Things That Make Me Cringe

I don’t really keep track of how many surgeries I do, though sometimes I think maybe I should start – just for the fun of it. If I had to guess I would say the non-elective surgery I do the most is a cystotomy. Either that or exploratories.

Cystotomy is literally cutting into the bladder. Cysto = bladder; tomy = surgical incision. There’s really only one reason I do this: to remove bladder stones.

Even just typing the term “bladder stones” makes my urinary tract cringe. The things I have felt and seen. . . *shudder*

Usually it goes like this: a dog or cat is having urinary issues, and when I have a look at the urine I see crystals. I recommend a radiograph to check for stones to go along with those crystals. Sometimes the crystals have not yet partied hard enough to form stones. Sometimes I wonder how the animal didn’t have problems before now.  If there are stones, I have a chat with the owner about the risks of leaving the stones in there and recommend surgery to remove them. Sometimes I can use a diet to dissolve them, but even still there are risks in the waiting.

Sometimes, an animal presents because it CAN’T urinate, thanks to a rogue stone making a go for the outside world and getting caught up in the urethra. (cringing again. . . ). In these cases, I will pass a catheter to relieve the immediate obstruction, and strongly recommend surgery as soon as possible to prevent reoccurrence.

Most cringe worthy case I’ve had? Cat came in blocked, which is actually not very often because of stones, and I passed a catheter to relieve the obstruction and empty the bladder. Before I passed the catheter, when I palpated his abdomen I felt a ginormous, very firm, melon that was his bladder. After getting a decent amount of urine out, I had my hand on his belly over his bladder, only now instead of being a firm melon, it was a giant sack of marbles. (I just experienced a bladder cramp thinking back on that.) That cat had surgery, it was the most stones I have ever removed from a cat, and he’s doing fine now.  . . but I will never forget that moment. *shudder*

When we go to surgery, it’s pretty easy to find our target: the bladder is usually all kinds of angry. Instead of being a thin walled little balloon I encounter during a spay surgery, I am greeted by a thick, red, ugly, thing. I try to find a spot in the bladder wall to make a hole – being sure to be far away from ureters (the tubes that bring urine from kidneys to bladder. They’re kind of important, don’t want to cut those). You don’t want too big of a hole, but you need to be able to get your bladder spoon in there and scoop out your stones. Yeah, bladder spoon. It’s a surgical tool that’s a bit of a scoop, with a scraping edge of it, so you can scrape the bladder walls for grit. Using it makes all of the sphincters in my urinary tract spasm.

Cystotomies come in wide variety : lots of little stones, lots of big stones, a few big stones with lots of little tiny gritty stones, one giant stone, smooth stones, crazy spiked jaggedy stones that make your bladder cry in sympathy for the bladder you removed them from. You always have a ‘before’ radiograph so you have an idea what you’re going in for. And you ALWAYS should take an ‘after’ radiograph to make sure you didn’t leave behind anything. The last thing you want, after the clients pay $1000+, is for the animal to come back next week with the same problem because you left one errant stone behind.

Random factoid about cystotomies: If you read an old surgery textbook, it will advise you to take the bladder up out of the abdominal cavity and flip it over to you make your incision on the dorsal (top) side of the bladder. The idea being that when the animal is standing, this side will be at a lower risk for urine leakage because gravity brings the urine to the bottom of the bladder. If you read current surgery textbooks, this idea has been abandoned and we make the incision on the ventral (bottom) side of the bladder. Why? Because the bladder is a balloon. It’s only as big as the volume of urine in it requires. There’s no air bubble. The pressure of urine against the ‘top’ it the same as the ‘bottom’. Silly old school surgical ideas. . .

When you’re confident you removed all your stones and grit, and you close up that bladder, you leak test it. Even if you buy into the old school dorsal side idea, you fill the bladder with sterile saline, give a squeeze, and make sure nothing bubbles out your incision. Then you place the bladder back down inside the abdomen, close the animal up, and take that post-op radiograph (making sure nobody touches your surgical instruments so they remain sterile just in case you have to go back in. If you don’t keep your instruments sterile, I guarantee your post-op rad will tell you to go back in.)

Bladders are pretty awesome about healing up. Once, when I was a student, I assisted on a cystotomy on a dog who had had a cystotomy 2 days prior, but still had stones left. . . and we could only barely figure out where the original incision was.

