By Dr Hussein Mohamed El Husseiny Domenstrator in

By: Dr / Hussein Mohamed El Husseiny Domenstrator in veterinary Surgery, Radiology & Anaesthesiology Dept. BVSc, Faculty of Vet. Medicine Benha University Edu Mail: hussien. alhussieny@fvtm. bu. edu. eg Email: Dr. Hussein_Elhusseiny 91@yahoo. com Facebook: Elmo 7 b 25@yahoo. com Twitter: dr. husseinelhusseiny 91@gmail. com Instagram: Vet. surgeon_hussein_elhusseiny

Operative surgery

Cystotomy in Dogs

CYSTOTOMY Definition: It is a surgical opening created in the wall of the urinary bladder. INDICATIONS: Cystotomy is indicated for treatment of bladder problems including: 1. Removal of bladder stones, bladder tumors, and blood clots. 2. To obtain a biopsy sample of the urinary bladder. 3. To repair a rupture or severe trauma to the urinary bladder. 4. To correct the abnormal insertion of the ureters into the bladder Anaesthesia: General anesthesia Control: Dorsal Recumbency

X- Ray

Cystoscopy

Ø Pre-Operative Preparation: 1. Withhold the food for 24 hours before the Opreation. 2. Clipping of the long Hair & Shaving of the Short Hair. 3. Washing by Warm Water & soap or Betadine Surgical Scrub. 4. Touching with Alcohol 70% 5. Touching with Betadine Antiseptic Solution or Tincture Iodine 2. 5%

Ø Laparotomy Incision: The U. B is approached through: In Female: Posterior Median Laparotomy Incision In male: the incision must be made parallel to the prepuce. Ø Cystotomy Incision: Achieved at the dorsal aspect of the bladder Ø Operative Technique: • 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. • Following cystotomy the bladder is washed out with sterile saline, in order to remove the inevitable blood clots. • 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. • The laparotomy incision is closed as usual

The bladder is lifted through the incision and the peritoneal cavity is carefully protected by adequate abdominal packs before the bladder is opened. If possible, the dorsal aspect of the bladder should be chosen for the cystotomv incision. After removal of the calculi or excision of the bladder wall, the thick mucous membrane is closed by a continuous suture of 3/0 chromic catgut.

the type of suture employed to close the mucous membrane should be acontinous mattress stitch which tends to evert the edges of the mucous membrane away from the lumen of the bladder. This is done to avoid raw edges of the mucous membrane protruding into the bladder lumen, where they can acts as afocus for the laying down of further cystic calculi. The detrusor muscle of the bladder is closed by a series of simple interrupted sutures using chromic cat gut, varying in size from 3/0 to No. 1 depending upon the size of the dog

Ø Post-operative Care: 1. Complete course of antibiotics as: cefotax, gentamycin, …. & anti -inflammatory drugs 2. Daily dressing of wound using mild antiseptic or antibiotic ointment 3. Application of neck collar to prevent licking or rubbing of the wound 4. A urinary catheter will have been placed at surgery. 5. It is important that the dog should be given the opportunity to empty its bladder at about 6 hours after the operation, and that this should be noted on its case notes.

Ø Possible Complications: v. General Complications as: 1. bleeding (hemorrhage) 2. Necrosis of wound lips & their Dehiscence 3. Sepsis & contamination 4. Swelling of abdominal wall v. Specific Complications as: 1. urine leakage 2. Post- operative retention of urine will lead to leakage and eventual rupture of the suture line which can be avoided by catheterization if urinary retention develops