Perioperative care: Give intravenous fluids for diuresis,
as well as analgesia and systemic antibiotics. (B602.18.w18)
See: Treatment and Care
- Anaesthetise the rabbit. See: Treatment and Care
- Anaesthesia and Chemical Restraint - Lagomorph Anaesthesia
- Place the rabbit in dorsal recumbency.
- Prepare the skin. (J513.6.w1)
- See also: Laparotomy in Rabbits
- Note: if retrograde catheterisation and flushing may
be needed to return calculi from the urethra to the bladder,
clip and scrub the external genitalia as well as the abdomen.
- If calculi are in the urethra, they should be pushed back into
the bladder for removal. (B600.14.w14)
- Use reverse urohydropropulsion to push calculi back to the
- Make a midline incision between a point a few centimetres caudal
to the umbilicus and the pubis (over the bladder).
- Incise the skin.
- Dissect through the subcutaneous tissues to the linea alba.
- Incise the linea alba with a scalpel, taking care not to cut
through into the bladder. (J513.6.w1)
- Or use Metzenbaum scissors and forceps to cut through
the linea alba. (B534.43.w43f)
- The incision can be from the umbilicus to the pubis; or
longer if additional exploration of the abdomen is required. (B601.17.w17)
- See also: Laparotomy in Rabbits
Cystotomy and urolith removal
- Identify and isolate the bladder. (B601.17.w17)
- Exteriorise the bladder.
- Use gentle traction on the apex. (B601.17.w17)
- Use atraumatic forceps (e.g. Babcock forceps) to grasp
the apex. B534.43.w43f)
- If necessary, cut the median ligament of the bladder to
allow exteriorisation. (B601.17.w17)
- Reflect cranially.
- Or reflect caudally. (B534.43.w43f)
- Exteriorising the bladder enables good visualisation and
incision in an avascular plane. (B615.8.w8)
- Place moistened laparotomy sponges or moistened gauze squares to
isolate the bladder from the abdominal cavity. (B601.17.w17)
- Place stay sutures to hold the bladder in place outside the
abdomen while removing the uroliths.
- Either place at the cranial and caudal ends of the
intended incision site. (B534.43.w43f,
- Or place one stay suture on either side of the
intended incision site, parallel to the line of the incision.
- Empty the bladder of urine.
- Either: Using a 25 G needle and syringe, empty the bladder by
- This is preferred to manual
expression, which may lead to rupture of the bladder. (B600.14.w14)
- Or: Make a stab incision with a No. 10 or No. 15
blade in the ventral region of the bladder, half way from the
apex to the bladder neck, and use suction to drain the
- Incise the bladder longitudinally through the serosa, muscular
layer and mucosa (likely to be thickened).
- Take care that the ureters are not damaged by the
- Enter through the ventral wall of the bladder. (B601.17.w17)
- The incision may be made in any avascular region of the
dorsal, ventral or apical surface. (B615.8.w8)
- Extend the stab incision used for draining the bladder by
suction, or make an initial stab incision taking care not to
penetrate through to the dorsal bladder wall. (B601.17.w17)
- Insert one blade of tissue scissors through the stab
incision and cut cranially and caudally, to make an opening as
long as required between the bladder neck and apex. (B534.43.w43f,
- Remove the uroliths.
- Use forceps to grasp and remove any large urolith, taking care not
to damage the mucosa, which may become partially everted during
this procedure. (B534.43.w43f,
- Use a surgical spoon/bladder spoon to remove smaller stones
and sludge. (B601.17.w17,
- Flush with sterile saline and use gentle suction to remove fine granular
material and blood clots. (B534.43.w43f,
- Check the urethra is patent.
- Pass a 3.5 French urinary catheter, normograde, to flush out
the urethra and check this is patent. (B601.17.w17)
- It the ureter is blocked, have an assistant pass a urinary
catheter retrograde to flush debris back from the urethra into
the bladder. (B601.17.w17)
- Note: Avoid forcing stones from the urethra back into the bladder as
they may become lodged in the urethra or the bladder neck. (B602.18.w18)
- Take samples for testing. See: Clinical Pathology of Lagomorphs
- Swab the bladder wall for bacterial culture.
- OR take a full-thickness bladder wall biopsy for
bacterial culture and sensitivity, and (if neoplasia is
suspected) for histopathology, (B601.17.w17)
- Submit calculi for chemical analysis. (B601.17.w17,
- Repair the bladder wall.
- Suture material
- Use an absorbable suture material. (B601.17.w17,
4-0 (1.5 metric) or 5-0 (1 metric) Monocryl or PDS. (J513.6.w1)
- Use a fine, absorbable suture material with low reactivity (e.g.
4/0 (1.5 metric) Poliglecaprone (Monocryl). Polygalactin (Vicryl) can also be
- 3-0 (2 metric) polyglactin 910 or polydioxanone on a taper needle.
- Suture pattern
- Repair the bladder in a
single layer using simple interrupted sutures of absorbable
monofilament suture material. (B601.17.w17)
- A continuous inverting pattern can be used, with 4.0 or 5.0
(1.5 or 1 metric) PDS or Monocryl, in a single layer. (B615.8.w8,
- If the mucosa is very thickened and oedematous, suture the
mucosa then the other layers. (J513.6.w1)
- A simple continuous pattern can be used. (B615.8.w8)
- A two-layer closure can be used, first a Cushing pattern
then a Halstead pattern. (B534.43.w43f)
- Do not penetrate to the bladder lumen with the sutures.
- Full-thickness sutures may be required if it is not possible
to identify the submucosa (holding layer). (B601.17.w17)
- Ensure that the sutures oppose the bladder wall edges, including
the submucosa, so a water-tight seal is formed and rapid healing
- Inject saline into the bladder then compress gently, to test
the seal formed by the sutures. (J513.6.w1)
- Replace the bladder in the abdomen and cover with fat. (B615.8.w8,
Closing the abdomen
- Close the abdominal wall with 3-0 or 2-0 absorbable suture
material in a simple interrupted pattern. (J513.6.w1)
- Close the skin with 3-0 non-absorbable sutures in a simple
interrupted pattern. (J513.6.w1)
- Or see: Laparotomy in Rabbits
- See: Treatment and Care
- Surgery - Post-operative care
- Provide analgesia. (B601.17.w17)
- Give intravenous fluids. (B601.17.w17)
- Give gastro-intestinal motility stimulants. (B601.17.w17)
- If infection is suspected, start antibiotic treatment
intravenously during the procedure, as soon as samples have been taken
for culture. (B601.17.w17)
- Consider modifying the diet to provide adequate but not excessive
levels of calcium. (B601.17.w17)