At a glance
What is a ruptured bladder?
A ruptured bladder is a tear in the urinary bladder which allows urine to escape into the peritoneal cavity.
Causes: Blunt force trauma, urinary blockage and medically induced.
Symptoms: Inability to urinate, abdominal pain, lethargy, loss of appetite.
Treatment: Stabilise the cat by correcting electrolyte and acid-base derangements and surgical repair of the bladder.
A ruptured bladder occurs when the urinary bladder tears, releasing urine into the abdomen. The most common causes of a ruptured bladder are blunt trauma (hit by a car, a fall from a height or a kick), the incidence increases if the bladder is distended, gunshot wound or a urinary blockage caused by calculi, mucous plugs or neoplasia and iatrogenic (medically induced during catheterisation, cystocentesis or manual expression of the bladder).
Once the bladder ruptures, urine leaks into the abdomen (uroabdomen) resulting in uremic poisoning, a life-threatening condition due to a dangerous build-up nitrogenous of toxins in the bloodstream as well as peritonitis (inflammation of the peritoneum).
Any cat who has had a serious trauma should be evaluated for a ruptured bladder, especially where a pelvic fracture has occurred. A traumatic injury will cause a bladder that ruptures quickly. If the rupture is due to a blockage, the cat may already be unwell due to a build-up of toxins in the body in addition to symptoms associated with a urinary blockage which include, straining to urinate, blood in the urine, abdominal pain and crying.
Clinical signs of a ruptured bladder:
- Absent urination (anuria)
- Frequent and unsuccessful attempts to urinate
- Distended abdomen (ascites)
- Loss of appetite
Your veterinarian will perform a complete physical examination of your cat and obtain a medical history from you. If he has been involved in a trauma, they will assess him for a broken pelvis and a ruptured bladder, both of which are common injuries.
- Ultrasound – A cheap and fast way to evaluate the bladder, an ultrasound will reveal an empty bladder with poor definition.
- Contrast radiography (positive contrast cystourethrography) – This procedure involves the administration of a contrast material that coats the wall of the bladder and is injected into the bladder through a catheter and an x-ray is taken. The
- Baseline tests – Will reveal elevated BUN (blood urea nitrogen), creatinine and potassium levels, elevated albumin, decreased sodium levels (hyponatraemia), metabolic acidosis, elevated neutrophils, and increased hematocrit (ratio of the volume of red blood cells to the total volume of blood).
- Abdominocentesis – A definitive diagnosis is made via abdominocentesis, which is a procedure to remove fluid from the abdomen via a needle. The fluid is then evaluated to determine its composition. Increased potassium and creatinine are both indicative of a ruptured bladder.
The initial goal of treatment is to stabilise the patient to reduce the risk of anesthesia.
- Intravenous fluids to correct electrolyte imbalances, azotemia (high levels of nitrogen-containing compounds in the blood), and cardiac arrhythmias due to high blood potassium levels.
- Urinary diversion is a process that reroutes urine via a urethral catheter or cystostomy tube to drain the bladder and a peritoneal catheter to drain the abdomen.
- Administer analgesia (pain relief) as chemical peritonitis is extremely painful and antibiotics (where indicated).
Surgical repair of the bladder:
- Surgical repair of the bladder involves identifying tears in the bladder wall and debriding any necrotic (dead) or damaged tissue. The bladder is sutured with two layers of absorbable sutures. Lavage (washing out) of the peritoneal cavity before the abdomen is sutured.
- The cat will remain on fluids until the cat can drink unassisted.
- Analgesia will continue for 48 hours post-surgery.
The prognosis is excellent for cats who receive prompt treatment.
The cat will be discharged with a care sheet and medications, always administer as instructed.
Keep cats indoors for at least two weeks post-surgery to allow the surgery site to heal.