Mini Review

Diagnostic and Therapeutic Cystocentesis in Dogs and Cats: Considerations

Sabrina Manfredi*, Giacomo Gnudi, Francesca Miduri, Eleonora Daga and Antonella Volta

Department of Veterinary Medical Science, University of Parma, Parma, Italy

Submission: February 01, 2019;Published: February 11, 2019

*Corresponding author: Sabrina Manfredi, Department of Veterinary Medical Science, Via del Taglio 10, 43100 Parma, Italy

How to cite this article: Sabrina Manfredi, Giacomo Gnudi, Francesca Miduri, Eleonora Daga, Antonella Volta. Diagnostic and Therapeutic Cystocentesis in Dogs and Cats: Considerations. Dairy and Vet Sci J. 2019; 9(5): 555775. DOI: 10.19080/JDVS.2019.09.555775

Abstract

Cystocentesis is considered a safe but invasive procedure and its diagnostic and therapeutic value in domestic animals has been recognized for over 80 years. Ultrasound guide can be useful to correctly localize the position of urinary bladder and to evaluate the distension and thickening of the wall before performing the procedure. Complications of cystocentesis in dogs and cats can occur but if performed with caution are usually rare. Ultrasound can be useful to recognize potential complications and can be important to make the proper diagnosis, to take the right treatment and avoid further unnecessary diagnostic procedures.

Keywords: Cystocentesis; Dog, Cat; Ultrasound

Mini Review

Cystocentesis is a procedure in which a needle is inserted thought the abdominal wall into the urinary bladder to withdraw urine [1]. The procedure is commonly performed in veterinary practice and has both diagnostic and therapeutic use [2]. Diagnostic cystocentesis circumvents many of the potential problems associated with collection of urine specimens by normal micturition, manual compression of the urinary bladder, or catheterization [1,2]. The main advantage of cystocentesis is that contamination of voided urine with blood, exudates, microorganisms, and other debris from the urethra, genital tract, and integument that may complicate interpretation of routine urinalysis findings is avoided [1,3]. When transurterhal catheterization is unsuccesfull in animals with urinary obstruction decompressive cystocentesis is advised as therapeutic intervention. In addition to reducing pressure on bladder wall and preventing rupture, it facilitates retropulsion of urethral plugs or urethroliths and improves the ease of catheterization case [4-6].

Cystocentesis is considered a simple but an invasive procedure with a potential risk of complications. It requires trained staff and might not be possible in all clinical situations [7]. The main contraindications to cystocentesis are an insufficient volume of urine in the urinary bladder and the animal’s resistance to restraint [1]. The procedure is also contraindicated in patients with pyometra [7], recent abdominal surgery or trauma, coagulopathy, thrombocytopenia and under anticoagulant therapy [3]. Finally, cystocentesis is not recommended in patients with urinary bladder neoplasia [3]. Usually wetting the skin with an alcohol solution is often used to see where the needle will puncture the skin, and not primarily as a disinfectant. If the animal is not clean the area can be shaved and scrubbed prior to performing cystocentesis; however, according to some author under routine circumstances this is not necessary [1]. Results of a study in 22 cats suggested that contamination of urine samples collected by cystocentesis does not occur even when the hair is not clipped or the skin disinfected [8]. The recommended technique to perform cystocentesis without risk to the animal involves palpation and immobilization of the urinary bladder as well as planning the site and direction of the needle puncture [9].

Currently, ultrasound-guided centesis has become the preferred method to safely collect urine [2]. In fact ultrasound guide can be useful to correctly localize the position of urinary bladder and to evaluate the distension and thickening of the wall before performing the procedure. Usually 22G-23G needles are used [2,3,4,10] connected to a 5 ml syringe [10]. Iatrogenic loss of urine into the peritoneal cavity during or after properly performed cystocentesis is unlikely unless there is extensive necrosis or inflamation of the bladder wall, which can occur after prolonged urinary tract obstruction. Furthermore, leakage can occur when there is movement of the patient during procedure and when pressure is applied to the bladder during procedure [1,4]. Septic peritonitis can occur after leakage of contaminated urine into peritoneal cavity [4,10]. Urosepsis is considered uncommon in veterinary practice, but can accompany uroabdomen if the patient has a concomitant urinary tract infection [10,11]. On rare occasions, cystoJournal centesis has been associated with a form of reversible collapse in cats secondary to a possible excessive vagal stimulation [12]. Occasionally, small submucosal hematoma formation has been observed in experimental cats after cystocentesis, but this had no notable adverse effects associated with it [1]. However urine analysis should be evaluated with caution ( hematuria secondary to iatrogenic trauma from cystocentesis). Accidental penetration of a bowel loop can result in a false-positive bacteriuria [2]. Laceration of the bladder wall or big vessels can occur if the animal is not properly restrained, if the needle length is too great for the size of the animal or due to inexperience of the operator [10,13].

