Diagnosing and Treating Canine Incontinence and Uroliths
•
0 likes•863 views
Alison Khoo, BSc, BVMS, DACVIM (Internal Medicine) Urinary incontinence is a common presenting complaint in veterinary practice. Treatment of refractory cases may become a major source of frustration for both owners and veterinarians. Medical, surgical, and interventional therapeutic options will be discussed.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Diagnosing and Treating Canine Incontinence and Uroliths
Similar to Diagnosing and Treating Canine Incontinence and Uroliths (20)
More from upstatevet
More from upstatevet (20)
Recently uploaded
Recently uploaded (20)
Diagnosing and Treating Canine Incontinence and Uroliths
- 1. DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 2. WWW.UVSONLINE.COM Urinary Incontinence Problem with storage vs. problems with voiding USMI: diagnostic and treatment options Ectopic ureters: diagnostic and treatment options Urinary stone disease: Case examples LECTURE OUTLINE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 3. WWW.UVSONLINE.COM Problems with storage Bladder overactivity Bladder atony Problems with voiding Increased outlet resistance Reflex dyssynergia Decreased outlet resistance URINARY INCONTINENCE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 4. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 5. WWW.UVSONLINE.COM Bladder overactivity Presenting signs: PU, pollakiuria, inappropriate urination Disease examples: cystitis (bacterial, cyclophosphamide induced, idiopathic, urocytolithiasis) Tx: address underlying cause/ relax bladder with oxybutynin/ propantheline PROBLEMS WITH STORAGE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 6. WWW.UVSONLINE.COM Bladder atony Presenting signs: patients do not posture to urinate / do not completely empty bladder Neurogenic vs. myogenic Tx: bethanecol +/- metoclopramide (only if urethral sphincter is relaxed) PROBLEMS WITH STORAGE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 7. WWW.UVSONLINE.COM Increased outlet resistance Increased bladder pressure leaking of urine through or around obstruction Presentation: dribbles urine with full bladder + unable to void completely Examples: urethral stone/ mass, urethral spams, neurogenic increase in urethral sphincter tone, prostatic disease Management: relieve obstruction, relax the urethra (phenoxybenzamine/ prazosin/ diazepam), urethral stenting PROBLEMS WITH VOIDING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 8. WWW.UVSONLINE.COM Reflex dyssynergia Large breed male dogs Presents: disrupted stream of urine or normal stream that stops midway even though urinary bladder still contains urine Commonly idiopathic (can be seen with UMN disease) Tx: a-adrenergic antagonists/ diazepam/ intermittent catheterization/ urethral stent PROBLEMS WITH VOIDING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 9. WWW.UVSONLINE.COM Decreased outlet resistance USMI, ectopic ureters PROBLEMS WITH VOIDING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 10. WWW.UVSONLINE.COM Largely condition of FS dogs May precede OVH ~20% of female dogs will develop USMI 2.9 yrs (mean) after OHE after 1st heat (range: immediate to 12 yrs) Dogs >20kg more likely to be affected 50% less common in females that are spayed before first heat (but incontinence was worse) PRIMARY SPHINCTER MECHANISM INCOMPETENCE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 11. WWW.UVSONLINE.COM Leakage when sleeping/ resting No urgency unless concurrent UTI Definitive dx based on UPP USMI 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 12. WWW.UVSONLINE.COM Goal: increase urethral smooth muscle and internal urethral sphincter tone Sympathomimetics Alpha agonists: PPA (results in continence in 50-86% of patients) Estrogen replacement therapy Estriol (incurin), diethylstilbestrol Increases a-adrenergic receptor responsiveness + improves urethral vascularity