• To access bladder lumen.

Uses

Indications

• Removal of cystic calculi in patients non-responsive to medical management, or male cats with risk of obstruction, when other methods are not available Urolithiasis.
• 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: bacterial Feline lower urinary tract disease (FLUTD).

Advantages

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

Disadvantages

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

Alternative techniques

Cystic calculi

• Dietary adjustment and medical dissolution for calculi:
  • Cystine.
  • Struvite Dietetic diet: dissolving and decreasing risk of struvite stones (uroliths).
  • Urate Dietetic diet: decreasing risk of urate stones (uroliths).
• Voiding urohydropulsion.

Urethral obstruction

• Retrohydropropulsion Urethra: obstruction.
  If successful, should follow this with cystotomy and retrograde flushing of the urethra to prevent re-obstruction.
• Urethrotomy.
• Urethrostomy, although this is best performed as an elective procedure Urethrostomy.

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 Urinalysis: centrifuged sediment        .
• Urine should always be cultured Urinalysis: culture and sensitivity (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 Fluid therapy: overview is mandatory especially if animal uremic.
• Attempts should be made to resolve metabolic anomalies prior to anesthesia/surgery.