Laceration of the aorta can result in life- threatening complications secondary to massive blood loss [13]. However, abdominal aorta and vena cava perforations during cystocentesis reported in a case series were not life threatening [10]. Acute abdomen with formation of a large blood clot was reported in a cat [10]. Other minor complications are nodular fat necrosis, subcutaneous abscess, bladder wall hematoma, endoluminal bladder blood clots, skin hematoma, mural bleeding, bladder wall detachment, focal perivesical peritonitis. All these conditions were self limited or required medical therapy and follow-up. In conclusion, serious complications after cystocentesis are rare and the introduction of ultrasound in performing urine aspiration may have contributed to the low number of complications. The possibility to check the urinary bladder before, during and after the procedure can be important to make the proper diagnosis, to take the right treatment and avoid further unnecessary diagnostic procedures.

References

1. Brown C (2006) Diagnostic cystocentesis: technique and considerations. Lab Anim, New York, USA, 35: 21-23.
2. Kruger JM, Osborne CA, Ulrich LK (1996) Cystocentesis. Diagnostic and therapeutic considerations. Vet Clin North Am Small Anim Prac 26: 353–361.
3. Vap LM, Shropshire SB (2017) Urine Cytology Collection, Film Preparation, and Evaluation. Vet Clin North Am Small Anim Prac 47: 135-149.
4. Specht A, Chan D, O’toole T, Kent M, Benson J, et al. (2002) Acute staphylococcal peritonitis following cystocentesis in a dog. J Vet Emerg Crit Care 12:183–187.
5. Hall J, Hall K, Powell Ll, Lulich J (2015) Outcome of male cats managed for urethral obstruction with decompressive cystocentesis and urinary catheterization: 47 cats (2009-2012). J Vet Emerg Crit Care 25: 256- 262.
6. Sørensen TM, Jensen AB, Damborg P, Bjørnvad CR, Guardabassi L, Jessen LR (2016) Evaluation of different sampling methods and criteria for diagnosing canine urinary tract infection by quantitative bacterial culture. Vet Jour 216: 168–173.
7. Davis H, Riel Dl, Pappagianis M, Miguel K (2013) Diagnostic sampling and therapeutic tecqniques. In: Basset JM, Thomas JA. Clinical Textbook for Veterinary Technicians. (8th edn), London,UK, pp. 605.
8. Fry DR, Halloway SA (2004) Comparison of normale urine samples collected by cystocentesis with and without prior skin disinfection. Aust Vet Prat 34: 2-5.
9. Lulich JP, Osborne CA (2004) Cystocentesis: lessons from thirty years of clinical experience. In North American Veterinary Community clinician’s brief. Urology.
10. Manfredi S, Carvalho C, Fonti P, Gnudi G, Miduri F, et al (2018) Complications of ultraound-guided cystocentesis in companion animals: 21 cases. Turkish Journal and Animal Sciences 42: 459-466
11. Stafford JR, Bartges JW (2013) A clinical review of pathophysiology, diagnosis, and treatment of uroabdomen in the dog and cat. Journal Veterinary Emergency Critical Care (San Antonio) 23: 216-229.
12. Odunayo A, Ng Zj, Holford Al (2015) Probable vasovagal reaction following cystocentesis in two cats. J Feline Med Surg Open Reports 22: 1-4.
13. Buckley GJ, Aktay SA, Rozanski EA (2009) Massive transfusion and surgical management of iatrogenic aortic laceration associated with cystocentesis in a dog. J Am Vet Med Assoc 235: 288–291.