3/12 Is Cystocentesis SAFE?

Status
Not open for further replies.
JoyBee&Ravan

JoyBee&Ravan

Member Since 2018
Do you think it's SAFE for your vet to perform a Cystocentesis?
http://journals.tubitak.gov.tr/veterinary/issues/vet-18-42-5/vet-42-5-13-1802-11.pdf

Bladder Lacerations,Hematoma,Mucosal detachment ,Blood clots These are some of the things I read . Often they are NOT reported,especially in cats!

Ravan had a cystocentesis performed by a Vet filling in when my regular vet was on vacation.The guy used an ultrasound but still poked Ravan in the bladder 3 times! Ravan was "screaming" & struggling.

When I brought him home he laid on the cold cement floor spread out so his stomach touched the floor. Every time he peed he did that. When I told my vet he said it wasn't caused by the Cysto. I like my vet but they all stick up for each other. There's no way to prove the Cysto hurt him.
Shortly after, Ravan started leaking urine. I brought him to the vet & he was thoroughly examined. I was told it was from Old age,nothing to do with the Cysto.

Including my cats now, I've had 18 in my life. Some lived over 20 years, Daisy 24 yrs. I have never had any of them leak urine.

Ravan was diagnosed with stage 2 Kidney disease. He's been doing well but several days ago he started leaking urine more than ever. And drinking water & peeing more. Usually when his BG is in low numbers he does NOT leak urine at all.

He also started having seizures 4 months ago. 3 so far. I don't know of any of this is from the vets mistakes but I think about it.

We are their Voice,their protectors. We need to speak up & ask questions & sometimes say NO to a procedure that might hurt them. I will always regret I let that Vet do the Cysto. It wasn't necessary. I could have gotten a urine sample myself. I will always be in the room when at the vet,watching & asking questions.

  • A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000.
https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html
( please read this article It's an eye opener)

If that many Humans die every year from Medical mistakes. How many animals die from mistakes????

  • Medical errors are the third-leading cause of death after heart disease and cancer.
 
Last edited:
Complications from cysto are extremely rare. The study shows 21 cases (in only 20 animals) across 11 years and 5 veterinary practices. That's an average of 0.36 cases per clinic per year which is tiny, especially when you consider that cysto is done several times daily in most clinics - there's more chance of a cat being injured from struggling when you put them in their carrier than from the risk of cysto. In addition to that, you have to remember that cysto is sometimes a completely necessary procedure - if an infection is suspected, it's the only way to get an uncontaminated sample to identify whether or not there is an infection and, if there is, what bacteria is causing it. Free catch at home cannot do this as the sample you get is necessarily contaminated. In cats with kidney issues, it's even more important to have an uncontaminated sample because if there is an infection that is wrongly identified and treated, or that goes unidentified, it can retrograde into the kidneys and cause additional, irreversible damage.

Cats that struggle during cysto most often actually do so because they don't like being held on their back. Unfortunately, they also often struggle more if their owner is present, trying to get back to the owner and away from the stranger restraining them. Cysto is generally done "in the back" away from the owner, not because there is something to hide, but because it is generally quicker, easier and safer that way. The procedure itself is generally not bothersome to them, although it is sometimes necessary to poke more than once. There is a good physical reason for that too - the vena cava lies very close to the bladder. It is vitally important that the person taking the cysto does not hit that. So, if the cat is struggling, or if their bladder cannot be penetrated safely at the angle the needle has been inserted at, you have to stop and start over to ensure that you don't accidentally hit that instead of the bladder. If the cat's bladder isn't all that full then it can make the process more difficult and can require more than one poke too.

It is possible that Ravan had some bruising (hematoma) from the procedure which might have explained him laying on a cold floor. However, that can also be a symptom of a urinary tract infection - in some cats, it's the only symptom. And doing it after urination, rather than all the time, would be more indicative of discomfort from an infection.

I can't rule out that Ravan was one of those very rare cases where there was a complication; however I doubt that the leaking urine or seizures are in any way related to the cysto. Some cats do leak urine as a result of kidney issues or old age - just like some humans do. That doesn't mean it will happen to all old cats, but to an extent you have to remember that the more cats you've owned that did not have this problem, the higher the chance that a current one will simply based on the percentage of occurrence. If the occurrence rate is 5%, the closer you get to having owned 20 cats, the higher the chances that at least one will have this sort of problem. Calcitriol can also cause increased urination, and may contribute to leaking - and that may develop over several months as the various chemistry values change. I actually don't see the results of the urinalysis on your labs sheet, so I don't know what was identified in the results of that.

I can do cystocentesis myself...and I am still perfectly comfortable with having others do the procedure on my cats - it really is so safe in qualified hands that I don't even need to think twice about it. Some cats will develop issues as a result of the condition that cause the labs (and cysto) to be requested. However, we do have to be careful to remember that correlation does not equal causation - it's very easy to assume that the one thing that was out of our control (the testing that someone else did) must be the cause of any issues. It's often the case that it's the underlying condition itself that is causing the symptoms we see.
 
manxcat419 said:
don't like being held on their back.
Click to expand...
My regular Vet commented to me that there was no reason to have Ravan on his back. He's had his own practice for over 40 years & said he's never had a problem with laying them on their side. He also "later" expressed concern that the vet did poke him 3 times in the bladder even with the ultrasound!

manxcat419 said:
if an infection is suspected
Click to expand...

