Cystotomy in Cats

Cystotomy is a surgical procedure used in cats to treat bladder stones. Although it is sometimes used for exploratory purposes, cystostomy is more invasive than other exploratory measures, including cystoscopy and ultrasound. Cystotomy is typically recommended to remove obstructions within the bladder, such as tumors, stones, and clots, which cannot be treated conservatively. This procedure may also be used to collect tissue samples for biopsy.

The approach and procedure steps may vary according to the expertise of the surgeon as well as the underlying condition.

1. Prior to surgery, the veterinarian or surgeon will run tests to ensure it is safe for the cat to undergo anesthesia.
2. The cat will be anesthetized. An oxygen tube will also be placed to administer gas anesthesia intraoperatively.
3. The abdomen will be shaved, cleaned, clipped, and draped.
4. Using a scalpel, the surgeon will incise the skin and abdominal muscle in order to access the abdominal cavity.
5. The surgeon will use sterile sponges to pack and isolate the bladder.
6. If urine is present in the bladder, it will be removed to avoid contamination.
7. The surgeon will remove obstructions such as bladder stones, clots, or tumors.
8. If the procedure is exploratory, the surgeon will explore the bladder and urinary organs during this time to identify the underlying condition. They may choose to take tissue samples.
9. The surgeon may choose to place a catheter. 
10. The abdominal cavity will be lavaged, or flushed, with a sterile saline solution prior to incision closure.
11. If cystotomy was used to remove stones or obstructions, an x-ray will be taken after surgery to ensure all obstructions have been removed.
12. The cat will be hospitalized for up to three days.
13. The catheter is generally removed between 24 and 72 hours after surgery.

The efficacy of the procedure will vary based on the underlying condition. Cystotomy is generally considered a safe and effective procedure which presents few complications. Most cats make a full recovery within two weeks following surgery. However, the prognosis will vary based on the underlying condition as well as the efficacy of additional treatment methods.

The vet will prescribe the cat pain medication to manage postoperative pain. An Elizabethan collar may be required so that the cat does not irritate the surgery site. Owners should prevent their cat from engaging in activity for up to two weeks following surgery to prevent wound rupture. They should also check the incision site daily to ensure no drainage, bleeding, or swelling has occurred. Surgeons typically use absorbable sutures for cystotomy. If non-absorbable sutures are used, the surgeon will schedule a follow-up appointment for ten to fourteen days after surgery to remove them.

The cat’s urine should be monitored throughout the recovery period. Small amounts of blood in the urine are normal for the first few days after surgery. However, if the cat is having difficulty urinating, or if the bloody urine lasts for more than three days after surgery, owners should seek immediate veterinary attention.

The cost of cystotomy may vary based on standards of living and additional costs incurred. The national average cost of cystotomy, not including preoperative testing or postoperative medications, is $300.

There are few risks associated with cystotomy, since it is a relatively simple procedure. However, complications are possible with any surgical procedure. Complications of cystotomy, although rare, may include:

• Remaining stones or obstructions
• Allergic reaction to anesthetic
• Difficulty urinating
• Recurrence of the condition
• Wound rupture
• Leakage of urine
• Hemorrhage
• Infection
• Anesthetic death

Unfortunately, there is a chance that the surgeon will not remove all the stones or obstructions. This may happen for many reasons, which is why the postoperative x-ray is imperative for ensuring all obstructions have been removed.

Bladder stones may be caused by a cat’s diet. Dietary changes are recommended for certain cases of bladder stones, since an improper diet can cause bladder stones. Owners should follow their veterinarian’s dietary guidelines carefully. Other conditions, such as cancer and congenital defects, cannot be prevented. Cats with congenital defects treated by cystotomy should not be bred.