Overview of the Cystotomy in Cats
Cystotomy is a surgical procedure in which an incision is made into the cat’s urinary bladder. The procedure can be done for many reasons, the most common being to facilitate removal of bladder and urethral stones. Other indications include helping to diagnose bladder tumors, repairing ectopic ureters and ruptured bladders, and aiding in the diagnosis of difficult-to-treat urinary tract infections.
Performing a Cystotomy on a Cat
The cystotomy procedure itself has relatively few complications. Cats must be placed under general anesthesia for a cystotomy. Thus, pre-anesthetic bloodwork may be performed before surgery to ensure that your pet is healthy and to help your veterinarian determine the best anesthetic regime to use.
The cystotomy is performed through an incision on your cat’s belly which is located towards the rear of the abdomen. In a male cat, the incision is off to one side of the prepuce/penis. The bladder is isolated and an incision is made.
Once the bladder has been accessed, your veterinarian removes the stones and so they can be analyzed for their composition; collects samples and cultures; or repairs ectopic ureters or the bladder wall. The bladder incision is sutured and the abdomen is flushed to remove any urine that may have leaked into it during the procedure. The abdominal incision is then closed.
After a cystotomy, your cat may be given pain-killers (analgesics) and antibiotics may be administered if infection is suspected or confirmed.
After your cat has been released from the hospital you must restrict his activity in order to allow the incision to heal. Keep your cat in the house where it is safe.
To ensure your cat’s comfort your veterinarian may prescribe anti-inflammatory medications or pain-killers (analgesics) for the first few days after surgery.
Oral antibiotics may be continued for several days until the culture results are available. The results may dictate that the same antibiotics be continued, that a different antibiotic be prescribed, or that antibiotics be discontinued altogether.
If your cat had stones in the bladder or urethra, his diet may need to be changed. Diet recommendations vary based upon the specific type of stones that are present.
Watch your cat closely for potential complications after surgery. Observe the incision twice daily for redness, swelling or discharge from the incision. Note the urine color and whether it appears to be blood-tinged. Also, determine whether your pet is urinating easily or appears to strain when urinating. If you have any concerns, contact your veterinarian immediately.
In-depth Information on Cystotomy in Cats
Cystotomy is one of the most common surgical procedures performed in cats. The procedure gives the surgeon access to the inside of the urinary bladder so that an underlying disorder can be treated or diagnosed.
Occasionally, cats form abnormal crystals in their urine secondary to a systemic illness, bladder infection, or nutritional imbalance. These crystals can grow to become solid calculi (stones) that can cause bladder irritation or infection. Additionally, stones may become lodged within the urethra and prevent the cat from being able to urinate. The presence of stones may cause your pet to urinate small volumes frequently; to have blood-tinged urine; to strain to urinate; or to be unable to urinate. Cystotomy allows these stones to be removed.
Ectopic ureters are also treated through a cystotomy. Ectopic ureter is primarily a condition of young cats where one or both ureters, the tube that normally carries urine formed in the kidneys to the bladder, open into an abnormal location. This can cause urinary incontinence (urine dribbling). If surgical correction is pursued, the repair procedure is done through an incision into the bladder.
The inside of the bladder may also be accessed to assist in the diagnosis of suspected bladder tumors. A sample of the abnormal tissue may be removed for biopsy or, if the mass is small, a portion of the bladder wall can be removed (partial cystectomy).
In some cases of severe, non-responsive urinary tract infections it may be necessary to open the bladder to obtain tissue samples for a more accurate culture. This will assist your veterinarian in determining which microorganisms are causing the infection so that an effective antibiotic can be prescribed.
The cystotomy procedure has few complications associated with it and is well tolerated by most animals.
The Feline Cystotomy Surgery
Depending on your cat’s age and overall health, blood work may be performed prior to anesthesia. Because general anesthesia is necessary, this information will help your veterinarian assess your cat’s kidney and liver function, as well as his overall health. Your veterinarian will also use this information to help determine the safest anesthetic regime for your cat.
Once your cat is anesthetized, he is placed on his back and the hair is removed from the belly with clippers. The skin is then surgically prepared by scrubbing with a surgical solution to decrease bacterial numbers and reduce the chance of infection.
The skin incision is made on the midline of cats. The bladder is gently elevated out of the abdomen and an incision is made through its wall. Urine is suctioned away and the inside of the bladder is examined.
After opening the bladder, stones (uroliths) are removed from the bladder or they are flushed into the bladder from the urethra and then removed. If a tumor is suspected, a sample of the bladder wall can be excised (cut away) and sent to the laboratory for biopsy. When infection is suspected a piece of the bladder wall and a sample of the stone that was removed are submitted for culture (to determine what bacteria are present) and antibiotic sensitivity (to determine which antibiotics the bacteria are most sensitive to). If ectopic ureters are identified, they are repaired.
The incision in the bladder is sutured and the abdomen is flushed with sterile saline to remove any debris or urine that might have leaked into it. The incision in the body wall and skin are then sutured.
Cats can be painful after any abdominal surgery and they are often given analgesics to keep them comfortable. Injectable or oral antibiotics may also be given to the patient after surgery if a urinary tract infection is suspected.
Follow-up Care for Cats with a Cystotomy
After discharge from the hospital your cat must be kept quiet to allow him to properly heal. Restrict activity for two weeks by keeping your cat confined to a carrier, crate, or small room whenever he cannot be supervised.
If a culture sample was taken, the specific type of antibiotic that your pet was originally sent home with may need to be changed based upon those results. Antibiotics may lead to decreased appetite or diarrhea – contact your veterinarian if you note any of these potential side effects.
If the cystotomy was performed because of a bladder tumor the biopsy report will indicate whether it is benign or malignant. Your veterinarian will have further advice based on these results and may refer you to a veterinary oncologist for additional treatment.
Depending on the specific type of stone a special diet may need to be given to prevent further stone formation.
Monitor the skin incision daily for signs of excessive swelling or discharge. These can indicate problems with the incision healing or suggest that an infection if present. Contact your veterinarian if you note these problems.
It is common for cats to have some blood in their urine after a cystotomy; however, the bleeding should resolve within a few days. If it persists or becomes profuse, inform your veterinarian.
Straining to urinate is also common after bladder surgery, especially if stones were removed from the urethra. This straining usually decreases over the first few days after surgery. It is important to make sure that your dog is actually able to urinate, even though he is straining to do so (make sure urine is coming out). If your pet is not able to urinate, contact your veterinarian immediately.
In rare cases, the bladder may not heal well after cystotomy and urine may begin to leak into the abdomen. If this occurs your pet may begin feeling poorly and the abdomen may appear distended. If your pet is not improving steadily after surgery or begins to feel badly (decreased appetite, lethargy) your veterinarian must be informed. If it is confirmed that the bladder is leaking, another surgery will be required to fix it.