Читать книгу Bovine Reproduction - Группа авторов - Страница 335

A cystotomy is ideally performed under general anesthesia with the individual in dorsal recumbency. Prior to creating the incision, the penis should be exteriorized and secured by clamping the apical ligament of the penis. A paramedian skin incision is performed lateral to the prepuce. The incision should be positioned relatively caudally to ensure adequate access and exteriorization of the bladder [27]. A paramedian or midline celiotomy can be performed. Once the urinary bladder is localized, stay sutures with 2–0 or 0 monofilament can be placed in the bladder to assist with the cystotomy. A routine cystotomy is performed with aspiration of urine. Removal of uroliths from the bladder trigone and proximal urethra can be assisted with the use of a surgical spoon, as well as copious lavage and aspiration of sterile saline. An 8‐ to 10‐French polypropylene catheter is then passed in both a normograde and retrograde direction. Hydropulsion is performed with saline and may relieve the urethral obstruction. However, excessive force and effort are contraindicated due to the risk of damaging the urothelium or causing a urethral rupture. The urethra is considered free of calculi when saline can easily be flushed normograde and retrograde [27]. If urethral patency is not obtained, a tube cystostomy should be performed. The bladder is closed with 2–0 or 3–0 monofilament suture in a single‐ or double‐layer inverting suture pattern. In cases of bladder rupture, the defect should be repaired and/or any necrotic tissue removed. In cases of bladder rupture, aspiration and lavage of the abdomen should be performed. The celiotomy, subcutaneous tissues, and skin should be closed in a routine fashion. Disadvantages of this procedure include the expense and duration of the procedure, potential for urethral rupture, and extensive postoperative urethral swelling resulting in significant stranguria or postoperative obstruction.