Dr. Phil Zeltzman’s Blog

Matilda, a 12 year old Lab, had difficulty urinating, frequent urination and blood in the urine.

A physical exam and X-rays at her family vet revealed that her bladder was literally full of stones!

This is a serious condition, but it was reassuring that she did not have a bladder tumor, which could cause the same signs.

The solution to remove Matilda’s stones was bladder surgery (please note that what follows pretty much also applies to male dogs and cats, as well as female cats).

Blood work was normal, including kidney values, which confirmed that Matilda was a good candidate for anesthesia.

The surgery is called a cystotomy. An incision is made in the belly, then into the bladder. The stones were then physically removed.

Here is a very short video showing removal of the bladder stones – BUT PLEASE BE AWARE THAT IT IS A BIT GRAPHIC AND NOT FOR THE FAINT OF HEART!!!

https://youtu.be/6DWEWU333D4

Removing the stones is the easy part. The sometimes tricky part is to remove stones that may have gone down the urethra (i.e. the tube between the bladder and the outside world). Stones can get stuck there and cause a blockage, preventing a pet to pee.

In males, another surgery is occasionally needed to create a new opening to allow peeing (this is called a urethrostomy).

Two tests are routinely sent to the lab:

. A stone analysis. The goal is to figure out which minerals the stones are made of. This is critical for vets to recommend the proper diet to prevent the stones from coming back.

. A culture. This is a sterile swab to determine if a bladder infection (UTI) might be the cause for the bladder stones – or a consequence. This is also a critical test to choose the proper antibiotic to take care of the infection.

This is all the stones we removed!

Once the bladder is all cleaned out, it can then be stitched up, as well as the belly. Recovery is typically 3-4 weeks.

Interestingly, bladder surgery patients can continue to experience the same urinary symptoms postop as before surgery – for different reasons:

. frequent urination, because the bladder is irritated and things feel weird “inside.”

. blood in the urine, because the bladder is very rich in blood vessels, and the bladder just had an incision.

These signs can last a week or two.

Matilda went home the next day, with antibiotics and 2 pain medications. She was progressively switched to a special food over 10 days.

A week later, the culture results showed that the antibiotic had to be changed. And 3 weeks later, the stone analysis confirmed that she was on the proper diet.

Committing to using the special food exclusively – for life – is extremely important. Bladder stones are formed because of an imbalance between minerals (most commonly calcium or magnesium), or a change in the pH of the urine.

So giving the special food for a few months, then going back to the old food, usually to save money, is a recipe for failure. Likewise, giving people food or treats may sound like a generous and loving idea, but you might recreate the imbalance between minerals and can be enough to cause more bladder stones… which means the poor dog may need another surgery.

Surgical removal of bladder stones is the most efficient way to address this condition. It also may be the only option when the urethra is blocked by a stone (urethral obstructions), which is a life-threatening emergency.

After 4 weeks of rest, Matilda was allowed to progressively return to her normal life, couch surfing and chasing tennis balls.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

PeeWee is a 7 year old male Pug who couldn’t urinate. He was examined at Barton Heights Veterinary Hospital and an X-ray revealed bladder stones. Some of the stones were able to go down the urethra, which is the tube between the bladder and the outside world. They got stuck and PeeWee couldn’t go to the bathroom.

The red arrow on the X-ray shows some bladder stones. Along the urethra, the green arrow is pointing to some strong stones that look like a string of pearls.

PeeWee needed two surgeries to fix him up! The first was a cystotomy. This is a bladder surgery that allowed the removal of stones. The stones that were blocking the urethra was pushed back into the bladder, and removed from there.

The second surgery was a urethrostomy.

We suspected that PeeWee had calcium stones, which can sometimes come back. The goal of the urethrostomy is to prevent (or at least greatly decrease) the risk of becoming blocked again. PeeWee had to be neutered in order to perform the urethrostomy.

A larger opening was created in the urethra, making it easier for small stones that might form in the future to escape with urine.

The stones were sent to a lab for analysis, which later confirmed the suspicion of calcium stones.

PeeWee rested for 3 weeks before he was released from his restricted activity. He is now back to normal. Life is much more pleasant when you can urinate!

Bladder stones do not discriminate. They can affect any dog or cat, of any breed, of any age. If your pet ever shows signs that they’re having trouble urinating, take them to the veterinarian as soon as possible!