Dietary dissolution of struvite stones

RE: Dietary dissolution of struvite stones

Anthony Todd — Fri, 06 Aug 2021 15:32:05 GMT

[quote userid="5726" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29927/dietary-dissolution-of-struvite-stones/231701#231701"] I just hope they stick with the urinary diet and follow-up this time![/quote]

Is that the basic low Mg++ diet? Will be difficult if on a high Mg++ diet. [ie cereal]

I don't think "infection" was even mentioned, let alone a cause in struvite cats??

RE: Dietary dissolution of struvite stones

KMurphy — Mon, 02 Aug 2021 17:26:36 GMT

These were the results from the few that we sent off:

Calculus Description

Number of Uroliths:- 3

Size:- 23mm x 14mm, 19mm x 11mm, 16mm x 13mm

Colour:- beige Surface:- smooth

Calculus analysis Identification Major Constituent:- 100% triple phosphate (struvite)

Dog is doing very well post-op and I just hope they stick with the urinary diet and follow-up this time!

RE: Dietary dissolution of struvite stones

Thomas Johnson — Mon, 02 Aug 2021 17:22:13 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29927/dietary-dissolution-of-struvite-stones/231307#231307"]I must admit, I remember learning at university that struvite was radiolucent and oxalate radiopaque but I wouldn't say that's been borne out in practice...[/quote]

Interesting, I remember being taught that struvite were the most radio-opaque, then oxalate, then cystine and with urate stones being the least radio-opaque.

RE: Dietary dissolution of struvite stones

Anthony Todd — Fri, 16 Jul 2021 11:15:53 GMT

Sorry to be thick, but if cats [ cockers I don't know] are on a low Mg++ diet AFAIK they don't get struvite crystals??

This has been the basis for FLUDT control since Jackson's work??

Hence all the fiddling with dried food additives to counter the highish Mg++ in cereal based foods.

RE: Dietary dissolution of struvite stones

Roland Bulkyn-Rackowe — Fri, 16 Jul 2021 10:45:03 GMT

I would say these do look like a few struvites I've seen. I usually proceed straight to surgery but I don't see a problem trying antibiotics and a dissolution diet and then surgery if concerned re obstruction.

RE: Dietary dissolution of struvite stones

niamhjl — Fri, 16 Jul 2021 07:47:17 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29927/dietary-dissolution-of-struvite-stones/231314#231314"]different from cats then???[/quote]

Yes. I said in my post above, that cats and cocker spaniels can get sterile struvite stones. In most breeds of dogs, the underlying cause will be UTI.

RE: Dietary dissolution of struvite stones

Anthony Todd — Thu, 15 Jul 2021 22:32:08 GMT

different from cats then???

RE: Dietary dissolution of struvite stones

Emily Rainbow — Thu, 15 Jul 2021 21:45:20 GMT

Yep - have a look at the ACVIM consensus on urolithiasis. If struvite these will be secondary to bacterial cystitis and will resolve with treatment of the infection. cystotomy is unnecessary unless there is evidence of blockage etc.

RE: Dietary dissolution of struvite stones

Anthony Todd — Thu, 15 Jul 2021 16:32:47 GMT

No views on low Mg++ diet with or without stone removal??? [that is if they are struvite for sure??]

RE: Dietary dissolution of struvite stones

Lucy Fleming — Thu, 15 Jul 2021 16:20:56 GMT

[quote userid="5726" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29927/dietary-dissolution-of-struvite-stones/231301#231301"]With regard to the composition, the dog had almost exactly the same presentation around 18months ago. Some of the stones (there were >50) were sent for analysis and were all struvite. [/quote]

I must admit, I remember learning at university that struvite was radiolucent and oxalate radiopaque but I wouldn't say that's been borne out in practice...

RE: Dietary dissolution of struvite stones

niamhjl — Thu, 15 Jul 2021 15:22:32 GMT

I had some CPD a couple of years ago where we were told that struvite stones in dogs almost always form due to chronic UTI - so urine culture and prolonged antibiotic treatment is important alongside the diet. As the stone dissolves, there will be bacteria embedded in the layers of the stone that will be released as it dissolves, so important to keep the antibiotics up until no radiographic evidence of stones anymore.

cats and cocker spaniels can get sterile struvite stones, but in pretty much any other breed, infection will be the root cause.

RE: Dietary dissolution of struvite stones

KMurphy — Thu, 15 Jul 2021 12:50:07 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29927/dietary-dissolution-of-struvite-stones/231293#231293"]I've no idea how long the whole process would take though, and I guess you would need to warn that as the stones shrink there is the risk that they reach just the right side to pass into the urethra and potentially lodge there. [/quote]

I did a little reading on this and, whilst often cited as a concern, it seems rarely to happen in practice. Even less so in a bitch, I would think. I do find that very interesting but don't think I would be brave enough to try it in a male dog for exactly that reason.

RE: Dietary dissolution of struvite stones

KMurphy — Thu, 15 Jul 2021 12:48:04 GMT

Thanks for the comments. Cost was a factor - it's a bigger upfront cost than repeat radiographs but I think the owners are coming round to repeat surgery now. With regard to the composition, the dog had almost exactly the same presentation around 18months ago. Some of the stones (there were >50) were sent for analysis and were all struvite. Urine pH is 7.5 so I'm thinking the same again this time.

Hopefully this time they'll stick with the recommended diet!

RE: Dietary dissolution of struvite stones

Beats — Thu, 15 Jul 2021 11:29:15 GMT

i'ved tried urohydropropulsion and remain convinced that, in my hands, cystotomy is much more efficient.

I'll happily take any tips from someone with more success than me though and give it another go!

RE: Dietary dissolution of struvite stones

Eamon McAllister — Thu, 15 Jul 2021 09:14:27 GMT

Has anyone here tried Urohydropropulsion? Back in the day I performed this procedure on females and it worked well. I was surprised at the size of some of the stones expelled.

RE: Dietary dissolution of struvite stones

Lucy Fleming — Thu, 15 Jul 2021 08:16:29 GMT

Another vote that these look very radiopaque to be struvite to me (though I appreciate animals don't always read the textbook). My preference would be for cystotomy, but if the dog is apparently comfortable, a poor anaesthetic candidate or the owners have cost concerns (and I'd put that concern last on the list as I suspect repeat sedation/ GA and radiographs would probably rapidly add up to a similar cost to a cystotomy) then there's probably no great harm in trialling dissolution and repeat rads after a month.

I've no idea how long the whole process would take though, and I guess you would need to warn that as the stones shrink there is the risk that they reach just the right side to pass into the urethra and potentially lodge there.

(Edited to add the fact that you say their previous post op compliance and follow up was poor would also make me much less inclined to try diet!)

RE: Dietary dissolution of struvite stones

Anthony Todd — Wed, 14 Jul 2021 20:14:25 GMT

Confirm struvite then low Mg++ diet???

RE: Dietary dissolution of struvite stones

Beats — Wed, 14 Jul 2021 17:39:34 GMT

no.

(and they don't look like struvite to me either, but even if they were, still no from me).

Large uroliths in female dog = lovely cystomtomy; it would be impossible to stop me just taking that dog to theatre.

then on to hill's cd muliticare strictly, antibiotics if suspicion that uti may habe been present, and sent off to https://urolithcenter.org/ via hills kind scheme