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

Abstract

Objective: To review current literature regarding uroabdomen in dogs and cats with respect to etiology, diagnostic approach, medical and surgical treatment, and prognosis.

Etiology: Uroabdomen in dogs and cats is most often associated with vehicular or blunt trauma. This condition may also result from urinary tract obstruction, traumatic bladder expression or catheterization, neoplasia, and postoperative leakage following abdominal or urogenital surgery.

Diagnosis: Disruption to the urinary tract should be considered when a patient is diagnosed with azotemia, hyperkalemia, and abdominal effusion. By comparing the creatinine concentration of the abdominal fluid to the serum or plasma creatinine concentration, a diagnosis of uroabdomen can be made if the creatinine ratio is ≥2:1. In most patients imaging studies with contrast are necessary to identify the exact source of urine leakage and to determine therapeutic options.

Therapy: Uroabdomen is a medical emergency, not a surgical emergency. Acute management involves stabilization of the patient with IV fluid therapy and treatment of hyperkalemia. Urinary diversion and, in some cases, peritoneal dialysis are necessary to stabilize the patient until life-threatening conditions such as hyperkalemia or concomitant injuries such as pulmonary contusions resolve. Once the patient is stable for anesthesia, surgical repair, if indicated, may be performed.

Prognosis: The prognosis of patients with uroabdomen depends on the extent of urinary and nonurinary injuries as well as the development of complications. Potential complications include dehiscence or urine leakage following surgical repair of the urinary tract, urosepsis, unresolving azotemia secondary to renal damage or underlying renal insufficiency, or stricture formation in the urinary tract.