Introduction

• A cystostomy tube permits drainage of urine from the bladder directly through the abdominal wall.
• Cystostomy tubes are considered when other less invasive means of obstruction relief or urinary diversion are not possible (eg transurethral catheterization, intermittent cystocentesis), or when more radical surgical procedures are not feasible to relieve distal urinary tract obstructions (eg in case of invasive neoplasia).
• Cystostomy tubes provide a practical, relatively simple avenue of temporary or long-term urinary diversion for dogs and cats with outflow obstruction of the bladder or urethra, or disruption of the urethra.
• Placement of cystostomy tubes does not require specialized equipment, and can be performed either at the time of primary surgical treatment of the urinary obstruction or trauma, or as an emergency procedure to help stabilize an obstructed uremic patient.
• There are a number of potential complications, most of which are avoided with proper surgical and aseptic technique during placement. Technical details for successful placement and management of tube cystotstomies are described below.

Uses

• Cystostomy tubes are indicated for urinary diversion in dogs and cats with either functional or mechanical obstruction of the bladder or urethra Urethra: obstruction, distal urinary tract disruption, or neurologic or idiopathic bladder atony. Common causes of obstruction in small animals include trauma Bladder: trauma rupture Urethra: rupture, inflammatory disorders, urinary calculi Urolithiasis, and neoplasia Bladder: neoplasia Urethra: neoplasia.
• These tubes can be used for short-term diversion to help stabilize patients until primary relief of the obstruction or repair of a traumatic urinary tract disruption is performed.
• In addition, cystostomy tubes may be helpful for management of permanent or slowly responsive neurological or detrusor dysfunction conditions of the bladder (causing urine retention), or as palliative treatment for nonresectable tumors of the bladder or urethra when other successful treatments are not available or possible.

Advantages

• Cystostomy tube placement is relatively quick and easy to perform. The procedure does not require specialized equipment, although special catheters (ports) may be preferred for long-term or permanent diversion in selected patients.

Disadvantages

• This invasive procedure carries with it the expense, and all the inherent risks associated with transabdominal wall catheter placement such as leakage, infection, dehiscence, irritation of the stoma site, tube obstruction, and accidental dislodgement.
• Proper management requires careful monitoring and handling of the tube, and draining of the bladder at least 3-4 times daily. Good owner and patient compliance is necessary for success of this diversion technique.

Requirements

Preparation

Procedure

Aftercare

Outcomes

Prognosis

• The prognosis is highly dependent on the primary disease process that required urinary diversion. Temporary tube cystostomy is easily managed and well tolerated. With more chronic diversion, urinary tract infection is inevitable and this usually requires intermittent antibiotic treatment when clinical signs occur.

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Beck A L, Grierson J M, Ogden D M et al (2007) Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995-2006). JAVMA 230 (8), 1184-1189 PubMed.
• Stiffler K S, McCrackin Stevenson M A, Cornell K K et al (2003) Clinical use of low-profile cystostomy tubes in four dogs and a cat. JAVMA 223 (3), 325-329 PubMed.
• Hayashi K, Hardie R J (1995) Use of cystostomy tubes in small animals. Comp Contin Ed Pract Vet 25 (12), 928-935 ResearchGate.
• Smith J D, Stone E A, Gilson S D (1995) Placement of a permanent cystostomy catheter to relieve urine outflow obstruction in dogs with transitional cell carcinoma. JAVMA 206 (4), 496-499 PubMed.