Does your pet have bladder stones or repeated urinary obstruction?  Are you considering a cystotomy? A perineal urethrostomy?

Cystotomy

 Radiograph of bladder stones

Radiograph of bladder stones

What is a cystotomy?

Cystotomy is a surgical procedure in which the surgeon has to make an incision into the bladder in order to correct a problem. 

 

When is a cystotomy indicated?

A cystotomy is indicated in the treatment of bladder stones, bladder tumors, urinary incontinence and urinary obstruction secondary to blood clots, stones or mucus. 

 

 What tests are needed preoperatively?

The type of diagnostic tests performed, depends on the animal’s age and general health.  An abdominal ultrasound and/or abdominal radiographs may be performed to determine the specific problem within bladder and to evaluate other body systems.  Typically, a general chemistry panel, complete blood count and electrolytes are conducted to evaluate your pet for any underlying problems prior to receiving anesthesia. A urinalysis will also be performed to evaluate kidney function and if there is an underlying urinary tract infection.

 

What is involved in a Cystotomy operation?

Since this is a surgical procedure involving opening the abdominal cavity, the animal needs to be placed under anesthesia.  The operation takes about 1 hour to 1 ½ hours to perform.  The animal will have an IV catheter placed.   The patient will be maintained on IV fluids throughout the surgery and after surgery.  The pet will also receive post operative analgesics to alleviate post-operative discomfort. 

 A sample of the bladder tissue and cystolith (bladder stone) will be submitted for histopathology and culture; respectively.  The cystoliths will also be submitted to a lab for analysis to determine type.   Test results will provide the Doctor with more information regarding long-term treatment and prevention.  The doctor will contact you about these results within 5-14 days.  Sometimes the stone analysis will take longer to return.  Most often times, the pet will need to be placed on a specific diet for the prevention of stone formations.

 

What are the risks and complications of a Cystotomy operation?

There are risks with any type of anesthesia.  General anesthesia has expected side effects to brain, kidney, cardiac and respiratory function which typically do not cause a problem, and are managed by the nurse anesthetist.  Patients are placed on a multi-parameter monitoring device, respiratory ventilator and a blood pressure machine in order to closely monitor these body systems.  Occasionally these side effects can be life-threatening in critical patients.  Generally, the risk of anesthesia is less than 1 %. 

 Post-operative complications include infection, the incision breaking down (dehiscence), and hemorrhage (bleeding), urinary obstruction and bladder leakage. Hemorrhage is the most common complication and subsides in about 3-7 days.  Occasionally, patients can develop a urinary obstruction from a blood clot.  This is very rare. 

 

What is included in postoperative care for a Cystotomy?

No running, jumping, or playing.  If the patient is a dog, take on short leash walks outside.  The patient needs to stay indoors for at least 10 days to help keep the incision area as clean as possible.  Monitor the incision site for signs of infection, which include redness, pain, swelling, heat and/or discharge from the incision.  Do not allow the patient to lick at the incision site.  Licking promotes infection, will damage the incision and delay healing.  Your pet will require an Elizabethan-collar to discourage licking; if he or she begins to lick.  The collar will have to remain in place at all times until suture removal.

 Typically, the pet will stay overnight in order to monitor the patient’s ability to urinate and to control discomfort with medications.  Patients are usually discharged the following day provided your pet is comfortable, eating, drinking and urinating well.   The patient will be sent home with medication to alleviate discomfort.  Recheck with TVEC or your regular vet in 10 days to have the sutures removed.  All of the patient history, post-operative instructions and test results will be faxed to your regular veterinarian. 

 

If your pet suffers from back pain and you would like to request a surgical consult, please fill out the following form.

Once you have submitted this form, we will contact you and your primary care veterinarian to set up the referral. Then we will schedule an appointment for you and your pet to come into our hospital to meet with our specialist.

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Your primary care veterinary clinic's phone number *
Your primary care veterinary clinic's phone number

Perineal Urethrostomy

 DIA: Urogenital system of a male feline

DIA: Urogenital system of a male feline

What is a Perineal Urethrostomy?

Perineal Urethrostomy is a surgical procedure in which an opening is created in the urethra, the channel that carries urine from the bladder. 

