Department of Surgery & Theriogenology

Course Title: Farm Animal Surgery & Clinics Surgery

Course Code: SUTH 463
Level-4, Semester-II
Credit Hour: 2, Contact hour: 2
 
 

Prepared by
Md. Anowarul Haque
Lecturer
Department of Surgery and Theriogenology
Sher-e-Bangla Agricultural University, Dhaka.
 Urinary System

Cystotomy is a surgical incision into the urinary

bladder

urethrotomy is an incision into the urethra.

Cystectomy is removal of a portion of the urinary

bladder.

Cystolithiasis and cystolithectomy refer to urinary

bladder calculi and their removal, respectively.

Cystostomy is the creation of an opening into the

bladder
Uroabdomen (uroperitoneum) is the presence of urine
in the abdominal cavity; urine may be leaking from the
kidneys, ureters, bladder, or urethra.

Urethrostomy is the creation of a permanent fistula

into the urethra
it is generally performed for irreparable or recurrent
urethral stricture, or to prevent repeated obstruction
(e.g., feline idiopathic cystitis [FIC]).
SURGICAL ANATOMY
The urinary bladder location varies depending on the amount of
urine it currently contains; when empty, it lies primarily within
the pelvic cavity.

The bladder is divided into the trigone, which connects it to the

urethra, and the body.

The bladder receives its blood supply from the cranial and caudal
vesical arteries, which are branches of the umbilical and
urogenital arteries, respectively.

Sympathetic innervation is from the hypogastric nerves, whereas

parasympathetic innervation is via the pelvic nerve. The pudendal
nerve supplies somatic innervation to the external bladder
sphincter and striated musculature of the urethra
The urethra in male dogs and cats is divided into prostatic, membranous
(pelvic), and penile portions
Cystotomy
Cystotomy may be performed for removal of cystic and
urethral calculi, identification and biopsy of masses,
repair of ectopic ureters

For the bladder, an abdominal incision is made from the

umbilicus caudal to the pubis (Fig. 25.5). The proximal
urethra (i.e., prostatic urethra) can be reached by this
approach
Isolate the bladder from the rest of the abdominal cavity by placing
moistened laparotomy pads beneath it.

Place stay sutures on the bladder apex and trigone to facilitate

manipulation

Make a longitudinal incision in the ventral aspect of the bladder, away

from the ureters and urethra, and between major blood vessels.

Close the bladder in a single layer using a continuous suture pattern

with absorbable suture material

If the dog has severe bleeding tendencies, consider suturing the

mucosa as a separate layer with a simple continuous suture pattern.
Potentially nephrotoxic antibiotics (i.e., aminoglycosides, tetracycline
[except doxycycline], and sulfonamides) should be avoided.

Penicillins and cephalosporins (e.g., ampicillin, amoxicillin, cefazolin,

cephalexin; Box 24.2) are concentrated in urine. They are effective
against most gram-positive organisms; cephalosporins also have an
enhanced gram-negative spectrum.

Fluoroquinolones (e.g., enrofloxacin; see Box 24.2) have broad activity

against aerobic gram-negative bacteria. Drug doses or dosing
frequency should be altered as required by the degree of renal
compromise.
Urinary leakage into the abdominal cavity eventually
causes

Uremia,
dehydration,
Hypovolemia,
Hyperkalemia, and
Death if undiagnosed or untreated.
Cystostomy (Prepubic Catheterization)
Temporary cystostomy or prepubic catheterization is
performed to provide cutaneous urinary diversion in animals
with urinary obstruction or with traumatized or surgically
repaired urethras.

It also may be advisable for animals with bladder atony

secondary to neurologic disease or for prevention of
overdistention of the bladder after surgery.
Cystostomy may be performed by placing a Foley
catheter (6–20 Fr, depending on the size of the
animal)

To place a Foley catheter , make a small midline

incision caudal to the umbilicus in females or
adjacent to the prepuce in males.

Alternatively, consider a 2- to 3-cm oblique inguinal

approach directly over the bladder.

