Bladder Lavage in Dogs

Bladder lavage refers to washing out the bladder using a solution (usually sterile saline) passed through a urinary catheter. This can be done by a first opinion vet, but in reality, there are relatively few indications for its use and it is rarely done. 

Bladder lavage is more widely used in human medicine, for people with long-term indwelling urinary catheters. Even then, the practice is controversial and reserved largely for freeing up blocked catheters. There is no evidence that washing out a bladder when infection is present is beneficial, indeed it could inflame the bladder lining and weaken its immunity. 

Bladder lavage is not painful. Urinary catheters are easy to pass in the male dog, and can be done without sedation. However, catheterization of the female is much more difficult and usually attempted only on anesthetized patients. 

A sterile urinary catheter is passed up into the bladder. The operative should have sterilized their hands and wear sterile surgical gloves. A blob of KY Jelly on the tip of the catheter, helps make it easier to pass into the urethra via the penile tip or the urethral prominence in the vagina. 

The length of the urinary catheter is pre measured so that the clinician stops passing the catheter once the tip is in the bladder. If the catheter is to remain in place then it may be sutured to the skin using a Chinese finger trap suture pattern. 

The bladder is emptied via the catheter. Volumes of sterile saline are then slowly infused into the bladder so that it is moderately full. The bladder may be gently massaged through the body wall and then the contents drained out via the catheter. This is repeated several times as needed. 

 The efficacy of bladder lavage is controversial, hence its lack of use. Human medicine shows us that lavage when infection is present can be counterproductive as it can further inflame the bladder lining and provide a portal for bacteria to enter the bloodstream. 

There is some benefit in bladder lavage when dogs have lots of crystal sediment in their urine. However, in this scenario bladder stones are more likely to form and cause a catastrophic problem such as a blocked urethra. This will then require a surgical procedure, cystotomy, to open into the bladder and remove the stone. Where appropriate, the bladder can then be washed out through the surgical incision in the bladder wall.

Bladder lavage is not painful and in itself has no recovery time. However, if it was performed to reduce the amount of grit or crystals in the urinary bladder, then the recovery time will be that linked to the treatment of the underlying condition which necessitates the lavage. 

Bladder lavage is inexpensive and principally involves the cost of catheterizing the bladder and the time it takes to wash the bladder out. This can range from $30 upwards, depending on the size of the dog and the complexity of the underlying condition. 

As already mentioned, the role of bladder lavage is limited. One use is to retrograde flush blockages in a catheter back up into the bladder, so that the catheter can drain free again. However, if the bladder wall is inflamed, instilling liquid can cause further inflammation and the risk of new blood clots being thrown up. 

Bladder lavage may offer short term relief from bladder debris, but once the bladder refills the inflammatory cells from the bladder lining, and crystals produced in the urine are likely to reform. It is therefore more effective to put the dog onto intravenous fluids in order to produce copious, dilute urine which the dog then voids - hence cleaning the bladder from the inside out.

For dogs with a history of forming bladder stones and crystals in the urine, analysis of their urine is crucial to prevention. By identifying what the minerals components of the sludge are, it is possible to feed a diet that is low in those minerals and hence discourage future formation. 

In addition, dilute urine is a healthy urine. Encouraging the dog to drink as much as possible is of huge benefit to bladder health. In the short term, intravenous fluids can help the production of dilute urine, and in the longer term, feeding canned food, providing drinking fountains, and plentiful bowls of fresh filtered water also help to make a dog drink more. 

Encouraging the dog to empty his bladder regularly also promotes good urinary health. This means letting the dog out to relieve himself at least once every four to six hours, and employing a dog walker or sitter if necessary, to ensure this happens.