What you need to know about stone removal options:
4) How many?
- Abdominal radiographs: what, where and how many.
- Abdominal ultrasound: ensure if there are upper urinary tract stones that no pyelectasia or ureteral obstructions are noted.
- Urinalysis and urine culture:
- For the what: stone type?
- UA helps us to ensure we are diluting the urine and maintaining appropriate pH for stones we are managing
- Cultures are important throughout dissolution and as maintenance
- Basic blood work prior to anesthesia, and to rule out any hepatic dysfunction if suspected
Options for removal of Cystoliths and Urethroliths:
- Failure to remove 14-20% of stones radiographically has been consistently reported.1,2
- This may contribute to high stone recurrence or 25-60%.3,4
- Scrotal or perineal urethrostomy
- Hemorrhage, urine leakage, bruising, stricture formation and chronic urinary tract infections
Minimally invasive options:
- Voiding urethrohydropulsion (VUH):
- When and who: Stones < 2-3mm in male dogs and <3-5mm in females
- No incision as removed with transurethral voiding
- Short procedure: approximately 15 minutes
- PCCL (percutaneous cystolithotomy): see diagram below for details
- Who: ANY sized dog or cat, bladder and/or urethra
- When: several or large stones
- 1.5cm incision, home same evening as procedure
- 100% stone removal as the entire tract is visualized and magnified with scope. 5
- No residual fragments, no mucosal damage, less suture material for stone nidus formation.
- Intracorporeal lithotripsy and Endoscopic basket removal:
- Who: Male dogs > 7Kg, NO male cats
- When: For small and low numbers of stones, bladder and/or urethra.
- Anesthesia can be prolonged, urethral irritation
- No incision, >8% urolith remain, home the same day 6,7,8
- Important: We recommend lateral radiographs every 3 months and close assessment of any historical urinary tract infections and urinalysis.
- This follow-up regime is essential to catching any stone recurrence when small enough to manage minimally invasively.
- Diet, water, water, water
- Specified therapies for various stones: K+citrate, Vitamin-B6
1. Bevan JM, Lulich JP, Albasan H, et al. Comparison of laser lithotripsy and cystotomy for the management of dogs with urolithiasis. J Am Vet Med Assoc 2009;234:1286–1294.
2. Grant DC, Harper TA, Werre SR. Frequency of incomplete urolith removal, complications, and diagnostic imaging following cystotomy for removal of uroliths from the lower urinary tract in dogs:
128 cases (1994–2006). J Am Vet Med Assoc 2010;236:763–766.
3. Brown NO, Parks JL, Greene RW. Recurrence of canine urolithiasis.J Am Anim Hosp Assoc 1977;170:419–422.
4. Lulich JP, Osborne CA, Thumchai R, et al. Management of canine calcium oxalate urolith recurrence. Compend Contin Educ Pract Vet 1998;20;178–189.
5. Runge, JJ, Berent, AC, Mayhew, PD, Weisse, WC. Transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi in dogs and cats: (27cases: 2006-2008).
6. Defarges, A. Dunn, M. Use of electrohydraulic lithotripsy in 28 dogs with bladder and urethral calculi. J Vet Intern Med 2008;22:1267-1273.
7. Adams, LG, Berent, AC, Moore, GE et al. Use of laser lithotripsy for fragmentation of uroliths in dogs: 73 cases (2005-2006). J Am Vet Med Assoc. 2008;232:1680-1687.
8. Lulich JP, Osborne, CA, Albasan, H. et al. Efficacy and safety of laser lithotripsy in fragmentation of urocystoliths and urethroliths for removal in dogs. J Am Vet Med Assoc. 2009;234:1279-1285.