Locate the bladder, and place stay sutures and a

purse-string suture into the bladder wall .
Place the tip of the Foley catheter into the abdominal cavity
through a separate stab incision in the abdominal wall. Make
a small stab incision into the bladder (within the purse-string
suture), and place the Foley catheter into the bladder lumen.

Inflate the balloon with saline, and secure the catheter

within the lumen by tying the purse-string suture

Pexy the bladder to the body wall with several interrupted

absorbable sutures. Close the initial incision, and secure the
catheter to the skin using a Chinese finger-trap suture .
Color French units mm
         Yellow-green 6 2.0
Cornflower Blue 8 2.7
Black 10 3.3
White 12 4.0
Green 14 4.7
Orange 16 5.3
Red 18 6.0
Yellow 20 6.7
Purple 22 7.3
Blue 24 8.0
Black 26 8.7
(A)To place a Foley catheter, make a small incision and locate the
bladder.
Place stay sutures and a purse-string suture in the bladder. Place
the tip of the Foley catheter into the abdominal cavity through a
separate stab incision in the abdominal wall.

(B) Make a small stab incision into the bladder, and place the
Foley catheter into the bladder lumen.

(C) Inflate the balloon with saline, and secure the catheter within
the lumen by tying the purse-string suture around it with a
Roman sandal suture

(D) Tack the bladder to the body wall with several absorbable
sutures.
Urethrotomy
Indication
Urethrotomy is performed in male dogs to remove urethral
calculi that cannot be retrohydropropulsed into the
bladder

Occasionally, urethrotomy is performed for a biopsy of

obstructive lesions (i.e., strictures, scar tissue, and
neoplasms).
Urethrostomy
Indication
(1)Recurrent obstructive calculi that cannot be managed medically;
(2) Calculi that cannot be removed by retrohydropropulsion or
urethrotomy
(3) Urethral stricture
(4) Urethral or penile neoplasia or severe trauma; and
(5) Preputial neoplasia requiring penile amputation. Depending on
the site of the lesion, urethrostomy can be prescrotal, scrotal,
perineal, or prepubic in dogs.
 Prescrotal Urethrotomy
Indication:
Prescrotal urethrotomy is used to remove calculi from the
distal penile urethra in dogs
 Prescrotal Urethrotomy

Procedure
With the dog in dorsal recumbency, place a sterile catheter
into the penile urethra to the scrotum or to the obstruction.

Make a ventral midline incision through the skin and

subcutaneous tissue between the caudal aspect of the os
penis and the scrotum.

Identify, mobilize, and retract the retractor penis muscle

laterally to expose the urethra.

Make an incision into the urethral lumen over the catheter.

 Prescrotal Urethrotomy
Remove calculi with forceps, and gently flush the urethra
with warm saline.

Close the urethra with simple interrupted or continuous

appositional absorbable sutures (4-0 or 5-0).

Then appose subcutaneous tissue and skin with simple

interrupted sutures

Remove the urinary catheter following surgery, regardless of

whether the urethra is sutured.
Prescrotal Urethrostomy
Prescrotal urethrostomy is performed similarly to
prescrotal urethrotomy, except that the urethral mucosa
is sutured to the skin.

Place simple interrupted absorbable sutures (3-0 to 5-0)

from the urethral mucosa to the skin
 Perineal Urethrotomy

Perineal urethrotomy is occasionally used to remove calculi

lodged at the ischial arch
 Perineal Urethrotomy

Procedure
Place a purse-string suture in the anus.

Place a sterile catheter into the urethra to the level of

the bladder or the site of the obstruction.

With the dog in sternal recumbency and the rear limbs

hanging over the edge of the table, make a midline
incision over the urethra, midway between the scrotum
and the anus.
Identify the retractor penis muscle, elevate it, and
retract it
Separate the paired bulbospongiosus muscles at their
raphe to expose the corpus spongiosum,

Then incise the corpus spongiosum to enter the

urethral lumen.

Close the incision as just described for prescrotal

urethrotomy
Perineal urethrostomy
Suture the urethral mucosa to the skin, as described for
prescrotal urethrostomy