Minimally Invasive Stone Removal from the Lower Urinary Tract

What you need to know about stone removal options:

1)    Who?

2)    Where?

3)    What?

4)    How many?

Diagnostics required:

  • 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:

Traditional:

  • Cystotomy:
    • 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
  • Urethrotomy:
    • 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

Post-operative management:

  • 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

Minimally Invasive Stone Removal from the Lower Urinary Tract

For more information, please contact our Internal Medicine Department at (310) 558-6100.

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References:
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.

Locations

South Bay

2551 W. 190th St., Torrance, CA 90504

Tel: (310) 320-8300 - Fax: (424) 293-7254

Los Angeles

9599 Jefferson Blvd., Culver City, CA 90232

Tel: (310) 558-6100 - Fax: (310) 558-6199

San Fernando Valley

20051 Ventura Blvd., Woodland Hills, CA 91364

Tel: (818) 887-2262 - Fax: (818) 704-0323

Central Valley

4300 Easton Drive, Bakersfield, CA 93309

Tel: (661) 281-1320 - Fax: (661) 302-4193

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