What Is a Cystotomy?
By: PetPlace Veterinarians PetPlace.com
Frequently Asked Questions
A cystotomy is a surgical opening created in the wall of the urinary bladder. This procedure allows the surgeon to look inside the bladder. While abdominal x-rays, ultrasound examination, and cystoscopy (scooping the bladder) are less invasive methods of looking into the bladder, cystoscopy has an important role in treatment of urinary bladder problems.
What Are the Indications for Performing a Cystotomy?
Cystotomy is most indicated for treatment of bladder problems including removal of bladder stones, bladder tumors, and blood clots. This procedure also can be done to obtain a biopsy sample of the urinary bladder. Cystotomy is done to repair a rupture or severe trauma to the urinary bladder. In cases of abnormal insertion of the ureters into the bladder (these are the thin long tubes that carry urine from the kidneys to the bladder), a cystotomy incision will be needed to correct the problem.
What Preoperative Examinations or Tests Are Needed Before a Cystotomy?
Preoperative tests depend in part on the age and general health of the animal as well as the cause for the cystotomy. Radiographs (x-rays) or abdominal ultrasound typically is done to diagnose the underlying illness prior to surgery. Often a complete blood count, serum biochemical test, a urinalysis, and possibly an EKG will be performed prior to surgery.
What Type of Anesthesia is Needed For a Cystotomy?
This is a surgical procedure that involves opening the abdominal cavity. General anesthesia is needed to induce unconsciousness, complete control of pain, and muscle relaxation. In the usual case, the pet will receive a pre-anesthetic sedative-analgesic drug to help him relax, a brief intravenous anesthetic to allow placement of a breathing tube in the windpipe, and subsequently inhalation (gas) anesthesia in oxygen during the actual surgery.
How Is the Cystotomy Operation Done?
Following anesthesia, the pet is placed on its back lying on the surgical table. The hair is clipped over the lower abdomen, the skin is scrubbed with surgical soap to disinfect the area and a sterile drape is placed over the surgical site. The incision is similar to a spay incision (midline). Your veterinarian uses a scalpel to incise the skin of the lower abdomen and to open the abdominal cavity. The urinary bladder is isolated with sterile sponges and an incision is made. Any urine is removed from the bladder to prevent abdominal contamination.
The operation then continues; for example, the surgeon may remove bladder stones, a tumor, or extensive blood clots. Often a urinary catheter is placed at the conclusion of surgery, to allow urine to drain easily from the bladder. At the conclusion of the procedure, sutures (stitches) that dissolve over time are placed to close the incision in the urinary bladder. The abdominal incision is then closed with one or two layers of self-dissolving sutures (stitches). The outer layer of skin is closed with sutures or surgical staples; these need to be removed in about 10 to 14 days.
How Long Does the Cystotomy Take to Perform?
The procedure takes about 45 minutes to 1-1/4 hours to perform in most cases, including the needed time for preparation and anesthesia.
What Are the Risks and Complications of a Cystotomy Operation?
The overall risk of this surgery is low. The major risks are those of general anesthesia, bleeding (hemorrhage), postoperative infection, urine leakage, and wound breakdown (dehiscence) over the incision. Overall complication rate is low, but serious complications can result in death or the need for additional surgery.
What Is the Typical Postoperative Aftercare For a Cystotomy?
Post-operative medication should be given to relieve pain, which is judged in most cases to be mild to moderate and can be effectively eliminated with safe and effective pain medicines. Often a urinary catheter will have been placed at surgery. This is typically removed in 24 to 72 hours. The home care requires reduced activity until the stitches are removed in 10 to 14 days. You should inspect the suture line daily for signs of redness, discharge, swelling, or pain and monitor your pet's urinary habits. Some blood-tinged urine is expected for the first few days, but obvious pain, straining or a lack of urination is not normal and should prompt a call to your veterinarian.
How Long Is the Hospital Stay Following a Cystotomy?
The typical stay following a cystotomy is 2-3 days but will vary depending on the overall health of the pet and the underlying reason for the surgery.
Authored by: Becky Lundgren, DVM
Platelets (thrombocytes) are produced in the bone marrow. Platelets circulate in the blood. When your pet is cut, platelets stick to the edges of the cut and to one another, forming a plug. They then release chemicals that react with fibrinogen and other plasma proteins, leading to the formation of a blood clot. If your pet has a condition called thrombocytopenia, his platelet count is low. When the platelet count is low, it is harder for clotting to occur.