USMI: MEDICAL MANAGEMENT 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 13. WWW.UVSONLINE.COM 1-1.5mg/kg PO BID to TID effectively controls incontinence in 74-92% of dogs May be less effective over time in some dogs If incontinence only occurs at night, the highest dose can be given before bedtime SE: restlessness/ mild behavioural changes Contraindications: systemic hypertension, marked renal/ cardiac disease Monitoring BP: baseline, 1 week, 1 months, 3 months and PHENYLPROPANOLAMINE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 14. WWW.UVSONLINE.COM Increases the number/ sensitivity of a-adrenoreceptors in the urethra Relieves incontinence in 65-83% dogs DES: requires compounding, may cause signs of estrus Bone marrow hypoplasia has been observed with higher dose regimens of DES ESTROGENS 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 15. WWW.UVSONLINE.COM Colposuspension 33% continent in 1 year, 33% improved but not continent Short lived effect Cystopexy Urethropexy Ductus deferentopexy Transpelvic sling USMI: SURGICAL MANAGEMENT 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 16. WWW.UVSONLINE.COM Patient selection: Negative urine culture Failed/ intolerant of medical therapy +/- failed EU USMI: URETHRAL BULKING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 17. WWW.UVSONLINE.COM Risks/ complications: Material intolerance, abscess formation Bleeding, urethral obstruction Failure of continence Expectations: Benefit 10-18 months USMI: URETHRAL BULKING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 18. WWW.UVSONLINE.COM USMI: URETHRAL BULKING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 19. WWW.UVSONLINE.COM USMI: URETHRAL BULKING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 20. WWW.UVSONLINE.COM 68% success with collagen alone lasting a mean of 17 months 80-90% success in conjunction with medical management Barth et al. did not report urinary retention as a complication USMI: URETHRAL BULKING 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS Evaluation of long-term effects of endoscopic injection of collagen into the urethral submucosa for treatment of urethral sphincter incompetence in female dogs: 40 cases (1993–2000) Andrea Barth, Dr med vet; Iris M. Reichler, Dr med vet; Madeleine Hubler, Dr med vet; Michael Hässig, PD, Dr med vet, MPH; Susi Arnold, PD, Dr med vet
- 21. WWW.UVSONLINE.COM Silicone cuff with tubing SQ metallic infusion port with actuator tubing USMI: HYDRAULIC OCCLUDER 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 22. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 23. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 24. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 25. WWW.UVSONLINE.COM Should have cystoscopy 2 week prior to r/o EU Not done on same day to limit urethral inflamation Scoped again 6 week post op to document volume needed to achieve complete vs 25, 50 and 75% closure USMI: HYDRAULIC OCCLUDER 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 26. WWW.UVSONLINE.COM All dogs had significantly improved continence scores 92% completely continent when Os were compliant 33% did not require inflation to achieve continence Urethral obstruction occurred as complication in 3/18 dogs USMI: HYDRAULIC OCCLUDER 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 27. WWW.UVSONLINE.COM Most common congenital cause for urinary incontinence Male dogs rarely exhibit signs of incontinence Female: male ratio is 20:1 Incontinence is typically constant but can be intermittent 2/3rds of dogs have bacterial UTI and may not show typical signs of UTI ECTOPIC URETERS 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 28. WWW.UVSONLINE.COM 75-89% have concurrent USMI 45% have pelvic bladder/ short urethra 93% have persistent paramesonephric remnant 64-80% have pyelonephritis and cystitis ECTOPIC URETER 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS Burdick et al.
