PRACTICAL TASK - MANUAL BLADDER EXPRESSION 

1. Gather together the equipment required:
   
   • Receptacle to collect the urine.
   • Protective apron and gloves.
   • Sterile sample pot if a urine sample is required for analysis.
   • Disinfectant and cloth for mopping up any spills.
   • Mild antiseptic to clean the patient afterwards.
   • Assistant to restrain the animal.
2. Put on the protective apron and gloves.
3. Reassure the patient.
4. Ask an assistant to restrain the patient in a standing position or in lateral recumbency. A conscious dog is likely to tolerate the procedure better standing up.
5. Put the urine collection container in place. You can lay down newspaper or polythene to protect the floor if available.
6. Gently palpate the bladder; it is situated medially in the caudal abdomen anterior to the pelvic brim. It may be intrapelvic in dogs with a short urethra. Remember that the bladder needs to be moderately full before performing this task.
7. Having established the position of the bladder and ensured that it is reasonably full, apply gentle pressure steadily and firmly from either side directed backwards towards the urethra. Never use force as this can result in rupture.
8. If a sample is to be collected for urine analysis, this should be collected mid-stream to avoid contamination with mucus or epithelial cells from the urethra, vulva or prepuce. Remember that boric acid is the preservative for bacteriology.
9. You might be asked to state reasons for performing manual bladder expression:
   
   • To assist a hospitalised patient reluctant to urinate in a strange environment.
   • To ensure that the bladder is empty prior to surgery.
   • To collect a urine sample for analysis.
   • To assist a recumbent patient with neurological damage. N.B. An animal with a suspected urinary tract blockage is best catheterised or relieved by cystocentesis as manual bladder expression could result in rupture.
10. You may also be asked about other methods of bladder emptying and when it would be appropriate to use these techniques:
    
    • Micturition (Free flow) - Natural urination.
    • Catheterisation - Commonly used in cats with urolithiasis; the catheter provides a patent route from the bladder to the urethral opening to reduce the risk of repeated blockage. Catheters may also be used to introduce contrast media in radiographic studies.
    • Cystocentesis (Supra-pubic puncture) - Aspiration of urine via a 23g needle inserted at a 45° angle through the abdominal wall. This is surprisingly well tolerated, and is a useful first aid measure since sedation or anaesthesia are not normally required.