• To access bladder lumen.

Uses

Indications

• Removal of cystic calculi in patients non-responsive to medical management, or male dogs with risk of obstruction, when other methods are not available Urolithiasis. Retrohydropulsion Urethra: retrograde urohydropulsion or urethrotomy Urethrotomy may be indicated to deal with urethral obstruction Urethra: obstruction.
• Catheterize ureters.
• Placement of ureteral stents.
• Bladder neoplasia Bladder: neoplasia.
• Repair of rupture Bladder: trauma rupture.
• Management of urethral rupture Urethra: rupture.
• Vesico-ureteral anastomosis Ureter: anastomosis.
• Investigation of hematuria Hematuria.
• Investigation of recurrent urinary tract infection (UTI) to sample calculi/bladder mucosa Cystitis.

Advantages

• Easy to perform.
• Minimal morbidity.
• Requires minimal equipment.

Disadvantages

• More invasive than catheter or cystoscopic retrieval of calculi Cystoscopy: transurethral cystoscopy/vaginoscopy , or medical management.
• Risk of disseminating bladder neoplasia (TCC) Bladder: neoplasia.
• Hematuria/clinical signs of cystitis post-operatively.

Alternative techniques

Cystic calculi

• Dietary adjustment and medical dissolution (diet for cysteine stones Dietetic diet: decreasing risk of cystine stones (uroliths) , diets for struvite stones Dietetic diet: dissolving and decreasing risk of struvite stones (uroliths) , diet for urate stones Dietetic diet: decreasing risk of urate stones (uroliths) ).
• Voiding urohydropulsion.

Urethral obstruction

• Retrohydropropulsion Urethra: retrograde urohydropulsion.
  If successful, should follow this with cystotomy and retrograde flushing of the urethra to prevent re-obstruction.
• Urethrotomy Urethrotomy.

Time required

Preparation

• 30 min.
• Clip and aseptically prepare caudal abdomen.

Procedure

• 60-90 min depending on reason for cystotomy.

Decision taking

Criteria for choosing test

• Identify the type of stone before management if possible, ie struvite  , cysteine  , urate  , oxalate  , etc.
• Urine should always be cultured Urinalysis (bladder mucosa and any calculi should also be cultured to increase yield).

Risk assessment

• If animal has urinary obstruction care with anesthesia as biochemical parameters, electrolyte and acid-base balance may be upset. Always obtain blood tests before surgery.
• Fluid therapy is mandatory Fluid therapy: for acid-base imbalance especially if animal uremic Uremia.
• Attempts should be made to resolve metabolic anomalies prior to anesthesia/surgery.