Cystotomy (Bladder Stone Surgery)

Not all bladder stones require surgery — some dissolve with a prescription diet. Surgery becomes necessary when:

• The stones are composed of a mineral type (such as calcium oxalate) that does not respond to dietary dissolution
• Stones are causing a urethral blockage, especially in male dogs or male cats, that cannot be cleared by catheterization alone
• The pet is having recurrent urinary tract infections driven by struvite stones that need rapid removal
• Stones are large enough to cause persistent pain, bloody urine, or difficulty urinating despite medical management
• Bladder wall changes — a mass or suspicious thickening — need direct biopsy

Radiographs and ultrasound at our hospital allow the team to count stones, estimate their size, and plan the most appropriate approach before recommending surgery.

Cystotomy is performed under general anesthesia with full monitoring. The steps of the procedure are:

• A small incision is made in the abdomen just in front of or over the bladder
• The bladder is isolated and secured with sutures to control any fluid spillage
• An incision is made directly into the bladder wall
• Stones are carefully removed — the surgeon flushes the bladder repeatedly and passes a catheter into the urethra to retrieve any small fragments that have moved forward
• Biopsies of the bladder wall are taken if abnormal tissue is present
• The bladder is closed in two layers with absorbable sutures, and the abdomen is closed normally

All retrieved stones are submitted for mineral analysis (crystallographic analysis) to guide long-term dietary and medical prevention.

Before cystotomy, the team gathers enough information to plan safely and completely:

• Urinalysis and urine culture to characterize any concurrent infection and guide antibiotic choice
• Abdominal radiographs (X-rays) and ultrasound to count and locate all stones, including any lodged in the urethra
• Pre-anesthetic bloodwork to assess overall organ health
• Food is withheld the night before surgery; water is usually allowed until a few hours prior

If the pet is experiencing an active urinary blockage, emergency catheterization or decompression may be performed immediately before scheduling surgery to stabilize them.

Most dogs and cats go home the same day or after a single overnight stay. Recovery is generally straightforward:

• Days 1–3: some blood-tinged urine is normal as the bladder heals; pain medication is prescribed
• Days 1–10: activity restriction — no running or jumping; short leash walks only
• 10–14 days: suture removal at a recheck visit; a urinalysis is checked to confirm the bladder is clearing
• Long-term: diet change to a stone-prevention formula and periodic urinalysis to catch recurrence early

Stone type results (from laboratory analysis) typically return within one to two weeks and guide any dietary recommendations going forward.

Cystotomy is a well-established procedure with a high success rate. Possible complications include:

• Urine leakage from the bladder closure — uncommon, but monitored closely with post-op observation
• Incomplete stone removal — the team takes care to flush every fragment, but very small pieces can occasionally be missed; post-op imaging at the recheck helps confirm the bladder is clear
• Persistent urinary tract infection if the underlying stone mineral has not yet been addressed by diet

Stone recurrence is the most common long-term concern, which is why stone analysis and dietary management afterward are so important. With the right prevention strategy, many pets remain stone-free for years.