Sex: Female desexed
Breed: Shih Tzu
History: Isabella (Bella) presented to the clinic with blood in her urine, increased thirst and increased urination. Bella had started to urinate in odd places and was only producing small amounts of urine, yet was constantly squatting to try and urinate. Bella’s owners mentioned she had a history of urinary tract infections which had been treated with antibiotics at another veterinary surgery whilst they were away on holidays.
Examination: On examination Isabella was depressed, but responsive. When palpated around the abdominal area she would tense up, indicating pain and discomfort.
Further diagnostics were required, so a urine test was performed. This test revealed a large amount of blood and protein in the urine. Protein is normally present in very small amounts; however large amounts can indicate bladder inflammation and infection. This can also be caused by bladder stones so ultrasound was undertaken to find out if there were any stones in her bladder.
A 25mm large single urolith (bladder stone) was visualised within the bladder during ultrasound examination.
Urolithiasis (bladder stones) result from the formation of calculi (uroliths) within the urinary tract. Stones are produced if excess minerals and other waste products solidify or crystallized in the bladder. Dietary and feeding patterns as well as infections can also influence the pH, volume and solute concentration of urine, which can contribute to the formation of the bladder stones as well.
Treatment: Due to the size of the stone, it was not possible to dissolve the stone by dietary or medical management. Bella required an operation called a cystotomy to remove the bladder stone under a general anaesthetic.
Bella was scheduled for surgery the following day with Dr Brothers. Bella was anaesthetised and placed on a drip to help maintain her blood pressure and hydration. A veterinary nurse closely monitored her vital signs.
A cystotomy was performed. This involved an incision into the bladder wall, to allow Dr Brothers to remove the bladder stone. Two stay stitches were placed on each end of the bladder to keep the incision open. A large 20 mm round urolith stone was removed.
Sometimes stones can lodge further down the bladder neck so Dr Brothers flushed the bladder out with sterile saline, to ensure that all stones were removed. The incision was sutured closed in two layers using absorbable suture material. Next the bladder was filled with sterile water to ensure no urine leaked from the suture line into the abdominal cavity. There was no leakage so Dr Brothers then sutured up Bellas abdominal muscles and skin.
Followup: Bella made an uneventful recovery and stayed the night in hospital on her drip. She was closely monitored to ensure she was producing urine. Bella was given both antibiotics and pain killers during and following the surgery. She remained on these for 10 days after the surgery as well.
The stone was sent off for analysis, to determine the type of stone. This analysis helps us decide which treatment to give Bella to prevent a recurrence of stones.
There are different types of stones such as struvite, calcium oxalate, crystine and ammonium urate. In some cases, various stones may be found. The most frequent is magnesium ammonium phosphate (struvite) and calcium oxalate.
The stone Bella had was a combination of struvite and calcium phosphate carbonate.
Dietary management can help prevent recurrence of the condition. Urinary diets such as Hill’s® Prescription Diet® c/d® dry and wet food is specially formulated with reduced levels of protein, magnesium and phosphorus for this reason.
Bella returned 10 days later for suture removal and she was back to urinating normally. A test of her urine showed that her infection had completely cleared, and that she was well on the way to a full recovery.
Now that the stone has been removed, Bella’s urine will require ongoing monitoring by her owner to ensure the infection is not recurring. This is done with a simple PH test strip on a weekly basis. Bella is back to her happy and healthy self and has not looked back since!