Cystotomy in Cats

What Is Cystotomy in Cats?

A cystotomy in cats is a common surgery to remove bladder stones. Research has shown that about 15–23% of cats with bladder issues (feline lower urinary tract disease) develop bladder stones, which are hard clumps of mineral.

These stones can then cause discomfort or pain for cats as well as irritation to the bladder (cystitis), blood in the urine, and even urinary blockage. Your vet may recommend a cystotomy to remove them and help your fur baby feel better.

Cystotomy in cats is a routine procedure but may need to be performed as an emergency if a cat is unable to urinate. 

Anatomy of a Cat Bladder

The urinary tract is made of the kidneys, ureters (tubes that drain urine from each kidney to the bladder), the bladder (sac that stores urine), and the urethra (small tube that carries urine from the bladder to the outside of the body).

Why Would a Cat Need a Cystotomy?

Some bladder stones can be dissolved using prescription urinary diets, but it can take a long time, up to several weeks. Your cat’s bladder stones may need to be surgically removed by cystotomy if:

• Your cat needs this lifesaving procedure because they are unable to urinate or have difficulty urinating (both emergency situations) due to the stones obstructing the bladder or urethra

• Attempts to dissolve the stones with a prescription diet were unsuccessful

Complications of Cystotomy in Cats

Cystotomy is considered a relatively low risk surgery. The most common complication, at greater than 40% chance, is a recurrence of stones. Your veterinarian will submit the stones for analysis to help determine the type and how best to prevent them in the future.

It’s very important to follow their post-op instructions, such as if a diet change is needed for life to prevent stones from reoccurring. 

Other possible complications include:

• Urinary tract infection

• Urine leaking from the bladder incision (uroabdomen)

• Damage to the urinary tract

• Bleeding

• Infection of the incision

• Anesthetic complication, including allergic reaction to anesthesia or, rarely, death

Benefits of Cystotomy in Cats

Cystotomy in cats is considered a safe, fast, and effective solution for cats with bladder stones. These bladder stones can cause uncomfortable symptoms and potentially dangerous complications. Removing them allows your cat’s bladder to fully heal and for your cat to feel better and be healthier.

Cost of Cystotomy in Cats

The average cost of cystotomy in cats is $1,000 to $3,000. This can vary depending on where you live, your individual veterinary hospital, and your cat’s health history and medical needs.

Most pet insurance policies cover unexpected surgery, including cystotomy, but it’s important to understand that insurance plans can range considerably in coverage.

Preparation for Cystotomy in Cats

The best way to prepare your cat for surgery is to schedule a pre-surgical evaluation with your veterinarian. Your vet will:

• Review your cat’s full medical history

• Make sure that your cat is up to date on vaccinations

• Perform a comprehensive physical examination

• Screen for any underlying health issues. This pre-anesthetic screening may involve blood work, urinalysis, and X-rays.

Some other tips to help prepare your cat include:

• Add a probiotic supplement (Fortiflora®, Proviable®) to your cat’s food to help aid digestion with diet changes or medication

• Calming pheromone diffuser to promote relaxation and decrease immune system stress for your cat

• Immune system support supplement (Imuquin®) on your cat’s food

• Short training sessions to help your cat get accustomed to wearing a soft body suit or onesie to protect their incision

It's important to follow your veterinarian’s specific pre-surgery instructions regarding your cat’s medications, feeding instructions, and exactly what time to withhold your cat’s food and water prior to surgery.

These are the steps typically involved in performing a cystotomy in cats:

1. Pre-op blood work, urinalysis, and X-rays are done to check the kidneys and determine how many stones are in the bladder.

2. The cat is placed under general anesthesia and the fur on the abdomen is shaved and the area is cleaned.

3. Using a scalpel, the veterinarian makes an incision in the abdomen below the navel (like where a spay incision might be, but this incision will probably be a bit longer).

4. The stones are removed from the bladder and submitted to a laboratory for evaluation to determine what type of stone they are. Sometimes a sample of urine or piece of the bladder wall is also submitted for culture to determine if any bacteria was present (urinary tract infection).

5. The bladder and abdomen are then closed with sutures and an X-ray is taken to ensure all stones were removed.

Some veterinarians may choose to place a urinary catheter at the time of surgery and may leave it in for one to three days in the post-op period. 

Some cats may be discharged the same evening after day surgery, while other cats will remain in the hospital for one to three days for observation to ensure they are eating and able to urinate normally before they are discharged.

Post-op Care and Recovery for Cystotomy in Cats

Depending on their medical needs, your cat may go home the day of surgery or may remain hospitalized for one to three days after their cystotomy. They will be discharged when they are eating and able to urinate, but it will typically take two to three weeks for your cat to fully recover.  

When you pick up your cat from the hospital, carefully review your veterinarian’s detailed discharge instructions, and discuss any questions and concerns you have about what to expect during your cat’s recovery.

You can help with their recovery in several ways, including:

• Provide a safe, comfortable space for your cat to rest and recover.

• Limit your cat’s activity for the first two weeks after cystotomy. Running, jumping, and playing can cause the stitches to open on the inside and outside layers, putting your cat at risk of life-threatening complications.

• Use pet stairs to prevent your cat from jumping up to their favorite places.

• Make their cat bed easily accessible on the floor.

• Administer prescribed medications to your cat such as pain relievers like Onsior™ and gabapentin. Wrapping medications in Pill Pockets™ can help!

• Protect your cat’s incision by having them wear a cone collar (hard or soft) or a suitical (soft body suit). Check the incision daily for redness, swelling, or discharge.

• Monitor your cat’s appetite, drinking, urination, bowel movements, and litter box habits. It is common for your cat’s urine to be a little bloody for the first week or two after cystotomy.

• Encourage your cat to drink more water by providing a water fountain. This helps your cat stay well hydrated and creates more diluted (watery) urine to prevent stones from recurring.

• Only feed the diet your veterinarian recommends. To prevent excess minerals and stones from reforming in your cat’s urine, your veterinarian will make a specific prescription urinary diet recommendation, such as Hill’s® c/d, Royal Canin® Urinary SO, or Purina® Pro Plan® UR.

• Transition your cat’s diet to a canned formula. A canned diet provides more water intake to create dilute urine and prevent sedimentation of minerals in your cat’s urine.

If you have any concerns about your cat’s symptoms or their surgical incision, contact your veterinarian right away.

Alternatives to Cystotomy in Cats

Your veterinarian may recommend trying to dissolve your cat’s bladder stones by using a prescription urinary diet, which can take up to several weeks. These prescription diets are formulated to dissolve stones and prevent the formation of crystals and stones, mostly by regulating urinary pH. Canned varieties are usually preferred to help increase your cat’s water consumption.

Dissolving bladder stones through diet doesn’t always work, either because the stones are too big or they are of a mineral composition that cannot be dissolved and that always require surgery. 

Cystotomy will be needed if your cat’s stones cannot be successfully dissolved by a prescription diet or if they’re causing an obstruction that requires immediate, life-saving intervention for your cat to be able to urinate.