VSR 421: Regional Veterinary Surgery (2+1)

 VESICAL CALCULI

• Symptoms related to stones in the urinary bladder are not always shown.
• Chronic cases will exhibit hamaturia and dysuria. Sometime complete obstruction of the urethra with stones in male dogs will cause bladder distension.
• In female there may not be bladder distension, but soiling of the perineal region with urine and urine smell will be there., palpation reveals crepitation of the calculi in th bladder

Diagnosis

• From symptoms, and palpation of the posterior abdomen will reveal stone like bladder.

Radiography

• Plain radiography will reveal distended bladder and vesical claculi if radiopaque will reveal stones. If they are radiolucent, pneumocystography will confirm the diagnosis.

Treatment

Cystotomy

• Anesthesia
  • Premedication
    • Hydromorphone – 0.1-0.2 mg/kg SC or IM
    • Butorphenol – 0.2-0.4 mg/kg SC or IM
    • Buprenorphine –5-15 microgm/kg IM
  • Induction
    • Thiopental -10-12 mg/kg IV
    • Propofol –4-6 mg/kg IV
  • Maintenance
    • Isoflurane or sevoflurane

Procedure

• Place the animal in dorsal recumbency.
• Prepare ventral abdominal region and vulvar area in female for aseptic surgery.
• Incise skin and subcutis on the ventral midline.
• In male incise skin and subcutis parallel and adjacent to prepuce.
• Identify and ligate preputial branches of caudal superficial epigastric artery in the subcutis.
• Incise linea alba from umbilicus to pubis and para preputial approach in male dogs.
• Identify bladder and isolate it by moistened laparotomy sponges.
• Place stay sutures on the bladder apex to facilitate manipulation.
• Make incision on the dorsal  aspect of bladder away from ureters , urethra and between major blood vessels.
• Remove urine by aspiration or intraoperative cystocentesis before cystotomy.
• remove the cystoliths
• Flush the bladder with normal saline to remove small calculi
• Examine bladder and mucosa for defects.
• Pass a catheter down the urethra to check for patency.
• Close the urinary bladder (Cystorraphy )in a single layer using continuous suture pattern.
• If two layer closure, suture the seromuscular layer by two continuous inverting suture lines (cushings followed by lembert).