Isolate the bladder and place stay sutures in it to facilitate manipulation. Make the incision in the dorsal or ventral aspect of the bladder. For a two-layer closure, suture the seromuscular layer with two continuous inverting suture lines.

CYSTOTOMY

GENERAL INFORMATION

• The incision into the bladder may be made on the dorsal or ventral surface, avoiding the ureters, urethra and major blood vessels.
• If exposure or catheterization of the ureteral opening is necessary, ventral exposure is preferred.
• Single layer appositional closure is recommended for most cystotomies and particularly for thick-walled bladders. Thin-walled bladders may be closed with an appositional or inverting pattern.
• Don’t forget to catheterize and retrograde flush!

 

MOST COMMON COMPLICATIONS AND DIFFICULTY

• Failure to remove all cystic calculi (in the neck of the bladder or urethra), catheterize and flush.
• An incision too close to the ureteral openings might result in occlusion of ureters due to local inflammation or due to inclusion in the closure.
• It may be impossible to avoid penetrating the bladder lumen in thin-walled bladders. The use of monofilament absorbable suture material is recommended to minimize the incidence of such complications.

"EXPERTS' ADVICE"

• Catheterize urethra from both directions.
• Incise ventral bladder wall when possible to avoid interfering with ureteral openings.
• Catheterize all cats and female dogs prior to surgery. This will allow retropulsion of stones from the neck of the bladder and urethra during surgery. A male dog can be catheterized at the surgical site, but the prepuce must be flushed and draped into the surgical field.
• Pinch the tip of the penis or catheter exit site and place finger tip in neck of bladder, then flush urethra. Release finger tip at bladder neck to allow calculi to flush up out of the urethra.

 

Close thickened bladder wall with a single layer closure. Avoid penetration of the bladder mucosa since exposed suture is calculogenic. Acceptable continuous patterns include Cushing, Lembert or simple continuous. A single, simple interrupted layer also works well in extremely thickened bladders.


CYSTOTOMY:
SUTURE AND NEEDLE OPTIONS

	Brand		Needle Type	Needle Reference
	Main Choice	Also Possible		Main Choice	Also Possible
BLADDER WALL	MONOCRYL*	PDS* II	Taper Point	SH-1, SH, CT-2, CT-1
LINEA ALBA	MONOCRYL* (young) PDS* II (adult)	VICRYL* PLUS	Taper Point Reverse Cut	SH-1, SH, CT-2, CT-1	RB-1, CT-3 FS-2, FS-1, FS, FSL, X-1, CP-2, CP-1
SUBCUTANEOUS	MONOCRYL* VICRYL* PLUS	PDS* II VICRYL*	Taper Point	RB-1, SH, CT-2, CT-1
SKIN CLOSURE	ETHILON* PROLENE*	Silk	Reverse Cut	FS-2, FS-1, FS	FSL, CP-2, CP-1, KS

	Cat/Small Dog (20 lbs or less)	Medium Dog (20-45 lbs or less)	Large Dogs (50 to 75 lbs)	Giant Dog (75 lbs +)
BLADDER WALL	4-0	4-0 or 3-0	3-0 or 2-0	2-0
LINEA ALBA	3-0	3-0 or 2-0 or 0	2-0 or 0	0 or 1
SUBCUTANEOUS	4-0	4-0 or 3-0	3-0 or 2-0	2-0
SKIN CLOSURE	4-0	4-0 or 3-0 or 2-0	3-0 or 2-0	2-0

 

Use the suture selection tool for specific product code recommendations.