Case Handling Urolithiasis (Kidney Stones) in Dogs.

Urolithiasis is a disease caused by a stone (urolith) or crystals in the urinary tract (urinary tract). Stones and crystals can be found in the kidney, urethra, and mostly in the bladder (bladder). 

The presence of stones or crystals can irritate the urinary tract, resulting in the channel was broken, blood was found with urine that can cause pain. 

Many cases are found in my practice where the stones and crystals causing a blockage in the urinary tract causing urinary retention. 

Case Handling Urolithiasis in practice 

Cases of urolithiasis in dogs is usually carried by the client with a dog anamnese difficult to urinate or pee just a little and sometimes bleed. In addition, decreased appetite or no appetite, weakness, and vomiting. Based on these anamense, clinical examination and examination of immediate urinary tract highly prioritized. At the time of clinical examination, palpation of the abdomen often feels the presence of bladder augmentation. After clinical examination, conducted by making X-ray or ultrasound examination of the abdomen with a horizontal position side (lateral).

Stones were removed from the bladder during surgery.

Based on the results of clinical examination and radiological / ultrasound, it can be concluded that the dog is suffering from urolithiasis. These results should be immediately informed to the client for approval for further handling. The information needs to be delivered to clients include: 

* Animals can not or difficult urination caused due to blockage or inflammation in the urinary tract. 

* For the treatment needs to be given transquilizer (Calming Drugs) or anesthesia. 

* Surgery should be performed to retrieve stones or crystals that cause blockage in the urinary tract. 

* All surgery and the use of drugs (anesthesia) there are risks. 

Following approval by the client in writing, the immediate actions as follows: 

1. The provision of sedation to facilitate injections of urine. 

2. Evacuation propylene urinary catheters of various sizes:

Dog race	Catheter size
Small	1,3 x 500 mm
Medium	2,0 x 500 mm
Large	2,6 – 3,3 x 500 mm

Size 2,6 x 500 mm

Size 2,0 x 500 mm

Size 1,3 x 500 mm

Image: Catheter 

A: Catheter female 

B: Male Catheter

The measure applies to male dogs, female dogs while using a metal catheter. When the time turns urine output by catheter blockage in the urethra, then tried to be a rock or crystal is driven into the bladder (where probably no need to open the urethra to pick up stones or crystals). 

3. Once the urine is successfully removed, the intravenous fluid that had been installed prior to surgery immediately streamed using IV intravenous catheter with the following sizes:

Dog race	IV Catheter Size
Small	24 G
Medium	22 G
Large	20 G

Image: IV Catheter

intravenous fluids should be given is 5% lactated Ringer's solution at a dose of 20-40 cc / kg / day. When the dog vomited a lot (as has happened uremia / renal failure), then the fluid is given Ringer Dextrose 5%. 

4. In addition to the evacuation of urine, blood tests need to be done as well: complete hematological, blood chemistry (kidney function: urea and creatinine), as well as several levels of electrolytes in the blood such as Potassium, Sodium, and Chlorine. Urine examination is also necessary to determine the presence of inflammation in the bladder, as well as the type of stone or crystal blockages.

Picture: Sediment in the urine 

A: Normal urine sediments

B: abnormal urine sediments

Picture: Crystals and cystine stones.

Picture: Crystals and calcium oxalate stones.

Picture: struvite crystals and stones.

Picture: Crystals and ammonium urate stones.




If it turns out the provision of drugs and replacement diets do not obtain maximum results, then surgery (cystotomy or urethrotomy) needs to be done.


ACTION SURGERY 

Most cases of urolithiasis who come to my practice has been treated and get a special diet to dissolve the stone or crystal. Therefore, 95% of the cases I deal with urolithiasis who came to surgery (cystotomy or urethrotomy).

Since quite a long time for it, then I use a gaseous anesthetic (isoflurane) using the anesthesia machine. During the operation I always put Endotracheal tube (hose to the respiratory tract) with the following sizes:

Dog race	Endotracheal tube size
Small	4,5 - 6
Medium	7,5 – 8
Large	8,5 - 10

Cystotomy (opening of the bladder) 

Cystotomy operation is done by opening the ventral abdominal section then open the bladder (bladder). Stone / crystal taken from the bladder after bladder stitched back. 

After surgery, the catheter still needs to be installed for 4-5 days to prevent the possibility of blockage by a blood clot. Provision of parenteral or oral antibiotics should be given for ± 6 days. To prevent the catheter is not removed by the dog, it is necessary to Elizabeth mounting collar. I have done remedial action has a successful rate of approximately 90%, if both kidneys are still functioning well. To remove the stones / crystals in the urethra it is necessary to open the urethra (urethrotomy) where the stone is located. Suppose forced to perform cystotomy and urethrotomy, then urethrotomy precedence. Once the catheter may enter the bladder, there was a cystotomy. 

Urethrotomy 

Urethrotomy done when stones or crystals are not successfully inserted into the bladder using a catheter. Usually I do urethrotomy in male dogs with caudal direction prepuce unfold before make an incision in the right ventral penis where stones or crystals are. The presence of stones or crystals can be detected earlier using a catheter or long sonde. After the stones or crystals known position, then made an incision in the urethra and then the stone or crystal is issued. Next, a catheter is inserted into the bladder through, then the incision sutured.