When Ravan was diagnosed with Diabetes this vet insisted he needed to do the Cysto to prove it was indeed Diabetes. I later learned the Cysto wasn't needed. An infection was NOT suspected.Ravan did not have any infection.

I've been going to my vet over 20 years & he has commented that when I'm in the room with Ravan it really helps to keep him calm. When he did surgery for Cancer on one of my cats he invited me to be in the room to observe.

Years ago I was in another state for several weeks having surgery on one of my cats. I literally lived at the clinic. I learned how to place an IV & a whole lot of other things. I also observed mistakes that were made.
One dog lost an eye because the "new" vet froze it by mistake while using Cryo to remove a skin tag! Not all "MISTAKES" are reported. There a lot that happens in the BACK room that the animals' owner never hears about. Including "Complications from CYSTO.

I would not go to a Vet that didn't allow me to be in the room.

manxcat419 said:
the closer you get to having owned 20 cats, the higher the chances that at least one will have this sort of problem
Click to expand...
I've been on this forum for over a year. Read hundreds of posts & asked people that have been here for many years about Ravan leaking urine. Not one has said they know of this happening to another cat.

I think it's reasonable to assume that the 3 POKES in the bladder could have damaged something & has caused the leaking. I'm not in a financial position to get more tests done to investigate. I try to do as little as possible NOT to stress my cats out.
I watched an Excellent video by Dr Karen Becker & Dr Pierson. They had some great information & commented that if you force meds & tests on your animal, the stress can kill them faster than if you just love them & let them be. It makes perfect sense to me.

Some cats are Ok to pill or give meds to. Some fight it & start hiding. One of my cats recently started struggling & hiding. I won't force her or run to the vet everytime she looks sick. She's 17 yrs old. I want whatever time she has left to be as calm & peaceful as possible.
 
JoyBee&Ravan said:
My regular Vet commented to me that there was no reason to have Ravan on his back. He's had his own practice for over 40 years & said he's never had a problem with laying them on their side. He also "later" expressed concern that the vet did poke him 3 times in the bladder even with the ultrasound!
Click to expand...
Then your regular vet is not following current guidelines which state that ultrasound should be used so that you can visualize where you're poking. Some vets, from the days before ultrasound, are skilled at getting a sample without. But ultrasound makes it safer because you're not going in "blind" or based on feeling the bladder only. To ultrasound the bladder effectively, the cat needs to be on its back. Again, if his bladder wasn't all that full or if he is overweight and there is a fat pad to get through to reach the bladder, or something else going on that is moving the bladder away from the expected position, more than one poke may be required. Because you don't go randomly poking around with a needle in a cat's abdomen near all the vital internal organs. Either you want the procedure safe, or you want it achieved at the first attempt every single time - you don't always get to have both of those.

JoyBee&Ravan said:
When Ravan was diagnosed with Diabetes this vet insisted he needed to do the Cysto to prove it was indeed Diabetes. I later learned the Cysto wasn't needed. An infection was NOT suspected.Ravan did not have any infection.

I've been going to my vet over 20 years & he has commented that when I'm in the room with Ravan it really helps to keep him calm. When he did surgery for Cancer on one of my cats he invited me to be in the room to observe.

Years ago I was in another state for several weeks having surgery on one of my cats. I literally lived at the clinic. I learned how to place an IV & a whole lot of other things. I also observed mistakes that were made.
One dog lost an eye because the "new" vet froze it by mistake while using Cryo to remove a skin tag! Not all "MISTAKES" are reported. There a lot that happens in the BACK room that the animals' owner never hears about. Including "Complications from CYSTO.

I would not go to a Vet that didn't allow me to be in the room.
Click to expand...
Cystocentesis is the gold standard for obtaining a urine sample for any lab profile. Unless the vet is unable to obtain urine by cysto because the bladder is empty (and the owner is not prepared to leave the cat with them for fluids and a second attempt), in which case you have to work with a free catch, all urine samples for lab analysis should be obtained this way. Again, your vet is breaking guidelines (and possibly the law). Owners should not be in the back while procedures and surgery are taking place. Surgery is not a spectator sport and there is a risk of contamination, as well as the issues that arise if the owner cannot deal with what's happening and needs to take staff away from the procedure to look after the owner. There are also huge liability issues from having an untrained, unqualified person hanging around during surgery. It is ILLEGAL in most states for an unqualified individual to place an IV anything. Yes, mistakes happen. But assuming that every outcome that you don't like is a veterinary mistake simply isn't true. The whole point of the study you posted about issues from cysto was that those mistakes were, absolutely, reported. And the incidence rate was minimal.

