Page 226 - Clinical Manual of Small Animal Endosurgery

214 Clinical Manual of Small Animal Endosurgery

(a) (b)

Fig. 7.5 (a) Normal bladder mucosa. (b) Normal ureteral opening in the
trigone.

and trigone is carried out to detect gross abnormalities such as masses
or uroliths. Urine is then drained from the bladder by opening the tap
opposite the saline inflow tap on the cystoscope. A 60 ml syringe can be
attached to this tap or alternatively a second giving set may be used to
drain urine by gravity into a suitable container. Once the bladder has
been emptied, saline flow is re-started to refill the bladder. Sometimes
several flushes are required to completely clear the bladder of urine or
particulate material. The whole of the bladder mucosa should be exam-
ined (Fig. 7.5a). Care must be taken not to over-distend the bladder as
this can lead to mucosal damage and bleeding, especially if the mucosa
is already inflamed through cystitis. The aim should be to maintain a
crinkly, undulating surface that is not under tension. This also facilitates
the taking of biopsies if these are required. To avoid over-filling, the flow
of saline is turned off once the bladder is sufficiently full to allow exami-
nation of the surface. Over-distension also moves the apex of the bladder
further away from the endoscope at the trigone, making visualisation of
the bladder wall difficult or impossible. In large breeds it is necessary to
keep the bladder quite flaccid in order to examine the whole of the
bladder mucosa, and it is sometimes helpful to have an assistant gently
manipulate the bladder through the abdominal wall to bring all areas of
the mucosa into view.
Haemorrhage from the bladder mucosa may present a problem since
quite small amounts of blood will impair the view. In the rare cases that
this interferes with the examination it may be preferable to insufflate the
bladder with air or carbon dioxide to enable a complete examination.
Carbon dioxide is preferred as air embolism may be a potential compli-
cation of insufflation with room air.
Once the bladder is partially filled with clear saline the image is
improved and detailed examination is carried out. The openings of both
ureters should be examined (Fig. 7.5b) and urine observed entering the