Bladder stones

RE: Bladder stones

Rob Davis — Thu, 31 Dec 2015 10:19:50 GMT

[quote user="Eamon McAllister"]

Urohydropropulsion? I tried it a few times in bitches and was amazed at the size of the stones that I managed to expel. If she is voiding them already then I will say that this technique is well worth a try. J Am Vet Med Assoc. 1993 Sep 1;203(5):660-3. Nonsurgical removal of urocystoliths in dogs and cats by voiding urohydropropulsion. Lulich JP1, Osborne CA, Carlson M, Unger LK, Samelson LL, Koehler LA, Bird KA. Author information 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul 55108. Abstract A technique called voiding urohydropropulsion has been developed that facilitates nonsurgical removal of urocystoliths. Voiding urohydropropulsion was performed in 11 dogs and 10 cats with urocystoliths. Urocystoliths were completely removed from 15 of 21 animals (5 female dogs, 3 male dogs, 5 female cats, and 1 male cat). The number of uroliths removed from any animal varied between 1 and 983. The mean time required to complete voiding urohydropropulsion in the 15 animals from which all uroliths were completely removed was 22 minutes. In 6 animals (2 female dogs, 3 female cats, and 1 male cat), not all urocystoliths were removed. Visible hematuria was induced in all animals as a consequence of voiding urohydropropulsion. In dogs, visible hematuria resolved within 4 hours. Dysuria was not induced by this technique in dogs. In many cats, visible hematuria and dysuria persisted for 1 to 2 days. One male cat developed urethral obstruction after we failed to remove a urolith from the bladder. The urolith was returned to the urinary bladder, and subsequently removed by cystotomy. Voiding urohydropropulsion is a simple and effective method that should be considered for removal of small urocystoliths from dogs and cats before cystotomy is performed.

[/quote]

I went to a lecture by Jody Lulich at BSAVA congress several years ago where he described urohydropropulsion. I clearly remember him grinning and saying "If you're not getting wet, you're not having fun!". I have used this several times and have been amazed how well it works. Females are easier (and can pass surprisingly large stones) and less messy than males!

He also wins the prize for the coolest thing I've ever seen in a veterinary lecture - laser lithotripsy. Scope with laser attachment inserted into urethra, see big spikey stone, aim and fire, stone obliterated.... it was like destroying the death star....

RE: Bladder stones

Gillian Mostyn — Tue, 29 Dec 2015 17:49:23 GMT

[quote user="Anthony Todd"]I't's going to take ages to dissolve bladder stones with diet, if ever[/quote]

I find myself agreeing with Anthony!

I'd go further and say that I think that leaving this dog with bladder stones is cruel. Anyone who's ever has a serious dose of cystitis would be likely to agree!

Seriously...I think.these owners are clouding your judgement. Their financial issues are regrettable...and have led to the heart problem going uninvestigated and untreated. However, if the dog needs surgery (which I think it does) then it needs surgery, heart problem or not. I'd compare this situation to those owners who know their pets have awful teeth and live in constant pain...but the owners say 'but Fido is old so we don't want to give him a GA.' Those clients don't get far with that line in my consulting room!

Good luck though, with whatever you do.

RE: Bladder stones

Anthony Todd — Tue, 29 Dec 2015 17:10:04 GMT

[quote user="Lucy Fleming"]The problem is (and bear with me, I am by no means a cardiologist!) what that mechanical/ hydraulic problem has done to the plastic/ adaptable myocardium - eg atrial enlargement etc. That abnormal tissue is then more prone to conduction abnormalities and arrythmias I believe.[/quote]

Yes but we [apparently] have an animal that is clinically and ostensibly normal so the effects you suggest would be noticed, I would have thought, during the suggested "walk in the park".

The pale membranes could well be chronic blood loss from the stones damaging the bladder wall, again apparently asymptomatic.

It's going to take ages to dissolve bladder stones with diet, if ever!

RE: Bladder stones

Lucy Fleming — Tue, 29 Dec 2015 16:08:43 GMT

[quote user="Anthony Todd"]

I would have thought an animal with an arrhythmia might under the action of anaesthetic drugs or premed but not with a mechanical/hydraulic problem?

And am I correct in supposing that a GA puts less demand on the heart than a walk in the park

[/quote]

The problem is (and bear with me, I am by no means a cardiologist!) what that mechanical/ hydraulic problem has done to the plastic/ adaptable myocardium - eg atrial enlargement etc. That abnormal tissue is then more prone to conduction abnormalities and arrythmias I believe.

