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Minimally Invasive Inguinal Approach for Tube Cystostomy

Authors


Address reprint request to Jonathan Bray MVSc, CertSAS, MACVSc, MRCVS, Diplomate ECVS, Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Herts, SG5 3HR, UK. E-mail: jpb@vetspecialists.co.uk.

Abstract

Objective— To report a technique for tube cystostomy placement via a minimally invasive inguinal approach and outcome in 9 dogs and 6 cats with urinary tract obstruction or detrusor atony.

Study Design— Case series.

Animals— Dogs (n=9) and cats (6).

Methods— Medical records (January 2004–January 2008) of dogs and cats that had tube cystostomy via an inguinal approach were reviewed. Retrieved data included signalment, diagnosis, surgical technique, and complications. Access to the bladder was through a muscle splitting approach in the inguinal region with the cystostomy tube placed through a skin incision made several centimeters proximal to this incision and secured in the bladder by a purse string suture. Cystopexy during closure of the muscle layers ensured secure closure and minimized the likelihood of uroabdomen if tube dislodgment occurred.

Results— Cystostomy tubes were placed in 5 cats as an emergency procedure for treatment of acute urinary tract obstruction or urethral rupture, and as an elective procedure in 9 dogs and 1 cat. No complications occurred during cystostomy tube placement. Postprocedural complications were minor (peristomal irritation in 2 dogs with latex catheters, catheter laceration, premature removal) and only occurred when tubes were retained for >4 weeks. Urinary tract infection at catheter removal in 6 dogs resolved with antibiotic administration.

Conclusions— An inguinal approach for cystostomy tube placement facilitated rapid catheter placement into the bladder with minimal soft tissue dissection. Cystopexy during abdominal wall closure provided peritoneal protection should premature dislodgement of the cystostomy tube occur.

Clinical Relevance— An inguinal approach should be considered for rapid tube cystostomy particularly in metabolically compromised animals.

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