NeuroBites – Manual Bladder Expression

 

 

 

Every week, the BVNS neurologists, residents and interns convene to discuss a human or veterinary neurology/neurosurgery article.

NeuroBites is a digestible synopsis written by Dr. Bush of the article covered in journal club.

Welcome to NeuroBites.


Carwardine DR, et al. Effectiveness of manual bladder expression in paraplegic dogs

Am J Vet Res 2017;78:107-112

Click HERE to read the article.


Dr. Palma, one of our neurology interns, did a very nice job with Journal Club this week. He reviewed an article which addresses a very common clinical situation – when a dog has had back surgery and can’t urinate AND we express the bladder – does this really help?

Things to know from this article:

What is the rate of urinary tract infection among dogs that need to have their bladder expressed following spinal surgery?
20-40%

Can a bladder infection be a problem?
Yes, it can make urination more difficult for the patient, cause discomfort and lead to kidney infection and possible infection of the surgical site.

How and when should we monitor for urinary tract infection?
Given that about 1 in 3 patients have an infection according to past studies – we should probably be doing a UA in all of these patients and possibly a culture too. Sometimes the UA looking for bacteria is normal but the culture where we try to grow bacteria is actually positive.

Does bladder expression work?
Well it is OK – generally we empty about half the contents of the bladder. This is probably enough to manage patient comfort and prevent overstretching and permanent incontinence but it’s not great.

Can we rely on ultrasound to know how full the bladder is?
NOPE.  When assessing bladder volume with ultrasound and then draining the bladder to see how much was actually in there – ultrasound was too inaccurate. Too often you might guess the bladder was full or empty and be wrong. It is better than nothing but should be interpreted with caution.

Who is better at bladder expression – Veterinarians or Technicians?
You guessed it – TECHS. Techs empty a bladder to about 53% and Veterinarians only 43% in this study.