- 29. WWW.UVSONLINE.COM Abdominal ultrasound Useful to exclude the diagnosis of ectopic ureter if normal jets of urine are observed CT scan Sensitivity of 90-100% (biased?) Urethrocystoscopy imaging method of choice to prove the presence of ectopic ureter and identify the termination point in the urethra Identifies other vestibular/ vaginal abnormalities Potentially therapeutic! ECTOPIC URETER: DIAGNOSIS 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 30. WWW.UVSONLINE.COM ECTOPIC URETER INTRAMURAL VS. EXTRAMURAL 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 31. WWW.UVSONLINE.COM Resect and reimplant extraluminal ureters +/- distal tract dissection Restoration of internal sphincter functional anatomy Diminished urinary stasis in the tunnel Decreased risk of re-canalization ECTOPIC URETER: SURGERY? 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 32. WWW.UVSONLINE.COM Post op: 30-78% persistent incontinence Better outcome for dogs <20kg Surgical complications Ureteral tear Stricture (~25%) Urinary leakage ECTOPIC URETER: SURGERY? 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 33. WWW.UVSONLINE.COM ECTOPIC URETER: LASER ABLATION 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 34. WWW.UVSONLINE.COM ECTOPIC URETER 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 35. WWW.UVSONLINE.COM Lymphoid follicular hyperplasia along laser line – self limiting Delayed laser reactions resulting in proliferative urethritis ECTOPIC URETER: COMPLICATIONS 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 36. WWW.UVSONLINE.COM Re-canalization SMI (up to 89% dogs in 1 study) Poor vaginal conformation Pelvic bladder/ short urethra Recurrent UTI ECTOPIC URETER: PERSISTENT INCONTINENCE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 37. WWW.UVSONLINE.COM 77% fully continent 47% with laser ablation alone 57% with laser + meds 63% with laser + meds + collagen ECTOPIC URETER: OUTCOMES 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 39. WWW.UVSONLINE.COM 2.5 yo Female Spayed Poodle Routine vaccine visit, not fasted CBC + chem unremarkable UA: USG >1.040, no proteinuria/ pyuria, no blood, marked struvite crystals, urine pH 8 CASE 1 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 40. WWW.UVSONLINE.COM 5 year old female spayed Labrador Retriever Hx: Stranguria, hematuria, pollakiuria CBC + chem unremarkable UA: USG: 1.020, pH >7.5, marked cocci CASE 2 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 41. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS CASE 2: RADIOGRAPH
- 42. WWW.UVSONLINE.COM Surgery? Medical dissolution? CASE 2: WHAT NEXT? 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS Surgery?
- 43. WWW.UVSONLINE.COM Appropriate if stone is not obstructing Diet change Reduces urine pH Decreases the amount of urea available for urinary bacterial conversion to ammonium Magnesium and phosphorus restricted Facilitates diuresis 4 weeks beyond radiographic resolution Antibiotics At least 2 weeks beyond radiographic resolution (guided by urine culture) Encourage polyuria CASE 2: DISSOLVING STONES 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 44. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 45. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 46. WWW.UVSONLINE.COM Look for structural and functional risk factors for UTI and address them Urine should be cultured monthly for 2-3 months and then as clinically indicated based on clinical signs and patient risk factors Foods marked to tx struvite uroliths will not prevent recurrence (may delay/ minimize urolith burden) Urine sediment evaluation and pH monitoring are not suitable diagnostic substitutes for urine cultures MINIMIZE RECURRENCE OF INFECTION INDUCED STRUVITE UROLITHS 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 47. WWW.UVSONLINE.COM 8 yo MN Miniature Schnauzer Dysuria, stranguria, hematuria BW unremarkable UA: USG: 1.030, pH 6, no bacteria, 2+ protein, 3+ blood CASE 3 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 48. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 49. WWW.UVSONLINE.COM Surgery? Urine culture? Medical dissolution? CASE 2: WHAT NEXT? 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS Surgery?
