Bladder surgery in is typically performed for the following reasons;
- Urinary calculi – these can partially or completely block urine outflow from the bladder, which can be both painful and life threatening.
- Urethral obstruction – this can occur from calculi, prostatic disease, neoplasia and from spasms of the urethra.
- Bladder rupture – this usually occurs as a result of a fall or road traffic accident, but can also happen secondary to a urethral obstruction.
- Bladder torsion – whilst rare, when it occurs it can be devastating if not corrected quickly. Immediate surgery is indicated when bladder necrosis is a concern.
Prepare for surgery
Before rushing to surgery, urinary emergencies need to be stabilised first. In order to achieve this, some important procedures need to be put in place.
- Blood tests – check all is well with a full blood profile. Look out for critical electrolyte imbalances such as hypokalaemia and hyperkalaemia, both of which are potentially life threatening.
- Blood pressure – if possible, check the animal’s peripheral blood pressure. Urinary tract obstruction can trigger a significant hypotensive event.
- Fluids – most patients will need intravenous fluids. Given isotonic crystalloid solutions such as 0.9% saline and lactated Ringer’s.
- Peritoneal dialysis – many cases of urinary obstruction and renal disease will result in the animal being azotaemic. Anaesthesia is likely to carry a higher risk unless the azotaemia is managed. Severe azotemia can be treated by peritoneal dialysis.
- Cystotomy – in acute and advanced obstruction, the bladder can be decompressed using cystotomy. A needle and syringe connected to a 3-way tap can be used to empty the bladder completely.
Bladder surgery – the basics
- Clip and scrub fully - animals that require bladder surgery will usually need to be catheterized. When preparing the patient, don’t forget to scrub the perineum and prepuce or vulva to ensure sterility.
- Ventral midline approach - the bladder is usually approached through a ventral midline incision of the abdominal. Cut down carefully to expose the bladder.
- Cut with care - the bladder itself, once identified and isolated, should be incised on the ventral or apical surface. This helps to minimise the risk of damage to the ureters.
- Be prepared – there are times when on opening the abdomen you discover a bladder wall tumour or maybe wall necrosis. In this situation a partial cystectomy may be required.
- Care with supply – it’s vital that the vascular and nerve supply to the bladder is kept intact. The neurovascular supply to the bladder enters via the trigone region. For this reason try to leave the trigone area intact.
- Closure patterns - cystotomy closure can be performed using 3-0 (2 metric) to 5-0 (1 metric) monofilament, rapidly absorbable suture material. Use either a single continuous appositional suture pattern or a two-layer inverting pattern. Make sure you include the submucosa but avoid full-thickness closure.
- Omentum helps - if the blood supply to the bladder is slightly compromised, omentum may be wrapped around the organ to aid healing.
Indwelling catheters – there are many indications post surgery to use an indwelling urinary catheter. These would include cases where there has been urethral damage, bladder atony and cystectomy. Indwelling urinary catheters should stay in place for as short a period of time as possible as urinary tract infections are common.
Analgesia – don’t forget to use pain relief post surgery. Opioids are most effective. NSAIDs provide analgesia and may decrease bladder inflammation but should be withheld until patients are fully hydrated to ensure no long-term renal damage.