Buddy’s Bad Luck:
A Case of Cystic and Urethral Calculi in a Dog
Olivia Miller
AUCVM Class of 2015
History
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10 year old male, castrated Miniature Schnauzer.
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Presented on 11/18/2014.
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~5 days of dribbling urine and stranguria.
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Cystic and urethral calculi.
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Current medications and treatments:
◦ Amoxicillin, enrofloxacin, meloxicam.
◦ IV fluid support, intermittent urinary catheterization to relieve
obstruction.
◦ On a diet of canine s/d.
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Previous cystotomy in 2011.
Presentation:
HR: 124 bpm
 RR: 32 brpm
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T: 101.4 F
MM: pink, slightly tacky
CRT <2s
BCS 3/9
Stiff, slow gait.
Significant bruising, edema of the inguinal and scrotal
regions.
Initial Plan:
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CBC/Serum Chemistry
Thoracic radiographs
Abdominal radiographs
Contrast Urethrogram
CBC/Serum Chemistry:
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CBC: unremarkable
Chemistry:
◦ Mild decreases in albumin, calcium.
◦ Mild increases in ALT, AST, ALP, bilirubin, BUN
Thoracic Radiographs:
Abdominal Radiographs
Urethrogram
Problem List:
Cystic calculi
 Urethral calculi
 Urethral tear
 Soft tissue damage
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New Plan:
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Off to Surgery!
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Cystotomy
Urethrotomy
+/- Urethrostomy
Collect samples for stone analysis,
culture/sensitivity.
Canine Urethrotomy
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Temporary incision.
◦ In comparison to urethrostomy- permanent opening
created.
More common in males.
Performed by making a sharp incision on midline and
gently extracting calculi using instruments and saline
lavage to push calculi into the incision site.
Primary wound closure or secondary wound closure.
Canine Cystotomy

Incision in ventral side of the bladder.
◦ Note location of trigone, apex, and ligaments.
Place stay sutures.
◦ -placed at 9, 12, and 3 o’clock positions.
 Aspirate urine- suction or syringe.
 Evaluate interior of bladder.
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Calculi removal.
Excise a small piece of the bladder wall along the
incision to submit for culture/histopathology.
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Single or double layer closure.
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Stage 1: Urethrotomy
Locating the urethra.
Subcutaneous stones.
Stage 2: Stone removal
Using the gallbladder stone spoon.
~Half of the calculi we removed.
Stages 3 & 4: Damage Assessment
and Cystotomy
Locating the urethral tear.
Beginning the cystotomy.
Stages 5 & 6: More stone removal!
Removing bladder stones.
Passing a urinary catheter.
Stages 7 & 8: Passage of a urinary
catheter and closure
Checking for any obstructions.
Placing a pexy.
Post-Op Care:
IV fluids: LRS at 15 mL/hr.
 Monitor urinary catheter/urine production.
 Hydromorphone 0.05 mg/kg IV q 4-6 hours.
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◦ Transition to oral Tramadol 4 mg/kg PO q 6-8 hours.
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Meloxicam 0.1 mg/kg PO with food q 24 hours.
Warm pack incision/surrounding soft tissues.
Royal Canin Urinary S/O.
Monitor incisions.
Daily bandage changes and lavage of surgical
site.
Comparing Radiographs:
Canine Urinary Calculi
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What are they?
◦ Organized concretions of mineral and organic
matrix.
◦ Two predisposing factors: supersaturation of the
urine with minerals and changes in urine pH.
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Common Types:
◦ Magnesium ammonium phosphate (struvite),
calcium oxalate, and urate.
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Less Common:
◦ Xanthine, cysteine, calcium phosphate and silica.
◦ Urate and cysteine stones are radiolucent!
Struvite Calculi
The most common in dogs.
 Composed of magnesium, ammonium, and phosphate.
 Clinical Signs:
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◦ Alkaline urine (pH > 6.5)
◦ Urinary tract infection.
◦ Large, radiodense calculi on radiographs.
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Causes:
◦ Urinary tract infection with urease producing bacteria
(often Staphylococcus or Proteus spp.)
◦ Sterile causes: Hereditary, dietary
Treatment/Prevention
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Treatment:
◦ Surgical removal
◦ Culture and susceptibility of urine/urinary calculi.
◦ Appropriate antimicrobial therapy for 14 days, then re-culture urine.
◦ Medical management: Low protein diet (ex: Hill’s S/D or Royal Canin
Urinary S/O)
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Prevention:
◦ Keep urinary tract infection free.
◦ Dietary management with acidifying diet.
◦ Urine culture every 3 months, repeat radiographs every 6 months.
Back to Buddy:
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Culture and susceptibility
results:
◦ Heavy growth of Staphylococcus
intermedius group
◦ Susceptible to
amoxicillin/clavulanic acid!
 Placed on 22 mg/kg every 8 hours
for 14 days.
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Stone analysis results:
◦ Magnesium ammonium
phosphate (struvite) and calcium
phosphate calculi.
Summary of Hospitalization
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Length of Stay: 11/18/14- 12/09/14
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Treatments:
◦ Daily bandage changes through 12/02/14
◦ Tramadol and meloxicam.
◦ Warm compress.
◦ Amoxicillin-clavulanic acid.
◦ Dietary management with Royal Canin Urinary S/O
◦ Removal of urinary catheter on 12/05/14.
◦ 12/08/14: Repeat radiographs revealed the “jelly bean shaped” calculus
was still present. Successfully removed later that afternoon!
◦ 12/09/14: Discharged
Update on Buddy
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Buddy is doing very well
at home!
◦ Playful and eating well!
◦ Though still urinating through
the urethrotomy site…
Take Home Points


Things don’t always go according to plan.
Take post-op radiographs!
References

Ettinger, Stephen J.; Feldman, Edward C. Textbook of Veterinary
Internal Medicine. 7th Edition. St. Louis, MO: Saunders, 2010. Print.

Smeak, Daniel. Urethrotomy and Urethrostomy in a Dog. Clinical
Techniques in Small Animal Practice,Vol 15, No 1. 2000. pp 25-34.

Thrall, Donald E. Textbook of Veterinary Diagnostic Radiology. 5th
Edition. St. Louis, MO: Saunders, 2007. Print.

Tobias, Karen M., and Spencer A. Johnston.Veterinary Surgery.Vol. 1.
St. Louis, MO: Saunders, 2011. Print.
Acknowledgements
Jarrod
 My Family & Friends
 Dr. Kry
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Dr. Tillson
My Omega Tau Sigma Family
Soft Tissue Surgery Rotation
Ophthalmology Rotation
Class of 2015
Questions?
Chemistry
Test
Result
Reference Range
Albumin
2.0 g/dL
3 – 4.3 g/dL
ALT
196 U/L
13 – 151 U/L
AST
61 U/L
18 – 55 U/L
ALK PHOS
368 U/L
14 – 152 U/L
Total Bilirubin
0.21 mg/dL
0 – 0.2 mg/dL
BUN
38.9 mg/dL
9 – 34 mg/dL
Calcium
9.0 mg/dL
9.6 – 12 mg/dL