Signs of thrombocytopenia vary, but can include petechial (small, pinpoint) hemorrhages in the skin or mucous membranes (lining of the mouth, for example), nosebleeds, hematuria (blood in the urine), melena (blood in the feces), and bleeding into the joints or body cavities. The lower the platelet count is, the more likely it is that your pet will show signs. (Some animals may show no warning signs at all, and the thrombocytopenia may be discovered only during routine health exams.)
Major causes of thrombocytopenia are immune-mediated thrombocytopenia (an autoimmune disease), bone marrow cancers, infectious diseases, hereditary diseases (von Willebrand's, for example), drug/vaccination reactions, vasculitis (leading to deep vein thrombosis), and disseminated intravascular coagulation.
Thrombocytopenia is not common in dogs and cats, although there are several breeds of dogs that are predisposed to it. Animals with cancer are at higher risk than those without cancer, but it can occur in a dog/cat of any age, breed, or sex.
Diagnostic tests include blood tests (platelet count, complete blood count, serum biochemistry, urinalysis, chest or abdominal radiographs (to look for diseases that could be causing the thrombocytopenia), tests for specific infectious diseases (Rocky Mountain spotted fever, ehrlichiosis, etc.), bone marrow aspiration, and tests for immune system function. Treatment is based on the cause of the thrombocytopenia, and may include antibiotics, corticosteroids, blood transfusions, etc.
Prognosis depends on the cause of the thrombocytopenia. A mild, self-limiting vaccine-induced thrombocytopenia has an excellent prognosis, while a thrombocytopenia due to cancer might have a much worse prognosis.
Date Published: 3/22/2004 6:40:00 PM Copyright 2004 - 2007 by the Veterinary Information Network, Inc. All rights reserved.
Physical Examination Findings
Petechial and ecchymotic hemorrhages in the skin and mucous membranes
Melena and hematochezia or hematemesis
Pale mucous membranes
Lethargy, weakness, and collapse
Scleral hemorrhages, retinal hemorrhages, and hyphema
If thrombocytopenia is severe, restrict activity to prevent fatal bleeding. Minimize bleeding caused by diagnostic procedures (e.g., minimize or eliminate jugular venipunctures and apply extended pressure after venipunctures). Bone marrow aspirate usually is safe. Once stabilized, treat as outpatient
Amount of bleeding
Platelet counts daily initially until patient is stable, then weekly until platelet count returns to normal range
Serial coagulation profile if DIC is suspected
Excessive bleeding, which can be fatal
Disorders that Decrease Platelet Numbers or Function
Immune mediated destruction of circulating platelets or the cells of the bone marrow that form platelets
Various disorders of the cells of the bone marrow, such as cancer, myelophthisis and myelofibrosis
Viral infections canine distemper virus, parvovirus
Bacterial infections Salmonella
Rickettsial infections ehrlichiosis
Certain parasites heartworm disease, Plasmodium infection
Neoplasia (cancer) in the body
Drugs that alter platelet production or function estrogen, trimethoprim/sulfas, chemotherapeutic drugs, phenylbutazone, aspirin and other nonsteroidal anti inflammatory drugs, azathioprine, albendazole, etc.
Hormonal imbalances, such as excessive production of estrogen as seen in hypothyroidism
Disorders of the spleen
Vasculitis (inflammation of the vessels)
Disseminated intravascular hemolysis (DIC), a complex, life threatening hemostatic defect that occurs secondary to many systemic diseases
Congenital platelet function disorders of the basset hound, foxhound, otterhound, Great Pyrenees, Scottish terrier, etc.
Vaccination with modified live viruses
Vasculitis inflammation of blood vessels
Hyperadrenocorticism a disease where the adrenal glands produce too much cortisone hormone in the body
Diabetes mellitus sugar diabetes
Uremia an increase in waste products not cleared by diseased kidneys
Clotting Factor Disorders
Inherited deficiencies of clotting factors that result in hemophilia
Toxicity with warfarin or warfarin-like products that antagonize Vitamin K
Liver disease that prevents the manufacture of clotting factors
Disseminated intravascular coagulation (DIC), which is widespread bleeding due to the consumption of platelets and clotting factors
Von Willebrand's disease, which arises from a deficiency of a factor needed for proper platelet function
Mucus Membranes and under the skin Bleeding: Petechia, Ecchymosis and Bruising
Understanding Your Pet's Medical Diagnosis
What is petechia?