For all my complaints of cringing, I kind of enjoy cystotomies. They have a certain satisfaction to them – I enjoy surgeries that have before and after pictures where you can see that you fixed the problem. Maybe that’s why I like castrations so much? You can’t tell by looking that I’ve removed the uterus, but an empty scrotal sack is pretty telling.

Or maybe I just enjoy ripping out testicles. Just because.

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About dottiemaggie

A veterinarian living and working in St John's, Newfoundland. I love my job, and I love my home. Professionally I am passionate about critical care and client education. Away from work I am passionate about enjoying life, spending time with friends, enjoying hobbies of all sorts, and exploring this wonderful province I call home.
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11 Responses to Things That Make Me Cringe

  1. My old dead cat Frank used to form crystals in his urethra quite regularly. Ultimately the vet re-routed Frank’s plumbing so that he’d pee out his back end instead of his penis. Old Frank didn’t appear to be bothered at all.

  2. Laura says:

    I had a cat with a bladder stone many years ago. The vet showed it to me after he removed it — it was one of those crazy jagged ones. It was actually very pretty, but I decided not to take it home with me.

    • dottiemaggie says:

      We send all the stones we remove off to a lab to be analyzed. . . I think, though, if I end up removing one from my own animal I’d want to keep one. . . but I’m odd like that 😉 (I had the head from my first femoral head osteotomy in a jar, and the staples from my own head injury in a jar, 2 cat fetuses at different developmental stages, and a giant kidney worm. . . )

  3. Amy Vansant says:

    Fascinating – and cringe-worthy for sure. But I would totally feel like a super-hero if I could do that. Albeit the sort that would be NO help should we be attacked by super-villains.

  4. James says:

    My Corgi had a cystotomy 6 days ago. He still exhibits symptoms of straining when he pees. He had been on Tramadol and Carprofen, but he has learned to refuses anything I put it in, so it has been 2 days without those. I took him back to my vet and he used a cather and felt some “resistance” – he put anesthetic on the cather and pushed again and was able to go to the bladder easily. He took an x-ray that looked clear. He gave us acepromazine, believing the pain was causing my dog to sort of spasm (the vet said there isn’t an antispasmodic for dogs – they’ve been taken off the market). So now he’s back on all meds. As soon as we got home, my dog wandered around the yard trying to pee. I am concerned that after 6 days my dog is not really any better. Oh – stone analysis came back (bad news) as calcium oxalate. Is there a recovery time that should be reasonable to expect? What are causes of continued symptoms?

    • dottiemaggie says:

      Hi James,

      6 days out does seem like a long time to still be that uncomfortable. I would worry that there are still stones or new stones that have already reformed, that would be the worst possible scenario. Keep in contact with your veterinarian about your dog’s progress, and if his discomfort is not improving I would want diagnostics to investigate such as an ultrasound.

      • James says:

        Thank you for the reply. Well, he developed some GI distress – diarrhea, and spent the night at WestVet hospital. A battery of tests to rule out Addison’s. I am concerned he has had permanent effects from the Carprofen. He’s on metrodiazanole for now. He slept all day yesterday, went for a walk today and passed thick yellow mucus. The internal medicine doctor asked me to report in today, so I am going home now to do that. The carprofen is the only connection I see between his cystotomy and this new problem, especially since he still urinates or tries to about 10 times each time out. He had colitis last summer, though…
        Thanks again for responding. Many blog writers don’t!

  5. Cait says:

    My 14yo otherwise healthy shih tzu was jut diagnosed with bladder stones and surgery recommended. She’s straining and needing to go out nearly hourly. I’m nervous bc of her age and also it’s surgery. Found this article comforting–her vet didn’t explain it was somewhat routine/common. How soon should it be scheduled, do I need to worry to much about possible obstruction? He said it was very very rare in females

    • dottiemaggie says:

      Hi Cait,
      It is definitely very rare for urinary obstructions to occur in female cats, but it is possible. I would schedule the surgery for as soon as possible, and just keep an eye out for signs of distress. If she becomes obstructed she needs the surgery as an emergency procedure, so the sooner you get the stones out the sooner that worry is off your mind.

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