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Cystotomy

ISSN 2398-2985

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Introduction

  • Surgical technique used for removal of uroliths, urinary bladder neoplasia, repair of bladder rupture, obtaining of diagnostic samples for histopathology and culture and sensitivity.
  • Urinalysis Urinalysis: overview (including urine culture), plain radiography  Radiography overview, contrast cystography, ultrasonography of the bladder and kidneys and an evaluation of renal function are recommended as part of the pre-operative evaluation of the patient.
  • In reptiles, most performed in Chelonia and lizards: also used for removal of eggs from the urinary bladder that may have descended into the urethra.

Uses

Advantages

  • Allows direct visualization of bladder mucosa where cystoscopy is prohibited by patient’s size.

Disadvantages

  • Requires general anesthesia.
  • Carries a risk of infection, bleeding, and post-operative complications.
  • Risk of post-operative adhesions.
  • More invasive than cystoscopy/cloacoscopy.
  • Risk of disseminating bladder neoplasia.
  • If incising into a flaccid bladder, there is a risk that both the ventral and dorsal walls will be cut.

Technical problems

  • Size of patient may make surgery challenging.
  • Requires trained staff comfortable with surgical techniques and anesthesia Anesthesia overview.

Alternative techniques

  • Cystoscopy/cloacoscopy where not prohibited by the size of the patient.
  • Euthanasia Euthanasia needs to be considered for any patient with advanced urinary bladder disease, uroliths or a blockage.
  • Lithotripsy.

Time required

Preparation

  • 10 min.

Procedure

  • 30-50 min.

Decision taking

Criteria for choosing test

  • Urolithiasis unresponsive to medical management: type of urolith present needs to be identified before undertaking surgery.
  • Recurrent urolithiasis.
  • Urethral obstruction.
  • Bladder lining biopsy: samples should always be obtained during cystotomy for culture and sensitivity.
  • Retained ova that descended into the urinary bladder following lay induction.

Risk assessment

  • Ensure the patient is hydrated prior to surgery – administer intravenous fluid support wherever possible.
  • Thorough husbandry review needs to be undertaken prior to surgery to ensure post-operative care is optimal to reduce chances of complications and recurrence of urolithiasis.
  • Survey radiographs with at least two views, dorsoventral and lateral, should always be undertaken before any surgery to ensure the uroliths are within the urinary bladder. 

Requirements

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Preparation

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Technique

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed Papers

Other sources of information

  • Szabo Z (2020) Soft Tissue Surgery: Rodents. In: Ferrets, rabbits, and rodents. Clinical Medicine and Surgery.  Ed: Carpenter J W & Quesenberry K E. Elsevier/Saunders, USA, pp. 477.
  • Divers S J (2019) Surgery: Principles and Techniques. In: BSAVA Manual of Reptiles. 3rd edn. Ed: Girling S J & Raiti P, BSAVA, UK. pp 231-232.