dog with a shunt - on the wrong diet and why incontinent after urethrostomy?

Re: dog with a shunt - on the wrong diet and why incontinent after urethrostomy?

scatty — Sun, 24 Mar 2013 14:42:10 GMT

Thanks a lot for all your responses so far.

Richard: No cystotomy done as of yet as we did not enter the abdominal cavity on this surgery......

Andrew: He is actually on the hepatic wet diet little and often. His owners normally give 3-4 meals a day. His urine came back with a clear result on culture and nothing else abnormal on the urine.

JHL: I agree that ignoring the testicle problem will not make them go away! So I will look into options for him...........

Re: dog with a shunt - on the wrong diet and why incontinent after urethrostomy?

james herriot lied — Sun, 24 Mar 2013 13:20:07 GMT

Honest answer? I think you're pushing water uphill, and are likely to continue through these kinds of crises for the rest of the dog's life as things currently stand. Medically, you'll get some brilliant answers on here from much cleverer people than me and many of them will have vast experience of shunts; always worth listening to.

But you have a condition which you're not curing, only managing. And so it's not your fault when there are occasional mishaps: the owners have put the kibosh on you by opting for a continuous long-term conservative approach, and as time goes on your stress levels will rise in proportion to the increasing difficulties that you face.

The owners don't like anaesthetics, but this is based on a gut feeling that they have, that an anaesthetic is intrinsically risky for the dog, and more so than trying to ameliorate the effects of the shunt. You've shown them that the dog can tolerate an anaesthetic, and also that there are consequences to the approach that they have chosen, one of them being painful urolithiasis and surgery. Additionally, you might be getting some problems with the testes: it could be a simple BPH, or there may be some growths occuring - but until you fish them out with a fairly straightforward procedure, you won't know.

Now might be a good time to discuss the next steps: going back to that venogram, and fishing those testicles out. Would you be up for doing the venogram in house, at the same time as the castration? Provided that it's an extra-hepatic shunt (which it will be), get talking to some referral surgeons - there are masses of them around these days, so costs aren't necessarily that high.

After nearly 20 years of GP practice, I can't always comment on the newest techniques. But I do know where most of my stress comes from, and it's from the restrictions placed on me by (often well-meaning) clients. I have no critiques for you, but I can see a path out of where you are.

Don't worry about dribbling urine right now - that urethra may well be in tatters and needs time to heal. Certainly, don't think about trying to tighten the USMI just yet. And I agree, feeding several times a day is much more important than fancy diets.

Get the owners onside, and you could potentially cure all of this dog's problems (other than the conformational ones....). Take charge!

Re: dog with a shunt - on the wrong diet and why incontinent after urethrostomy?

Andrew Kent — Sun, 24 Mar 2013 10:23:32 GMT

If you can stop the dog from being ammonaemic then you should stop stone formation, how often a day do they feed the dog? Often people use hepatic diets as an excuse to feed them less frequently when this is more important than diet type. We tend not to use hepatic diets, but use highly digestible GI diets instead and feed them 3-4 small meals a day, so that there is less for the liver to deal with at each moment.

have you cultured the urine? UTIs are very common in dogs with shunts and could be resistant to the antibiotic the dog is on if it has been on it long term. Is the rest of the urinalysis normal?

Andy

Re: dog with a shunt - on the wrong diet and why incontinent after urethrostomy?

Richard Carter — Sun, 24 Mar 2013 09:53:34 GMT

Hi - not an expert but not aware that diet modification does much for urate crystal formation. Looking in the text book, refers to stones developing in acid urine so the usual LUTD diets no good. Re the surgery and the incontinence - depends on length of time blocked, how much damage the urolith caused and whether there are still fragments of stone in the urethra as new stones may still be being formed and of course the possibility that the prostate is now a complicating factor. If muscles, nerves etc all ok, should regain control 1 - 2 weeks.

Was a cystotomy done to remove the other stones mentioned? If not, perhaps castration can be done at same time?