And while a GA would appear to be no 'extra' effort for the heart, changes in things like blood pressure/ systemic vascular resistance etc induced by pre-med or induction agents could lead to alterations in stroke volume and rate to try to maintain homeostasis/ cardiac output (*disclaimer, this is only what I can dredge from my memory in 5 mins between consults, and is, as you can see the sweeping-est of generalisations)

RE: Bladder stones

Anthony Todd — Tue, 29 Dec 2015 15:33:51 GMT

[quote user="Robin Grimmer"]I'm just worried it will decompensate under GA, or have a fatal arrhythmia. [/quote]

Why would an animal with a flow murmur decompensate or have fatal arrhythmia under GA?

I would have thought an animal with an arrhythmia might under the action of anaesthetic drugs or premed but not with a mechanical/hydraulic problem?

And am I correct in supposing that a GA puts less demand on the heart than a walk in the park?

Just asking.

RE: Bladder stones

Robin Grimmer — Mon, 28 Dec 2015 23:04:43 GMT

Yes, it's a reasonable idea. However, it's the anaesthesia I'm worried about rather than the surgery and I could probably do the surgery in a similar time to the hydropropulsion and am more familiar with it. Normally I would have no hesitation with surgery.

I'm seeing the dog again tomorrow. If it's coping with the bladder stones I'll probably hang fire til I get the stone analysis back and cross fingers that it's struvite and I can dissolve it with diet.

RE: Bladder stones

Andrew Kent — Mon, 28 Dec 2015 19:31:31 GMT

[quote user="Robin Grimmer"]

[quote user="Eamon McAllister"]

[/quote]

I've used this technique in male dogs to flush urethral stones (usually stuck at the os penis) back in to the bladder and then done a cystotomy. You put the catheter in the distal urethra, then occlude the proximal urethra by inserting a digit in the rectum and pressing down. Attach a syringe and build some pressure, then release the pressure by relaxing your digit up the rectum, and the sudden release in pressure causes the stone to go back up in to the bladder.

How do you do this in bitches to flush stones from the bladder out?

[/quote]

the flushing back into the bladder is retrograde hydropulsion.

Urohydropulsion involves sedating or anaesthetising dog, passing urinary catheter and filling bladder with fluid then holding the dog in a vertical position and applying pressure over the bladder. It's hard work (especially for the holder) but the aim is that gravity puts the stones into the bladder neck and they are carried out as you express the bladder.

I I have used it to good effect in small female dogs with small stones so agree it is another option.

Andy

RE: Bladder stones

Robin Grimmer — Mon, 28 Dec 2015 18:33:13 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]Here's where it gets tricky.[/quote]

Is an asymptomatic murmur actually going to make surgery or an anaesthetic more risky?

The animal copes, asymptomatically, with normal life and I've always thought that a GA, on full O2 and minimal metabolic demand, is less stressful, with lower cardiac demand, than a walk in the park.

Does a loud murmur actually diminish cardiac output that much? Surely if it did the dog would be exercise intolerant or have an existing cardiac cough?

Sooner or later, with the stones in situ, there will be other complications, as well as the current haematuria.

I can't see the benefit to the dog of having the murmur investigated, frankly, I mean what would it tell you which will benefit the [asymptomatic] dog.

I seem to remember there was a survey done on racing greyhounds that showed the positive correlation between the loudness of murmurs and the dogs' performance.....

Wouldn't the dog have a happier Xmas without a bladder full of rocks?

PS Don't discuss it with the owner until about the 27th or you'll be at the practice today, from about 2 to 4pm......!

[/quote]

I'm not convinced it is asymptomatic. It has quite pale mucous membranes, the murmur is much worse now than when we saw it as a puppy. (We haven't seen it since then). Quite honestly, I wouldn't trust these owners to know if it is normal or not. I'm just worried it will decompensate under GA, or have a fatal arrhythmia. I'm hoping it's a dissolvable stone, but Andy is probably right, more likely to be oxalate.

RE: Bladder stones

Robin Grimmer — Mon, 28 Dec 2015 18:29:18 GMT

[quote user="Eamon McAllister"]

[/quote]

How do you do this in bitches to flush stones from the bladder out?

RE: Bladder stones

Hannah Wynne Richards — Sat, 26 Dec 2015 08:57:46 GMT

How do you perform voiding urohydropulsion?

With the greyhounds, it's probably similar to the resting heart murmur you sometimes find in horses - the consequence of bradycarfia induced by being super fit

Wynne

RE: Bladder stones

Anthony Todd — Fri, 25 Dec 2015 11:03:16 GMT