Page 227 - Clinical Manual of Small Animal Endosurgery

Female Reproductive Tract 215

bladder (see Fig. 7.13c, below). With the bitch in ventral recumbency
the openings are positioned at roughly 10 and 2 o’clock near the trigone.
They appear fairly prominent in the flaccid bladder but may be reduced
to flattened slits as the bladder becomes more distended. The endoscope
is withdrawn almost back to the urethral opening and rotated around
its long axis by rotating the light guide post. This enables the surgeon
to utilise the 30° angle of view to visualise the entire trigone. The rest
of the bladder mucosa is then examined for polyps, masses or other
abnormalities.
Once the examination is complete and any biopsies have been taken
the bladder is drained and the endoscope gently removed. If biopsies of
the vestibule or vagina are required, these are taken at the end of the
procedure as haemorrhage may otherwise hamper the view.

Postoperative care
Antibiotics are not usually required following this procedure unless
indicated by underlying pathology. Analgesia is advisable and is provided
by opiates pre- and immediately postoperatively and continued with
non-steroidal anti-inflammatories if renal function is not compromised.
Careful observation for 24–48 h postoperatively is advisable following
more invasive procedures such as laser resection of TCC. Urethral spasm
or occlusion of the urethra by adhesions or seroma can occur and may
require catheterisation.

Complications
The use of cold saline for irrigation, especially in a small patient, can act
as an appreciable heat sink and lead to hypothermia. Careful monitoring
of core body temperature throughout the procedure is recommended.
The use of saline at body temperature is advisable, especially in patients
of small size.
Complications of diagnostic cystoscopy are rare and are almost always
the result of iatrogenic trauma or over distension of the bladder with
saline. Bruising and trauma to the urethra may lead to urethral spasm
and swelling. In rare cases urethral perforation can occur, especially if
the angle of view of the endoscope is not taken into account when
advancing down the urethra in small patients. Perforations will usually
respond to the placement of an indwelling Foley catheter for 48–72 h to
allow healing to take place. Surgical repair is rarely required.
Over-distension of the bladder may result in haemorrhage from the
mucosa which interferes with the examination but is rarely a major cause
for concern for the patient. Severe over-distension could result in rupture
of the bladder wall where it has been weakened by pathological processes
and this will require surgical repair. However, this is extremely unlikely
where saline irrigation is supplied under gravity feed.