Tuesday, November 17, 2009

Toby's Bladder Stones

Toby is a five-year-old Yorkie whose owner noticed he had blood tinged urine after he had an "accident" in the house. Toby's owner immediately brought him into Friendship on emergency. besides being worried about the bloody urine, she was also alarmed that Toby had peed in the house, since he had never done this before. I assured her he most likely had a urinary tract infection, and submitted urine for analysis and culture. I then sent him home with a broad-spectrum antibiotic. Though the urinalysis results would be available the same day, we would need to wait three to five days for the culture to come back.

I had the urinalysis results back an hour later. There weer some inflammatory cells, which you can see with an infection, but no bacteria present. I advised Toby's owner to monitor his closely; if the signs continued and the culture was negative, Toby might have bladder stones, also known as uroliths. It was very important that she make sure he was able to pass urine. Since male dogs and cats have a narrow urethra compared with females, stones have a tendency to get stuck in this area. This creates a urinary blockage and requires emergent treatment.

When I called Toby's owner four days later with the negative culture results, she informed me that the bloody urine and accidents had not resolved with antibiotics. I had Toby come in immediately for an x-ray to see if any stones were present in his bladder. Sure enough, he had multiple bright white objects in his bladder consistent with uroliths. Luckily he was not obstructed and immediately surgery was not required.

Toby's owners had two options at this point. We could try switching his diet to see if the stones would dissolve. Alternatively, we could take him to surgery, remove the stones and submit them for analysis. His owners decided to go forward with surgery. I performed a cystotomy, entering the abdomen and making an incision in the bladder to remove the stones. Toby sailed through surgery and was able to go home the next day.

A few weeks later, the results of the stone analysis revealed that Toby had calcium oxalate stones. This was not great news, as this type of stone has a very high frequency of recurrence. Fifty percent of patients will have stones return within three years of initial diagnosis.

We started Toby on a prescription diet to alter the acidity of his urine and switched him from dry food to canned food. Thanks to its increased moisture content canned food would ideally create a more dilute urine. Toby's owners were instructed to take him out more frequently to prevent urine from sitting in his bladder too long.
Calcium oxalate stones are extremely frustrating for owners and veterinarians, give the high rate of recurrence and relatively ineffective means of prevention. The good news is that so far Toby hasn't had any more bladder stone episodes -- and he is very pleased with his new food.

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