Leaving No [Bladder] Stone Unturned

July 17, 2013

The veterinarians at The Animal Medical Center attended to several canine patients last week – Chompers, Maxie and Theo – all of whom were suffering from bladder stones, technically called cystic calculi. Bladder stones form when the urine contains excess amounts of a substance, usually a mineral, such as calcium or phosphate. The cause of the excess can be due to diet, abnormal metabolism, a genetic defect, or most commonly, a urinary tract infection.

X-rays can be used to find some bladder stones. Below, you can easily see the four stones in poor Chompers’ bladder. His stones were easily found, but that is not always the case. For example, dogs with stones resulting from an abnormal liver blood vessel, or from the a very specific kidney abnormality of Newfoundland dogs, stones require identification through ultrasound testing.

stones1

Chompers has four bladder stones

The second patient, Maxie the Maltese, had several stones identified on an ultrasound performed because she was having accidents in the house. A urine sample was submitted to the lab, which showed an infection. Treatment with antibiotics was given to control the infection, but additional treatment will be necessary to remove the stones.

stones2

Ultrasound image of Maxie’s stones

Theo, a one year old Yorkshire terrier came to The AMC’s ER for blood in his urine. Because abnormal liver blood vessels and bladder stones are common in Yorkies, his surgeon performed an abdominal CT scan to investigate. The scan confirmed a half inch diameter bladder stone and an abnormal liver blood vessel. Both the stone and the abnormal blood vessel were corrected during surgery.

The bright white circle is a bladder stone resulting from a liver abnormality.

The bright white circle is a bladder stone resulting from a liver abnormality

Rock removal
The traditional method of removing bladder stones requires surgery, which is a procedure many general veterinarians routinely perform. Once the bladder is accessed via a skin incision, the bladder is opened and a scoop is used to remove the stones. After closure of the incisions, an x-ray is taken to ensure all stones have been successfully removed.

These days, there are as many methods of stone removal as there are stones in some bladders. Non-surgical methods sound easy, but calculolytic (stone dissolving) diets work for certain stones, called struvite. Urohydropulsion flushes small stones out of the bladder, but will not work if the stones are too large. Another method of non-surgical stone removal is lithotripsy. Bladder stones are pulverized using lasers, allowing the fragments to pass through the urine.

Minimally invasive methods of stone removal can also be used. These procedures require an endoscope which enters the bladder after passing through a skin incision.

Signs your pet may have bladder stones:

  • Accidents in the house
  • Bloody urine
  • Staining to urinate

If you see any of these, have your pet evaluated by your veterinarian immediately, because bladder stones make your pet uncomfortable and there is a risk of a urinary blockage if the stones lodge in the urethra.

All the treatments described above are available at The Animal Medical Center, including the minimally invasive procedures such as lithotripsy. If you suspect your pet may have bladder stones, our veterinarians are on site 24/7 to diagnose and treat your pet.


Urine Dribbling: Plugging the Leaking Dog

December 14, 2011

Willa came to The AMC today. Her owner was worried she might have diabetes because the dog bed was smelly and soaked with urine the last couple of mornings. Dogs with diabetes (and cats too!) will drink and urinate excessively, often having accidents in the house. When I questioned Willa’s owner, the “accidents” only happened when the dog was sleeping and there was no increase in water consumption or urinations. A quick test of the urine the owner brought with her dog determined diabetes was not the problem.

Causes of Urine Dribbling
Simple and complex disorders can lead to urination abnormalities in dogs. Infections, bladder stones and hormone problems are common causes of urine leakage and can readily be identified with routine blood tests, analysis of urine and x-rays. The x-ray to the right shows a dog with four large stones in its bladder. In some cases, a special diet will dissolve bladder stones. In this case, surgical removal of the stones resolved the urine dribbling.

In Willa’s case, testing showed no urinary tract infection, no stones and no blood test abnormalities. Because she is an older spayed female dog, I thought she might have “urethral incompetence.” Large breed, older, spayed female dogs are at risk for developing this condition, which may be related to a lack of estrogen in spayed female dogs and occasionally neutered males.

Treatments for Urine Dribbling
Commonly it is treated with medications including drugs to tighten the urethra (known as α-blockers), such as phenylpropanolamine, ephedrine or pseudoephedrine, or with estrogen replacement therapy using diethylstilbestrol. Recently, the Food and Drug Administration approved estriol for use in dogs.

If your dog resists taking medications, specialists at The Animal Medical Center can inject collagen into the urethral wall using special noninvasive endoscopic equipment to help narrow the urethral lumen and prevent urine dribbling. For refractory cases, AMC specialists also use a hydraulic urethral occluder.

Willa quickly responded to treatment with estrogen and once again has a dry bed in the morning. With all these options available to plug the leak, no dog should have to suffer with a stinky, wet bed.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit http://www.amcny.org. To make an appointment, please call 212.838.7053.


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