Diagnosis of Urinary Bladder Rupture Using Ultrasound Contrast Cystography: In Vitro Model and Two Case‐history Reports

Abstract

Because urinary bladder rupture can be life threatening, a simple, safe technique for evaluating patients is desirable. Current diagnostic protocols involve radiographic imaging, but ultrasound-based contrast techniques have not been methodically evaluated in veterinary patients with urologic trauma. Ultrasound contrast cystography (contrast cystosonography) involves infusion of microbubbled saline solution through a urinary catheter. It was performed in an in vitro model and in 2 dogs with naturally occurring urinary bladder rupture. A positive result consisted of visualizing microbubbles sonographically in fluid surrounding the bladder immediately after infusion of contrast into the urinary catheter. A positive result was obtained both in the in vitro model and in the 2 dogs, with radiographic and surgical confirmation of naturally occurring intraperitoneal urinary bladder rupture in the dogs. Based on the results of this study, ultrasound contrast cystography appears to be more sensitive than two-dimensional (2D) abdominal sonography for detecting naturally occurring urinary bladder rupture in dogs.

Fluorescein as a diagnostic marker of bladder ruptures: an experimental study on rabbit model

“…Positive contrast cystography, computed tomography, and ultrasonography are also used to diagnose urinary bladder rupture (5,12,18). Retrograde positive contrast cystography is rarely rewarding in animals if there is an obstruction in the urethra or urolithiasis.…”

A clinical review of pathophysiology, diagnosis, and treatment of uroabdomen in the dog and cat

“…Following initial stabilization and laboratory diagnostics, abdominal imaging is necessary to document the location of the disruption in the urinary tract. Imaging modalities include abdominal radiographs, abdominal ultrasound, retrograde positive contrast cystography, excretory urography, and computed tomography (CT) . In human medicine, CT is the diagnostic test of choice .…”

“…Ultrasonography is a noninvasive technique that can be used to assess the architecture of the kidneys and other structures and to confirm the presence of fluid. However, ultrasonography is of limited utility for determination of the site of disruption in the urinary tract . The ureters are difficult to image sonographically due to their small size although they may be imaged as they enter the urinary bladder.…”

“…The urinary bladder is best imaged when it is moderately full so that the bladder wall and lumen may be evaluated. Patients with urinary tract leakage may have a collapsed, empty urinary bladder, exhibiting a thicker wall and reduced definition . The entire urethra can be evaluated via ultrasonography; however, due to interference by the pubic bones, a transrectal approach is necessary for assessment of the caudal portion of the urethra, which may or may not be feasible…”

“…A more recent use of ultrasound to evaluate bladder rupture incorporates the use of a microbubbled sterile saline solution . One study reported the prospective use of contrast cystosonography in 2 dogs with ascites from suspected bladder rupture.…”