http://www.youtube.com/watch?v=6nnIHqEoDVI
This is a good surgery
video done by the
Silsistra Veterinary
Clinic in Bulgaria.
The process of surgery
must be systematic so that
a high standard of care is
achieved.
1. Bladder is taken out
and is packed and
surrounded by
gauze
swabs so that there is
no backflow of urine into
the abdomen (seen in the
video).
2. Two anchor sutures on
either side of the
incision. (I don't find
this process necessary).
3. A syringe to take out a
urine sample for analysis
(done by me) if no urine
sample had been collected
earlier.
4. Bladder incision below
the apex of the bladder.
5. Stone removal using
forceps.
6. I do a 360-degree sweep
of the inside of the
bladder using artery
forceps to feel for more
stones. A gritty feeling.
(However, X-rays will show
most stones).
6. Irrigate bladder with
normal saline (via urinary
catheter or syringe in
saline).
7. Pass a catheter from
inside the bladder
into the urethra to ensure
no stones obstruct the
urethra, especially in the
female cat (seen in the
video).
8. 2 layers of inverting
sutures. I find that
artery forceps to anchor
one end of the first
continuous layer which is
knotted at both ends. Then
another artery forceps to
anchor the other end of
the 2nd continuous layer.
These forceps are useful
in providing traction in
tightening the continuous
sutures.
*9. A syringe of saline is
injected into the cat's
bladder to ensure that
there is no leak from the
sutured area (seen in the
video).
Or syringe in saline from
the penile urethra end
catheter in male cats or
dogs.
Dogs with stones behind
the os penis may need to
be syringed with a
20-ml
syringe of saline to push
the stones into the
bladder so that they are
removed via the bladder
incision.
10. I account for all
stones removed as shown in
the X-rays. The stones are
shown to the owner and the
numbers are recorded in
the medical records.
Unless there are
thousands. It will be good
to take digital images for
recording.
11. Some clinics do
another X-ray of the
bladder after stone
removal to prove that no
stones are present. This
is an additional cost but
may be wise in defensive
medicine.
X-rays show
include the kidneys.
12. I make it mandatory
for all my vets to
send
the stones for chemical
analysis even if the
owner does not agree to
it.
13. Advices on the regular
monitoring of urine and
special diet are ignored
by most owners for various
reasons. So, some cases of
bladder stones do recur.
P.S. 1. I have a video
produced on the cost of
bladder stone surgery in
the dogs and cats in
Singapore. The video is
at:
Video: Costs of bladder
stone surgery. The
costs just for anaesthesia
and surgery are from $800
to $2,000 depending on the
time taken to do the
surgery.
P.S 2.
It is like feast and
famine. Sometimes bladder
stone cases come together
to Toa Payoh Vets.
Images of 4 recent bladder
stone surgeries done by Dr
Daniel at Toa Payoh Vets
are shown below:
 |
 |
 |
 |
 |
 6138
- 6141. Bladder stones |
 |
 |
| 6135
- 6136. Bladder rupture in a
12-year-old Maltese. The
urethra had been obstructed
with stones for some weeks.
Owing to financial
constraints, no detailed
tests have been done. Blood
tests in the vomiting dog
showed kidney failure. |
 |
|
6170.
Urinary stones in a Shih
Tzu. The surgery was done
yesterday, June 4, 2013. The
bladder mucosa was 1-cm
thick as the owner
procrastinated on doing
X-rays and surgery for many
weeks. The big stone was >2
cm across. |
A fifth case of a pug
with calcium oxalate
bladder stones is
scheduled. Practice makes
perfect is applicable for
surgeries too.
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