Minimally Invasive Tube Cystostomy

A caudal abdominal/inguinal approach for placing tube cystostomies is described in 9 canine and 6 feline patients in need of emergency or elective urinary diversion. Tubes were placed in 5 cats for management of acute urinary tract obstruction or urethral rupture after suspected vehicular trauma. Elective cystostomy tube placement was performed in 9 dogs and 1 cat to aid in the management of detrusor atony or reflex dyssynergia. The animals were placed in right lateral recumbency. The pelvic limb was pulled caudally to expose the surgical site, and the bladder was palpated through ballottement or by infusing saline through a urethral catheter. A small incision was made through the skin. Subcutaneous fat and muscle were gently separated in the directions of their fibers to expose the peritoneum, which was incised. The bladder was identified and pulled into the incision. A purse-string suture was placed in the bladder wall, and a Foley catheter was placed via a stab incision. The bladder was secured to multiple layers of the abdominal wall by using absorbable suture material and was then secured to the skin with a Chinese finger-trap suture pattern. The catheter was then attached to a bag for continuous drainage or capped for intermittent evacuation.

No complications occurred during placement of tubes in either emergency or elective surgeries. Postrenal azotemia resolved in all cats. One cat could urinate normally after 4 days of urinary diversion, but the tubes were maintained for 5 to 31 days (median, 10 days). No infection was found on culture in 1 cat at the time of tube removal, and no urinary tract complications developed in any cat. Tubes were maintained for 10 to 49 days (median, 32 days) and removed when residual urine volumes declined to normal and the dogs appeared capable of urination. Minor complications at the stoma site, such as irritation and granuloma formation, occurred in 3 dogs. Subsequent urinary tract infection developed in 3 dogs during tube management, but treatment with amoxicillin–clavulanate resolved the clinical signs. One dog had a persistent urinary tract infection throughout treatment, including when the tube was placed.

COMMENTARY: This report describes a quick and relatively simple way to manage cases that require access to the urinary bladder for drainage. This technique was not technically difficult, did not require expensive equipment, and could be performed in general practice. It is especially useful in cases of urethral rupture or in cats with blocked urinary tracts.The authors did not culture all patients, so it is unclear whether we should assume lack of infection in the animals—it may be reasonable to administer prophylactic antibiotics upon removal of the tube or to recommend routine culture of the indwelling tube and urine throughout treatment. Other reports have suggested that all patients with tube cystostomies should be assumed to have a urinary tract infection.—Heather Troyer, DVM, Diplomate ABVP (Canine & Feline Practice)

Minimally invasive inguinal approach for tube cystostomy. Bray JP, Doyle RS, Burton CA. VET SURG 38:411-416, 2009.