 

When is a Perineal Urethrostomy surgery indicated?

 DIA: Urogenital system of an obstructed male feline

DIA: Urogenital system of an obstructed male feline

Perineal Urethrostomy is performed in patients when the urethra is obstructed.  Urethral obstructions can be secondary to uroliths (urinary stones) or grit, blood clots, mucus plugs, urethral spasm and/or scar tissue from recurrent episodes of obstruction.  This surgery is commonly performed in male cats because anatomically they have a narrow urethra.  Urethral obstructions are extremely rare in female cats because their urinary tract is much wider.  Sometimes this condition can be managed medically, once the obstruction is alleviated with an indwelling urinary catheter.  However, surgery is indicated if the patient has recurrent episodes of urinary obstruction or the obstruction can not be alleviated with a catheter. 

 

What tests are needed preoperatively?

Tests include a general health profile, complete blood count, electrolytes and a urinalysis to evaluate kidney function and detect any underlying problems prior to receiving anesthesia.  Radiographs and an ultrasound may be performed as well.  Sometimes obstructed patients are very sick because of the accumulation of toxins and urine waste products in the bloodstream.   These patients may require several days of intense IV supportive care in order to stabilize them for surgery. 

 

What is involved in a Perineal Urethrostomy?

As in human patients, general anesthesia is used to make sure the animal is unconscious for muscle relaxation and pain control. This will involve using a pre-anesthetic analgesic (alleviates discomfort), a brief intravenous anesthetic in order to place an endotracheal tube and then the patient is maintained on gas anesthesia for the remainder of preoperative preparation and surgery. 

 The surgery is performed just under the rectum, where the male urinary tract is at its widest point (e.g. pelvic urethra).  The surgical site is shaved and disinfected with surgical scrub and alcohol for a sterile operating field.   Then the patient is transported to the operating room and rescrubbed. These pre-operative procedures require about 15 to 20 minutes. 

 The surgery will take approximately 1 to 1 ½ hours to perform.  The surgical procedure involves removing the scrotum and transecting the penis to expose the pelvic urethra.  Then the urethra is sutured to the surrounding tissue creating a new wider urethral opening.  The pet will be maintained on IV fluids throughout the surgery and post-operatively.  The patient will also receive post operative analgesics to alleviate discomfort. 

 

What are the risks and complications with Perineal Urethrostomy surgery?

There are risks with any type of anesthesia.  General anesthesia has expected side effects to brain, kidney, cardiac and respiratory function which typically do not cause a problem, and are managed by the nurse anesthetist.  Patients are placed on a multi-parameter monitoring device, respiratory ventilator and a blood pressure machine in order to closely monitor these body systems.  Occasionally these side effects can be life-threatening in critical patients.  Generally, the risk of anesthesia is less than 1 %. 

 Post-operative risks include infection, the incision breaking down (dehiscence), hemorrhage (bleeding), re-obstruction, fecal or urinary incontinence and stricture.  Hemorrhage is the most common complication because the urinary tract is very vascular.  Hemorrhage usually subsides in about 2-3 days.  Occasionally, patients can develop a urinary obstruction from a blood clot.  This is very rare.    Please recheck with your veterinarian or TVEC if your pet is unable to urinate because this is a medical emergency and warrants immediate intervention. 

 

What is included in post operative care for Perineal Uresthrostomy?

No running, jumping, or playing.  The patient needs to stay indoors for at least 10 days to help keep the incision area as clean as possible.  Monitor the incision site for signs of infection.  Signs of infection include swelling, redness, pain, heat and/or discharge.  Recheck with your veterinarian or TVEC if you suspect infection.    Licking will promote infection and damage the surgical site; sometimes beyond repair.  Your pet will have to wear an Elizabethan collar at all time until suture removal.    

 The pet will stay overnight for continued IV supportive care and medications for discomfort.  Usually your pet will go home the following day. 

 Do not use granular litter in the litter box.  Granular litter will stick to the incision, promote infection and cause irritation.  Use newspaper, “Yesterdays News” litter or Styrofoam chips until the sutures are removed in 10 days.  Suture removal requires sedation because of the sensitivity of the surgical site.  Please do not feed your pet the morning of the appointment because he or she will require sedation for suture removal.