What Is a Cystotomy? Procedure, Reasons, and Recovery

A cystotomy is a surgical incision into the urinary bladder, most commonly performed to remove bladder stones. The term comes from the Greek words for “bladder” and “cut,” and the procedure is one of the most frequently performed surgeries in veterinary medicine, though it also has well-established applications in human surgery for trauma repair, foreign body removal, and tumor excision. Despite sounding dramatic, cystotomy is generally straightforward and the bladder heals well, but the details of why it’s done, how recovery works, and what comes afterward are worth understanding.

Why a Cystotomy Is Performed

The single most common reason for cystotomy is the removal of urinary stones, also called uroliths or calculi. In dogs and cats, stones can form from minerals that crystallize in concentrated urine, eventually growing large enough to cause pain, bloody urine, or outright blockage of the urinary tract. When stones are too large or too numerous to dissolve with dietary changes, or when they’re made of a mineral type that doesn’t dissolve well, surgical removal through cystotomy becomes the standard treatment.¹ A case report of a mixed-breed cat, for example, documented an oval stone identified on ultrasound that was causing persistent urinary symptoms and required surgical removal.²

Stones aren’t the only reason to open the bladder, though. Cystotomy or the related procedure of partial cystectomy (removing a section of the bladder wall) may be indicated for bladder trauma, tumors, a persistent urachus (a fetal structure that should close at birth but sometimes doesn’t), or urachal diverticula (pouch-like bulges left behind by that structure).¹ In humans, traumatic bladder rupture from an accident can require emergency surgical repair. One published case involved a 23-year-old man whose bladder ruptured into the abdominal cavity after a car collision, requiring surgical closure.³

Foreign bodies that migrate into the bladder wall present another indication. In one case, a woman developed chronic pelvic pain and urinary tract infections because an intrauterine device had become embedded in her bladder wall, requiring a combination of cystoscopy and laparoscopy to remove it.⁴ Bladder diverticula, which are outpouchings of the bladder wall, can also require surgical excision when they grow large enough to cause urinary tract infections, stone formation, incontinence, or, rarely, malignancy.⁵

How the Procedure Works

In its traditional open form, cystotomy is approached through a midline incision in the abdomen. The surgeon exposes the bladder, then makes a cut along its ventral (belly-facing) surface. This location is preferred because it provides the best access and avoids the blood vessels and ureters that enter the bladder at other points. If stones are the reason for surgery, the surgeon removes them one by one and then flushes the bladder thoroughly with sterile saline to dislodge any fragments or smaller stones that might be hiding in the folds of the bladder lining. A biopsy of the bladder’s inner lining and a culture sample are typically collected at the same time to check for underlying disease or infection.¹

Closure is done with absorbable suture material, meaning the stitches dissolve on their own over time and don’t need to be removed later. A single-layer closure using an appositional suture pattern (where the wound edges are brought together neatly rather than overlapped) is standard.¹ The suture choice matters. Ex vivo studies comparing different suture materials have found that both barbed and traditional monofilament sutures produce similar leak pressures when used for cystotomy closure, suggesting barbed sutures may be a viable option, though this hasn’t been fully confirmed in living patients yet.⁶

One detail surgeons pay attention to is keeping suture material out of the bladder’s interior. If suture threads are exposed to urine on the inside of the bladder, they can act as a starting point for new stone formation, essentially giving minerals something to crystallize around. The appositional technique helps keep suture buried within the bladder wall rather than poking through into the lumen.

Minimally Invasive Approaches

Open surgery through a traditional abdominal incision remains the most common method, but minimally invasive options have been gaining ground. Laparoscopic-assisted cystotomy uses small camera ports inserted through the abdominal wall, allowing the surgeon to visualize the bladder on a screen and make a smaller incision to extract stones. A review of 23 dogs and cats that underwent laparoscopic-assisted cystotomy for stone removal showed the technique to be a feasible alternative to fully open surgery.⁷

In human surgery, laparoscopic repair has been used successfully for traumatic bladder rupture, avoiding the larger incision that an open approach requires.³ Robotic-assisted surgery has also entered the picture for more complex bladder procedures, such as excising large diverticula, where the precision of robotic instruments can help navigate around the ureters.⁵ These approaches generally mean less postoperative pain and a faster return to normal activity, though they require specialized equipment and training that not every facility has.

