Cystotomy is conducted with the patient in dorsal recumbency. Male dogs can be positioned with the pelvic limbs extended caudally because the prepuce can be included in the prepared field should urethral catheterization be necessary. Placing the pelvic limbs of female dogs and cats in so-called “frog-leg” position with the tail hanging over the surgery table can provide good access for normo- or retrograde urethral catheterization intraoperatively; this positioning also works well in male cats when cystotomy is combined with either urethral catheterization or perineal urethrostomy.
The ventral abdomen should be clipped and aseptically prepared from the xiphoid to the caudal aspect of the pubis. The perineum can also be included in the preparation. The prepuce and vulva should be flushed with antiseptic solution (eg, 0.05% chlorhexidine solution) surgically prepared and included in the field to facilitate intraoperative catheterization.
Related Article: Imaging the Urinary Tract
In cats and female dogs, a ventral midline celiotomy is performed from just caudal to the umbilicus to the cranial brim of the pelvis. In male dogs, a parapreputial skin incision is used. Ligation or electrocoagulation of the preputial branches of the caudal superficial epigastric vein and subcutaneous vessels minimizes bleeding. Transect the preputial muscle, retract the prepuce to the opposite side, and perform a midline celiotomy. The preputial muscle can be tagged with suture to identify it during closure.
Although a cystotomy can be performed on the dorsal or ventral surface of the bladder,2 a ventral midline cystotomy is recommended. Ventral cystotomy provides excellent visualization of the bladder lumen—especially the trigone area—and can be extended into the proximal urethra if additional exposure is necessary.