Cystocentesis



Figure 51.2 Transabdominal ultrasound image of the urinary bladder in an alpaca. The ideal site for needle insertion is the curvature of the urinary bladder as it contacts the body wall.

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Figure 51.3 Use of an 18-gauge spinal needle, with concurrent ultrasound guidance, to perform cystocentesis.

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Practice Tip to Facilitate Procedure

If a large volume of urine is to be removed, thus necessitating prolonged needle placement, it is recommended that an extension set be used between the needle and syringe to allow for repeated syringe removal. Additionally, an over-the-needle intravenous catheter may be used and the stylette removed to induce less trauma to the urinary bladder wall.

If xylazine is used alone or in combination to facilitate this procedure, glucosuria should be expected and must be considered when interpreting results.

Urinalysis should be performed within 20 minutes of sample collection or refrigerated/shipped on ice for laboratory testing within 2 days (Table 51.1).

Values for fractional excretion and electrolytes in urine in llamas fed hay-based diets have been published (Lackey et al., 1995).




Table 51.1 Urinalysis reference ranges for llamas at sea level (Adapted from Fowler, 1998).











































Color Clear, light yellow-amber
Specific Gravity 1.013–1.048 (mean 1.023)
pH 7–8.5
Protein Negative Some 1+
Glucose Negative Some 1−3+
Ketones Negative Some 1+
Urobilinogen Negative Some 2−3+
Bilirubin Negative
Blood Negative
Sediments Calcium Oxalate common

Uric Acid rare

POTENTIAL COMPLICATIONS


The procedure is contraindicated in patients with a small volume of urine in the urinary bladder, obstruction of urine outflow from the bladder if surgery is not planned, recent abdominal surgery, suspected bleeding disorders or caudal abdominal tumors. Risks include urinary bladder laceration, rupture, laceration of bowel with subsequent peritonitis. In general, cystocentesis is discouraged in camelids. The urinary bladder is intra-pelvic in location unless distended, and thus, risk of bowel perforation is significant. Ultrasound-guided cystocentesis is always preferred. In cases of urinary outflow obstruction, bladder pressure is sufficient to cause persistent leakage after cystocentesis in some camelids. Thus, this procedure is not suited for transient alleviation of bladder distension unless surgery or other means of clearing the urinary obstruction are performed soon afterward.


PATIENT MONITORING/AFTERCARE


The patient should be monitored for normal urination and the development of uroperitoneum. Caution should be exercised for patients with bacterial cystitis or other urinary bladder wall compromise because of increased risk of urine leakage and septic peritonitis.


RECOMMENDED READING


Ballweber LR. 2009. Ecto- and endoparasites of New World Camelids. Vet Clin N Am Food Anim Pract; 25(2):295–310.


Fowler ME. 1998. Medicine and Surgery of South American Camelids, 2nd ed. Ames:Blackwell.


Lackey MN, Belknap EB, Salman MD, et al. 1995. Urinary indices in llamas fed different diets. Am J Vet Res; 56(7):859–865.


McLaughlin BG, Evans NC. 1989. Urethral obstruction in a male llama. J Am Vet Med Assoc; 195(11):1601–1602.


Miesner MD. 2009. The straining camelid: GI or urinary? In: Proceedings of the 81st Western Veterinary Conference 2009. Available at: http://wvc.omnibooksonline.com/data/papers/2009_V559.pdf


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Nov 6, 2016 | Posted by in GENERAL | Comments Off on Cystocentesis

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