JoyBee&Ravan said:
I've been on this forum for over a year. Read hundreds of posts & asked people that have been here for many years about Ravan leaking urine. Not one has said they know of this happening to another cat.

I think it's reasonable to assume that the 3 POKES in the bladder could have damaged something & has caused the leaking. I'm not in a financial position to get more tests done to investigate. I try to do as little as possible NOT to stress my cats out.
I watched an Excellent video by Dr Karen Becker & Dr Pierson. They had some great information & commented that if you force meds & tests on your animal, the stress can kill them faster than if you just love them & let them be. It makes perfect sense to me.

Some cats are Ok to pill or give meds to. Some fight it & start hiding. One of my cats recently started struggling & hiding. I won't force her or run to the vet everytime she looks sick. She's 17 yrs old. I want whatever time she has left to be as calm & peaceful as possible.
Click to expand...
With all due respect, even on this forum you're only speaking to a tiny percentage of cat owners. Urinary incontinence is a well-known issue among middle-aged and older cats. The more common causes are:
  • Disruption of the nerves around the bladder
  • Lesions on the spinal cord
  • Lesions in the brain
  • Overactive bladder syndrome
  • Urinary tract infections
  • Chronic inflammatory disease
  • Pressure on the bladder caused by a mass
  • Underdevelopment of the bladder or other birth defects
  • And neutering - although that is rare.
Since you don't want to do additional testing, you can't jump to the conclusion that the damage was caused by the cysto. That's unreasonable in the extreme given all the possible causes (and nerve disruption around the bladder is rarely if ever caused by cysto - and would improve with time as the nerves heal, not progress). While it may be true in some instances that forcing meds and tests cause stress to a cat that may be damaging, it's far from always being the case. Animals that go untreated for illnesses will still die far faster, and with more complications, than animals where the cause of a problem is identified and treated. If you don't test, and only treat sometimes, you'll never really know what the cause of anything is. And blaming that on the vet, or an assumed mistake because that's "less stressful" to the cat than testing and treating, is a common but usually incorrect conclusion.
 
No point in voicing my Opinion. Apparently you know more about the Law & what a vet should and should not do.

I can say that after over 50 years of experience with my animals, I "never" jumped to conclusions.

I will always be very grateful to the very few Vets that have "broke the law" That did NOT follow the Guidelines! as you put it,and allowed me to be an active partner in my animals care. And to "help" me when I could not afford certain procedures.

It's not necessarily that I do not want additional testing.I CAN'T AFFORD IT! I did not come from an affluent family. I was a single mother struggling to get by. Some vets saw this & went out of their way to Help. THANK GOD for their COMPASSION!! and not following the rules!

The comments about a cat getting stressed out & hastening their death,were not my thoughts. They came from two well respected Veterinarians, Dr. Karen Becker and Dr. Lisa Pierson.
I feel it makes sense & agree with their advice.
 
Last edited:
JoyBee&Ravan said:
Apparently you know more about the Law & what a vet should and should not do.
Click to expand...
I'll say just this much and then I'm done with this conversation since apparently you want an argument, not the facts - and I'm not up for an argument. Yes, as a vet tech I think I may just have rather more insight into procedures and legal liabilities and obligations in the veterinary field than most people could be expected to. There are times when it is acceptable to have an owner present, and times when it is actively discouraged if not legally not permitted. And there are rules and laws about what can and cannot be done depending on individual qualification level. Not following the rules can lose a vet their license. That's why they follow the rules for the most part.
 
The original research paper cited by the OP is fatally flawed, and doesn't answer the question--how safe is cystocentesis in cats?-- as posed. Why so? Because the authors merely collected data about cats that had complications. To answer the question, they should have compared The Total Number of Cats Undergoing Cystocentesis to The Number of Cats Having Complications. This would have generated a crude number: of all the cats in the study, some specific percent had complications. To obtain a more meaningful percent, the authors could have broken down risk rates correlated to facility type (veterinary teaching hospital vs solo practitioner, etc), risk rates correlated to procedure type (ultrasound guided or not, for instance), risk rates correlated to final diagnosis (obviously some diagnoses present greater risk at paracentesis than others), risk rates correlated to experience of practitioner....and so forth. At the end of the day, we are left in ignorance about the risk of complications of this procedure.
 
Not to flog a dead horse, but even if we had a study detailing the risks of cyctocentesis in cats, there is the other question: is this procedure necessary for the goal stated? That is, does making the diagnosis of diabetes require cystocentesis? If a blood draw for serum glucose and fructosamine will answer the same question at less risk to the patient, then the cystocentesis is unjustified.
 
I would say is an invasive procedure, and like any other procedure like it has some degree of risk involved, it is not 100% safe so I think taking the decision of doing it or not has to be based on what the problem or desease is, is the procedure going to give really useful information about it ?, is the treatment going to be different depending on the result ? Are there some other less risky options of getting the same information or similar, the actual condition of the cat as to what would be worse or more risky, given his actual condition doing it or treating him with out the results so is hard to say
 
Status
Not open for further replies.
Back
Top