Management of Obstructive Urolithiasis by Tube Cystostomy in Calf with Ruptured Bladder
Akash, PhD Scholar, ICAR-IVRI, Izatnagar, Bareilly, UP-243122 Email- anant.akash9@gmail.com
Tube cystostomy is a technique of urinary diversion in which a Foley’s catheter is placed into the urinary bladder lumen via laparotomy procedure. The technique is used in the treatment of urethral obstruction, urethral rupture or ruptured urinary bladder. Left ventral abdominal area from the level of umbilicus to scrotum is washed and shaved for aseptic surgery. Lumbosacral area is also washed and shaved for giving epidural anaesthesia. Surgery can be performed under lumbosacral epidural anaesthesia using 2% lignocaine hydrochloride. Animal is restrained on operation table in right lateral recumbency. Incision site is prepared with the scrubbing of chlorhexidine and pasting of povidone iodine and animal is drapped in shroud. 5 cm lateral to midline and 1-2 cm cranial to rudimentary teats in prepubic region a 2cm long paramedian skin incision is given. Rectus abdominis muscle and its sheath at the site of skin incision are separated using pointed end scissor and peritoneum is incised. Bladder is exteriorized and necrosed part of the bladder is trimmed. Ruptured bladder is repaired using double row of inverted suture. Straight artery forceps is passed anteriorly from the incision to a distance of about 15cm making subcutaneous tunnel. Tip of the artery forceps is brought out of the skin near preputial orifice by making a nick incision. No. 14 French Foley’s catheter is pulled through the tract formed with the help of same artery forceps. Foley’s catheter is passed into the bladder through an opening made by scalpel blade. Balloon of Foley’s catheter is immediately inflated with 5-6 ml of sterile saline. External end of the catheter is pulled to oppose the bladder wall to the inner aspect of the abdominal wall. Bladder is replaced back into the pelvic cavity. Abdominal muscle layer is sutured with catgut or PGA suture material. Skin incision is closed with No.1 or No.2 non-absorbable suture material. Part of Foley’s catheter outside the abdomen is fixed with abdominal wall by 3-4 interrupted sutures. In the postoperative care suture line should be dressed daily with povidone iodine. Antibiotics and analgesics should be given at least for 3 days after surgery. Suture should be removed after 10-12 days on completion of healing. Once the free flow of urine is observed from urethra Foley’s catheter is blocked for 3-4 days. After deflation of the balloon Foley’s catheter is removed. Tract left by catheter should be dressed with povidone iodine solution until healing. Tube cystotomy is an efficient technique with minimal postoperative complications for management of obstructive urolithiasis in small ruminants.