Stabilization Before Emergency Surgery

Not every cystotomy is a scheduled, straightforward stone removal. When the bladder has ruptured, whether from trauma, obstruction, or disease, the situation becomes an emergency. Urine leaking into the abdomen (a condition called uroabdomen) causes dangerous electrolyte shifts, most critically a rise in potassium levels that can affect the heart. Before a patient can safely undergo anesthesia and surgery, the medical team needs to stabilize them with intravenous fluids and correct the high potassium. Temporary urinary diversion, sometimes through a catheter and sometimes through peritoneal drainage, buys time until the patient is stable enough for the operating table.⁸

This distinction matters for pet owners in particular. If your dog or cat is straining to urinate and nothing is coming out, or if the abdomen seems distended and tender, that can signal a blocked or ruptured bladder. The immediate goal is stabilization, not a rush to the operating room. Surgery happens once the patient’s bloodwork and heart rhythm are in a safe range.

Recovery and Healing

The bladder is one of the body’s better healers. In a porcine (pig) model comparing different closure techniques, bladders repaired with standard sutures showed no leakage on imaging at one week postoperatively, and by six weeks, repaired bladders could be filled to high pressures without any leakage at all.⁹ There was more inflammation in the first days after surgery, as you’d expect, but by the six-week mark, there was no meaningful difference between the repair methods tested. The practical takeaway: a properly closed bladder seals up fast.

For dogs and cats, the typical recovery involves a few days of reduced activity, pain medication, and sometimes a short course of antibiotics if infection was present. The animal is usually kept on a urinary catheter for a day or so after surgery or simply monitored to make sure it can urinate comfortably on its own. Many pets go home within a day or two and are back to near-normal behavior within a week, though exercise restrictions may continue for two to three weeks while the abdominal incision fully heals. For humans undergoing cystotomy, the timeline varies with the extent of surgery and the reason for it. A straightforward stone removal or foreign body extraction may allow discharge within a few days, as was the case with the woman who had an IUD removed from her bladder wall and went home seven days after surgery without complications.⁴

Complications to Watch For

Cystotomy is considered a relatively low-risk procedure, but it isn’t without potential problems. The most commonly reported postoperative complications are urinary tract infections and recurrence of stones. A survey of 106 veterinary practitioners in Ontario found that the majority followed standard recommendations for the surgery itself, but some gaps existed in how practitioners managed antibiotics, pain relief, and follow-up testing after the procedure.¹⁰ Interestingly, the same survey found some counterintuitive associations: practitioners who used absorbable multifilament suture or made their incision on the dorsal (top) surface of the bladder actually reported fewer postoperative infections than those following the more typical ventral approach with monofilament suture. The researchers flagged this as a surprising finding that warrants further study rather than a reason to change standard practice.

Other potential complications include:

Urine leakage: If the closure doesn’t hold, urine can leak into the abdomen. This is uncommon with proper surgical technique but becomes a concern in patients with very diseased or thin bladder walls.
Incomplete stone removal: Small stones or fragments can remain behind if the bladder isn’t thoroughly flushed. This is why many surgeons take a post-flush radiograph (X-ray) before closing, to confirm the bladder is clear.
Suture-related stone formation: If suture material protrudes into the bladder lumen, it can serve as a nidus for new crystals to deposit on, eventually forming a new stone around the thread.
Incisional infection: As with any abdominal surgery, the skin incision can become infected if not kept clean during the healing period.

Most of these complications are manageable when caught early. Follow-up urinalysis and imaging (usually a few weeks after surgery) help detect recurrent stones or lingering infections before they become serious problems.

Preventing Stone Recurrence After Surgery

Removing stones surgically solves the immediate problem, but without changes to diet and hydration, new stones can form. The recurrence rate for urinary stones in dogs and cats is high enough that prevention deserves real attention. Recommendations from the American College of Veterinary Internal Medicine emphasize increasing moisture intake as the single most important step. High-moisture foods (more than 75% water content) or adding water to dry kibble significantly reduces the concentration of stone-forming minerals in the urine. The goal is to achieve dilute urine, which for dogs means a urine specific gravity at or below 1.020, and for cats below 1.030.¹¹

The specific dietary strategy depends on the type of stone. For calcium oxalate stones, which are among the most common and cannot be dissolved medically, the consensus recommendations include avoiding urine acidification (keeping urine pH above 6.5) and limiting diets with excessive animal protein, since high protein intake increases calcium in the urine while decreasing citrate, a natural inhibitor of crystal formation.¹¹ For struvite stones, which are often associated with urinary tract infections in dogs, treating the underlying infection can prevent recurrence, and dietary acidification (the opposite of what you’d do for calcium oxalate) may be recommended. This is why stone analysis after surgery is so important: the prevention plan depends entirely on what the stone is made of.