- 50. WWW.UVSONLINE.COM Will NOT dissolve Options: Traditional: surgery cystotomy, ureterotomy or nephrotomy Minimally invasive percutaneous cystolithotomy CALCIUM OXALATE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 51. WWW.UVSONLINE.COM Combines cystic and urethral stone retrieval for any size, sex or species Should be avoided in the face of an active UTI Unable to flush abdomen before closure PERCUTANEOUS CYSTOLITHOTOMY (PCCL) 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 52. WWW.UVSONLINE.COM PCCL 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 53. WWW.UVSONLINE.COM PCCL 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS Berent et al, JAVMA
- 54. WWW.UVSONLINE.COM Runge et al, 2011 reported <3% of patients had stone fragments found on post op rads Advantages: Superior visualization of urinary tract from bladder to urethra (decreased risk of leaving stones behind) Smaller incision, less suture, reduces risk of infection Same day discharge Less bladder trauma PCCL PROGNOSIS 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 55. WWW.UVSONLINE.COM Identify intrinsic risk factors Disorders that cause hypercalciuria should be addressed Primary hyperPTH Idiopathic hypercalcemia in cats hyperadrenocorticism MINIMIZE CALCIUM OXALATE UROLITH RECURRENCE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 56. WWW.UVSONLINE.COM Diet High moisture foods/ add water to kibble Aim for USG <1.020 in dogs and <1.030 in cats Avoid diets that promote urine acidification High amounts of animal protein Feeding high sodium diets? Short-lived benefit MINIMIZE CALCIUM OXALATE UROLITH RECURRENCE 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 57. WWW.UVSONLINE.COM Lulich, Berent et al. 2016. ACVIM small animal consensus recommendations on the treatment and prevention of uroliths in dogs and cats. JVIM Applegate, Olin et al, 2018. USMI in dogs: A update. JAAHA Runge, Berent et al., 2011. Transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi in dogs and cats. JAVMA Owen et al. 2019. Ureteral ectopia and urethral sphincter mechanism incompetence: an update on diagnosis and management options. JSAP Barth etl al. 2005. Evaluation of long term effects of endoscopic injection of collagen into the urethral submucosa for treatment of USMI in female dogs. JAVMA Berent et al. 2012. Evaluation of cystoscopic-guided laser ablation of intramural ectopic ureters in female dogs. JAVMA REFERENCES 10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS
- 58. WWW.UVSONLINE.COM10/17/2020DIAGNOSIS AND TREATMENT OF CANINE INCONTINENCE AND UROLITHS QUESTIONS?
Editor's Notes
- SNS: Hypogastric nerve stimulates detrusor beta receptors, causing relaxation of the detrusor muscle SNS stimulates alpha 1 receptors of the bladder neck and internal urethral sphincter causing smooth muscle contraction and closure of the urethra to urine outflow As bladder fills, stretch receptors in the detrusor muscle mediate sensory info to the brain via hypogastric and pelvic nerves PSNS pelvic nerves tells detrusor muscles to contract. Sympathetic input to the internal and external urethral sphincter is inhibited resulting in relaxation of smooth muscle of the internal urethral sphincter and striated muscle of the external sphincter. The skeletal muscle portion of the urethral sphincter is controlled by the pudendal nerve
- Bladder overactivity occurs due to hyperexcitaility of the storage phase. This results in an inability to permit adequate bladder filling. Drugs listed decrease detrusor activity and have urethral antispasmodic effects Cystitis- oxybutynin, NSAIDS, pentosan sulfate Oxybutynin -contraction of the smooth muscle of the bladder is stimulated by the release of acetylcholine by the nerves within the bladder . Oxybutynin suppresses involuntary contraction of the bladder's smooth muscle by blocking acetylcholine release. It also directly relaxes the bladder's outer muscle layer. Propantheline- anticholinergic (antimuscarinic) Amitryiptyline- has anticholinergic and anti-inflammatory properties- can be used for repeat offenders. Tricyclic antidepressants such as amitriptyline may help improve bladder storage.
- Neurologic causes such as LMN injury including the sacral spinal segments S1-S3 will cause overflow incontinence. This occurs when the pressure in the bladder exceeds the weak urethral sphincter, resulting in constant dribbling. Pelvic n. damage causes a lack of conscious sensation of bladder filling and detrusor muscle relaxation. Perineal reflex and sensation is decreased. The bladder is usually easily expressed but can persist due to internal sphincter tone (hypogastric innervation) UMN injuries can disrupt coordination and can cause increased urethral tone/ overactive bladder. Vs LMN bladder- overflow incontinence Non neurologic causes would include any cause of urethral obstruction- uroliths, urethral plugs. Neoplasia, prostatic disease etc.
- Lack of coordination between bladder contraction and urethral relaxation during mitritition
- Urethral pressure profilometry
- OVER HALF of dogs treated with regular PPA that failed to respond, became continent when treated with sustained release PPA.
