain medications, and possibly antibiotics are common prescriptions following surgery
• Calculi are sent for analysis to determine whether special diets or medications are needed
• An Elizabethan (E) collar (“cone”) is provided and must be worn at all times to prevent self-trauma of the surgical site. A loose fitting breathable T-shirt or post-surgical onesies may also be considered.
• Daily monitoring of the surgical site. Complications include oozing, a foul smell, swelling or pain at the surgical site. A bandage may be applied to the surgical site to be kept on for the first day (and removed thereafter) after surgery to minimize leaking from the incision.
• An increase in urgency to urinate and accidents may occur
• Blood tinged urine is common (active dripping of frank blood is not normal and should prompt you to call your veterinary surgeon)

Prognosis

• Prognosis is excellent as long as the patients have not suffered serious kidney injury from prolonged obstruction (this can be confirmed by trending blood work renal values such as urea, creatinine, SDMA and urine specific gravity) and the appropriate diet and medications are continued lifelong.
• In cats, obesity and lack of environmental enrichment is closely linked to the development of relapsing episodes of urinary issues and the potential for more crystal and stone development in the urinary tract