In humans, similar principles apply. Increasing fluid intake, adjusting dietary habits, and sometimes taking medications to alter urine chemistry are the mainstays of stone prevention. The underlying message is the same across species: surgery addresses the stone that’s there now, but long-term management is what keeps the next one from forming.

Cystotomy Versus Related Procedures

The terminology around bladder surgery can be confusing because several related procedures sound similar but differ substantially. A cystotomy is an incision into the bladder, made with the intent of closing it back up. A partial cystectomy involves removing a portion of the bladder wall entirely, which is done when the tissue itself is diseased, as with tumors or severely damaged areas. The bladder is elastic and can compensate for losing a section of its wall, though capacity may be temporarily reduced. A cystectomy (without the “o” that indicates a simple cut) means removing the entire bladder, a far more radical surgery usually reserved for advanced bladder cancer. A tube cystostomy is different again: it involves placing a tube directly through the abdominal wall and into the bladder to divert urine, either temporarily while the urinary tract heals or permanently if normal urination isn’t possible.¹

Understanding these distinctions matters if you’re a pet owner reviewing a surgical estimate or a patient reading a procedure consent form. A cystotomy for stone removal is on the less invasive end of the spectrum and carries a very different prognosis from a full cystectomy.

One of the Oldest Operations in Medicine

Cutting into the bladder to remove stones is not a modern invention. It is one of the oldest documented surgical procedures in history. The ancient Greeks recorded the practice of lithotomy (literally “stone cutting”), and the technique evolved through five recognized historical phases over the centuries, from the Celsian method through lateral approaches and eventually to suprapubic cystotomy, in which the surgeon enters through the lower abdomen above the pubic bone.¹² The Hippocratic Oath famously includes a line often interpreted as physicians pledging not to “cut for the stone,” instead leaving it to specialists, which gives a sense of how established and how feared the procedure was in antiquity.

For most of human history, bladder stone surgery was performed without anesthesia, without antibiotics, and without the imaging tools that let modern surgeons confirm every stone has been removed. Mortality rates were grim. The fact that people still submitted to it speaks to how excruciating untreated bladder stones can be. Modern cystotomy, performed under general anesthesia with advanced suture materials and guided by ultrasound and radiographs, is unrecognizable compared to its ancient predecessor, but the core idea has remained unchanged for thousands of years: open the bladder, take out the stone, close the bladder back up.

1
Seminars in Veterinary Medicine and Surgery. Cystotomy, partial cystectomy, and tube cystostomy
2
Media Kedokteran Hewan. Bladder Stones Removal Surgery Using Cystotomy in a Mix Breed Cat: A Case Report
3
PubMed Central. Laparoscopic repair of a traumatic bladder rupture
4
PubMed Central. Removal of foreign bodies embedded in the urinary bladder wall by a combination of laparoscopy and carbon dioxide cystoscopic assistance
5
PubMed Central. Surgical techniques: robotic bladder diverticulectomy with the da Vinci-S surgical system
6
PubMed. Comparison of leak pressures for single-layer simple continuous suture pattern for cystotomy closure using barbed and monofilament suture material in an ex vivo canine model
7
PubMed Central. Laparoscopic-assisted cystotomy for urolith removal in dogs and cats – 23 cases
8
PubMed. A clinical review of pathophysiology, diagnosis, and treatment of uroabdomen in the dog and cat
9
PubMed. Comparison of healing after cystotomy and repair with fibrin glue and sutured closure in the porcine model
10
PubMed Central. Cystotomy practices and complications among general small animal practitioners in Ontario, Canada
11
Wiley Online Library (Journal of Veterinary Internal Medicine). ACVIM Small Animal Consensus Recommendations on the Treatment and Prevention of Uroliths in Dogs and Cats
12
PubMed. ‘Cutting for the stone’: the ancient art of lithotomy