Petechia is the medical term for small, pinpoint reddish areas caused by bleeding, commonly seen on the skin and gums.
Ecchymosis refers to larger patches of the bleeding. Bruising is the resultant staining that occurs.
What causes petechia?
Petechia is caused by platelet-associated bleeding disorders that impair the ability of body to stop bleeding. Diseases that affect either platelet number or function can result in petechia. An increase in platelet destruction or a decrease in platelet production will result in thrombocytopenia (that is, low numbers of platelets). The causes of thrombocytopenia include infectious diseases involving bacteria, viruses, or blood parasites. The number of platelets also can decrease from immune-mediated diseases where the animal's own immune system destroys the platelets. Specific diseases that impair platelet function include von Willebrand's disease, liver disease, and congenital heart disease. Petechia can result from drug reactions or hormonal imbalances.
What are the signs of petechia?
Petechia is a sign itself. It indicates a problem with the platelets or blood vessel wall leading to pinpoint bleeding under the skin or gums. Pets with petechia may have other bleeding problems leading to the presence of blood in the urine or bowel movement. An animal with petechia also may have nosebleeds.
How is petechia diagnosed?
Petechia is diagnosed by physical examination. The specific cause of petechia can be diagnosed using specialized tests. The number of platelets and their function can be assessed using specific blood tests. Biochemical analysis of blood is useful to identify causes of petechia related to hormonal imbalances or kidney and liver dysfunction. Radiographs (X-rays) or an ultrasound examination of abdominal organs also may detect characteristic abnormalities associated with various diseases.
How is petechia treated?
The treatment of petechia may include fluid therapy, blood or platelet transfusions, and medications directed at treating the underlying disease. Specific treatments for congenital diseases that impair platelet function are not known. Drugs that alter platelet function should be avoided. The animal's activity should be minimized to reduce the risk of minor trauma that may cause a bleeding episode. Massive bleeding can result in shock, requiring emergency treatment.
What is the prognosis for animals with petechia?
The prognosis (outcome) for animals with petechia is variable depending on the underlying cause. Severe illness and death can result if bleeding occurs in any of the major organs, especially the brain.
Disorders of primary hemostasis (platelet- or vessel-wallmediated) that result in bleeding into the skin or mucous membranes to a degree out of proportion to the trauma
Increased platelet use or destruction--immune-mediated disease, consumptive coagulopathy, or infectious disease such as ehrlichiosis. Immune-mediated disease can be primary autoimmune, isoimmune in the newborn, secondary to viruses, bacteria, ehrlichia, rickettsia, or protozoa. Some infectious diseases cause thrombocytopenia by immune-mediated mechanisms.
Low platelet production-- myelophthisis, aplastic anemia, and drug reactions (e.g., estrogen toxicity)
Sequestration of platelets in a large spleen, liver, or other sizable mass of microvasculature usually does not cause thrombocytopenia to the degree necessary to result in bleeding.
Petechiae, ecchymoses, and bruises usually are not mistaken for anything else. However, injuries causing an expected amount of bleeding or bruising must be ruled out by history and physical examination.
Usually as an inpatient until a definitive diagnosis is made
Minimize activity to reduce the risk of even minor trauma.
Discontinue any medications that may alter platelet function (eg, aspirin and other NSAIDs).
DRUGS AND FLUIDS
Maintenance of fluid volume by administration of balanced electrolyte solutions is recommended in all conditions. Blood or platelet transfusion may be necessary to survival before a definitive diagnosis is made. Obtain serum, whole blood, and any other samples necessary before initiating such treatment.
No specific treatment is available for the congenital thrombocytopathies. In patients with an acquired thrombocytopathy, the underlying disease must be treated.
In patients with thrombocytopenia, platelet count daily until a response is seen.
Death or morbidity as a result of hemorrhage into the brain or other vital organs
Shock as a result of hemorrhagic hypovolemia