Cystotomy — removal of bladder stones
Opening the bladder and removing stones that will not dissolve with diet or that block the flow of urine. We send the stones for analysis so that we can choose how to prevent recurrence.
What it involves
Cystotomy is an incision into the urinary bladder to remove stones (calculi) and to flush the urethra. Stones form from minerals that precipitate out of the urine; they irritate the bladder wall, cause blood in the urine and recurrent infections, and in male animals they can become lodged in the urethra and completely block the outflow of urine.
Not every stone requires surgery. Struvite stones in dogs can often be dissolved with diet and treatment of the infection. Calcium oxalate stones and most of the others do not dissolve — they have to be removed. The type of stone can be inferred from a urine test, X-ray and ultrasound, but certainty comes only from analysis of the removed stones.
After the procedure the work is only beginning: the composition of the stone determines the diet and the check-ups meant to prevent recurrence. Without this, in many patients the stones come back within a year or two.
When it is used
When X-ray or ultrasound shows stones that are not suitable for dissolving, are large or numerous, or cause recurrent infections and blood in the urine. Urgently — when a stone has blocked the urethra and the animal cannot pass urine; this is life-threatening, because within 1–2 days it leads to uraemic poisoning and kidney damage.
We also perform the procedure when a trial of dissolving the stones with diet over several weeks has had no effect, or when the stones need to be identified in order to choose the treatment.
Indications: symptoms that should prompt a visit
- The dog or cat passes urine often, in small amounts, with straining.
- Blood is visible in the urine, or the urine is brownish.
- The cat repeatedly goes into the litter tray, squats and passes nothing — this is an emergency.
- The male animal strains, cries out when trying to pass urine, and has a hard, painful abdomen.
- Recurrent bladder infections despite antibiotics.
- Bladder stones were found on an ultrasound or X-ray done for another reason.
- The animal passes urine in unusual places at home and licks the area around the urethral opening.
Conditions for which we use it in particular
Diagnostics beforehand
We carry out diagnostics entirely on site: a urinalysis with sediment (presence of crystals, blood, bacteria, pH) and culture, a blood test with assessment of the kidneys, an abdominal X-ray (most stones are visible) and an ultrasound of the bladder, which also detects stones not visible on X-ray and assesses the thickness of the bladder wall. We also check the kidneys and ureters — stones there change the treatment plan.
Pre-anaesthetic assessment according to STD-01. In patients with obstruction we first unblock the urethra and correct electrolytes (especially potassium), and operate only once they are stable.
How it proceeds
The patient arrives fasted. After premedication with pain management we induce inhalation anaesthesia with intubation and monitoring of vital signs (STD-02). We place a catheter in the bladder so that the urethra can be flushed during the procedure.
Through an incision in the lower abdomen the surgeon lifts out the bladder, incises it and removes all the stones, flushes the urethra in both directions so as not to leave any small stones behind, and closes the bladder with a watertight suture. The procedure takes roughly 45–90 minutes.
Recovery from anaesthesia in a hospital kennel. Most patients go home the same day or the next morning; patients after an obstruction stay longer on fluid therapy. We send the stones for analysis of their composition.
Aftercare
For several days the urine may be slightly bloody — this is normal. A collar, restricted activity for 10–14 days, and medication (painkillers, and an antibiotic if needed, based on the culture result) as scheduled. Wound check after 2 days, suture removal after 10 days.
Once we receive the stone analysis result, we set a diet and a check-up plan: a urine test after 4–6 weeks, then every 3–6 months, and a follow-up ultrasound once a year. Call immediately if the animal is not passing urine, is vomiting or is lethargic.
Frequently asked questions
Can stones be dissolved without surgery?
Only some — mainly struvites and some urates. Oxalates do not dissolve. A trial of dissolution makes sense when the tests point to it and the animal has no obstruction.
Will the stones come back?
Without a change of diet and check-ups — in many patients, yes. A diet matched to the composition of the stone, increased water intake and regular urine tests greatly reduce recurrence.
My cat squats and passes nothing — is this urgent?
Yes. In male cats, urethral obstruction leads within a day to uraemic poisoning and heart rhythm disturbances. Go immediately; outside opening hours, go to a 24-hour animal hospital.
Does a special diet need to be fed permanently after the procedure?
In most cases, yes; diet is the basis of prevention. We choose it after the stone analysis and discuss how to combine it with everyday feeding.
We manage every case individually. The scope, indications and course described above are indicative; we agree the exact diagnostic and treatment plan during the consultation. This content is for information only and does not replace a veterinary consultation.
Do you have questions about cystotomy?
Call us or book a consultation. We will set out the diagnostic and treatment plan in writing, before you decide.