- PPA dosed BID to TID vs. DES dosed SID for 3-5 days then EOD to lowest effective dose Incurin is dosed per dog not per weight
- Cystoscopic guidance Injection into peri-urethral submucosal tissue via cystoscope Goal is to close urethra down as much as possible
- Barth et al.: 10/40 improved and 6/10 continence achieved with oral meds
- Ring is placed around urethra and closed with suture SQ metallic infusion port with actuator tubing Actuating tubing (black arrows) is connected onto the adaptor of the infusion port and the blue cuff (white arrowheads) is advanced to cover this junction
- Male dogs have a longer distal urethra that could allow for continence despite more proximal termination of the ectopic ureter- will present later (3 yo vs. 6 mo)
- CT studies that showed accuracy of 100% excluded studies with poor contrast filling and reviewers were aware that all dogs in the study had at least one ectopic ureter Disadvantage of scope- unable to examine upper urinary tract
- Intramural ectopia= >95%
- ntramural ectopic ureter is treated by ligation of the distal submucosal ureteral segment and creating a new ureteral opening in the trigone of the urinary bladder (neoureterostomy and urethral-trigonal reconstruction); however, incontinence persists commonly (44–67%) because the intramural segment of ureter disrupts the functional anatomy of the internal urethral sphincter mechanism Sx is tx of choice for extramural EU- complication rate is high and they are at risk of Developing hydroureter due to mucosal edema, or stricture formation
- Endoscopic images of a dog with ectopic ureters. The dog is in dorsal recumbency during a cystourethroscopy. A) The left ectopic ureteral opening is visualized inside the urethral lumen (yellow asterisk). B) An open-ended ureteral catheter is placed inside the ectopic ureteral lumen (black arrow). C) A diode laser (red arrow) is cutting the medial ureteral wall over the ureteral catheter (black arrow) to advance up the neo-ureteral orifi ce to the bladder lumen. D) The neo-ureteral orifi ce is now inside the urinary bladder lumen (yellow asterisk). A guidewire (black arrow) is still inside the ureteral lumen.
- Other complications: Perforation of urinary tract Hemorrhage recanalization
- Endoscopic images with the dog in dorsal recumbency after the cystoscopic-guided laser ablation procedure. The top image shows a thick vaginal band (persistent paramesonephric remnant) pulling the urethral orifi ce open. This band splits the vaginal opening into two compartments. The middle image is the remnant of the vaginal band after it is laser-ablated with a diode laser. This band went all the way back to the cervix and was completely cut down with the laser to the level of the cervix seen here. The bottom image is the vaginal (bottom) and urethral orifi ce (top) after thepersistent paramesonephric remnant is lasered open showing an open vagina. It is hypothesized that the VV segment remnant can cause persistent UTIs or incontinence by anchoring the urethral orifice in an open position or pooling of urine in the vagina.
- Continence rates are better in male dogs and up to 100% with laser ablation
- Struvite crystals are significant in dogs when they are infected with a urease producer- usually staph/ proteus/ enterococcus. Affected dogs usually have signs of a UTI s and you would expect bacteriua/ pyuria or both. Cystralluria without uroliths does not require treatment and crystalluria without stones should not cause clinical signs. Struvite crystals are normal in normal dogs with concentrated urine and can precipitate if urine cools down- so on a freecatch that an O brings in.
- The average duration of dissolution therapy in dogs is 3 to 3.6 months, with a range from 2 to 5 months The duration of therapy is individualized to the patient. Larger calculi have a reduced surface area relative to small calculi and therefore take longer to dissolve When dissolution dietary compliance cannot be achieved, using urinary acidification with D-L methionine could be considered. A recent abstract demonstrated efficacy at 100 mg/kg PO q12h when given with appropriate antibiotics even when diet was not changed
- 1 month of diet + ab
- 2 months later
- Bladder apex is grasped atraumatically with forceps and brought to the level of incision. 3 stay sutures are placed in the apex using 3-0 polydioxanone Stab incision is made in bladder lumen and an endotip screw trocar inserted into the bladder lumen , angled towards the urethra. The cap is unscrewd from the trocar and the urine is trained with a pool tip suction A urinary catheter is placed and used to irrigate the bladder and urethra
- For larger stones, a stone basket is used to grab the stones out the trocar At this point we may only be able to do middl to large female dogs (no flexible scope)