In this VETgirl online veterinary CE video blog, we discuss the fundamentals of performing a cystotomy in a dog.

A 5-year-old, male neutered, Lhasa Apso presented to the emergency service with a urethral obstruction secondary to cystic calculi. The patient was stabilized, heavily sedated, and unobstructed with urethral retrohydropulsion. An indwelling urinary catheter was left in place until surgery the following day.

At the time of surgery, the previous night’s urinary catheter was removed and the ventral abdomen and and prepuce were aseptically prepped for surgery. A new sterile red rubber urinary catheter was placed while flushing with sterile saline. A ventral midline incision from the umbilicus to the pubis was made to enter the abdomen. In male dogs, the incision should be extended lateral to the prepuce to access the urinary bladder. Moistened lap pads were used to isolate the bladder from the rest of the abdomen. A stay suture was placed at the bladder apex. An incision in the ventral aspect of the bladder was made, away from the dorsally located ureters and urethra, and between major vessels. The incision is extended with scissors and urine is suctioned away. Using sterile forceps and a spoon, the cystic calculi were removed. The urinary catheter was then repeatedly flushed to loosen any remaining calculi. The catheter was then flossed to ensure urethral patency.

A small section of the bladder mucosa was excised and submitted for culture, as well as one of the bladder stones. Don’t forget to crush the bladder stone with a hemostat prior to placing in the culturette. The bladder mucosa should be examined for any defects or irregularities, and biopsies can taken if needed. The bladder is closed with absorbable, synthetic, monofilament suture, either with a single interrupted or single continuous pattern. Two layer closures and inverting pattern closures are unnecessary and excessive in closing a cystotomy as the bladder returns to 100% strength in a short period of time. The abdomen was closed utilizing standard technique. Post-operative radiographs are taken to confirm complete removal of all cystic and urethral calculi. The stones are then submitted for stone analysis to help guide appropriate follow up therapy.

  1. Monofilament to reduce the ability of bacteria or stones to adhere and a more quickly absorbable suture like monocryl (3-0/4-0) as opposed to PDS will also help prevent stone adherence and tissue irritation. Suture material in contact with alkaline urine (esp with Proteus spp infection) will lose tenisle strength more rapidly so extramucosal bites should be used. In sterile or E. coli contaminated urine, full thickness bites through the bladder wall can be used.

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