Louis CaOx Stones Flashcards
(34 cards)
small numerous stones in bladder - likely what kind? what should we do?
- Likely Caox but you never know!
- Removal of theses stones is recommended
> can’t dissolve (dispite what food resps say)
should we always perform urolith analysis?
- yes, all uroliths should be submitted (even recurrence)
- quantitative analysis
- results in less than 2 weeks
options for stone removal, from most to least invasive
- cystotomy
- laporoscopic cystotomy
- cystoscopy
- voiding with hydropulsion
CaOx more likely in
adult neutered male dogs
Surgical Removal of stones advantages, disadvantages
Advantages
* Uroliths type diagnosed
* Anatomic abnormality correction
* Urinary bladder sample for culture
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Disadvantages
* Long anesthesia
* Invasive
* Incomplete removal of uroliths (14%)
* Suture induced stone formation
> 9.5% of recurrent stones suture
induced (1999-2006)
> 18.5% in 2018!!!!
> Surgical technique, suture type??
advantages of non0invasive stone removal procedures, and what our options are?
Shorter hospital stay and less pain
* Voiding urohydropropulsion
* Endoscopic
> Basket removal
> Lithotripsy
Voiding Urohydropropulsion
* Indications
* Advantages
Indications
* Stones< urethral diameter
* Female (short and large urethra)
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Advantages
* Minimally invasive
* Easy to perform
* Removal and analysis of stones
Voiding Urohydropropulsion contraindications
Contra-indications
* Large or Jack-shaped stones
* Male cats: risk of obstruction
Intracorporeal Lithotripsy purpose
- how it works?
break up larger stones
* Ho:YAG laser
* Endoscopic guidance under
anesthesia
* Fragmentation of the stones in the bladder and urethra
* Fragments removed by voiding urohydropulsion or basket
Candidates for Lithotripsy
- patients and stones
Patients
* Female dog or cat > 4kg
* Male dogs with urethral stones
Stones
* <2cm in females
* <1cm in males
* Urethral stones easier
* <5 stones for males
Intracorporeal Lithotripsy effectiveness
- Complete fragmentation of stones in all female dogs and 86.7% of male dogs
- Complete urolith removal in 82-84% dogs
- Removal rate higher in females (83-96%) than in males (68- 81%) (Lulich 2009)
- Complete urolith removal in 100% dogs with urethroliths
Post-operative care for Lithotripsy
- Antibiotic (amoxicillin)
- Anti-inflammatory # 5 days
- Micturition monitoring
- Stone analysis
Lithotripsy vs Cystotomy
- how do they compare
- Similar urolith removal and complications
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Lithotripsy - 23 minutes longer (average)
- Discharged 12 hours sooner
Lithotripsy Limitations
- Equip mentcost
- Operator experience
- Size of the patient/scope
- Only for bladder and urethral stones
- Remaining fragments: nidus for new stones?
Percutaneous Cystolithotomy (PCCL)
- when is this technique appropriate?
- how do we approach it? general technique?
- For male dogs (litho not possible)
- For male cats
- Under general anesthesia
- Mini incision (1.5cm) regarding bladder apex * Babcock to grab the bladder wall
- 3 Stay sutures
- Incision of bladder wall + suction
- Port and endoscope
What type of diet should a dog with stones (unknown type) be fed before analysis results?
Maintenance canned diet or Urinary S/O
best method of stone prevention? how can we facilitate this?
Increase Water Consumption
* Use a pet water fountain (continuous filtered fresh running water)
* Provide the pet with fresh water in water dishes in multiple sites
* Add a small amount of flavoring agent to drinking water (tuna juice or low- sodium bouillon)
* Add additional water to dry or wet food
* Offer the dog or cat ice cubes (additional fluid & treat)
* Offer several meals per day
Prevention CAOx
- rule out which pre-disposing factors?
- Cushing
- Obesity
- Hyperparathyroidism
Prevention of Calcium Oxalate Uroliths
- ↑ water consumption
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Potassium citrate - Complexes with calcium (soluble Calcium Citrate)
- Mild urine alkalinization (↑ solubility of CaOx)
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For hypercalcemic cats - Higher fiber content diet
- Vitamin B6
- Hydrochlorothiazide
Diet for Calcium Oxalate Stones Prevention, and goals of this
- Canned diet
- Goal USG:
- <1.020 in dogs
- <1.040 in cats
- Hill’sc/d,PurinaSt/Ox, Royal Canin Urinary S/O
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goal is to increase water consumption, avoid acidifying urine
Diet for Calcium Oxalate Stones Prevention - advice specific to schnauzer?
schnauzer predisposed to pacreatitis
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Becarefulwith Schnauzer (too much fat)
* If hyper lipidemic: Royal Canin Low Fat S/O index (canned)
* If not hyperlipidemic: Royal Canin Urinary S/O Moderate Calorie
* Hill’s w/d
acceptable human foods for dogs prone to stones?
- Vegetables: avocado, cabbage, cauliflower, mushrooms, green peas, radishes, white potatoes
- Fruit: avocado, banana, grapefruit, mangos, melons (cantaloupes, honeydew, watermelon), plums
- Melon increase water intake
Detrimental Human Food for uroliths
- Meats/fish: bologna, herring, oysters, salmon, sardines
- Vegetables: asparagus, baked beans, broccoli, carrots, celery, corn, cucumber, eggplant, green beans, green peppers, lettuce, spinach, sweet potatoes, tofu, tomatoes
- Dairy: cheese, ice cream, milk, yogurt
- Fruits: Apples, apricots, cherries, most berries, limes, lemons, oranges,
pineapple, tangerine - Grains and nuts: corn bread, fruit cake, grits, peanuts, pecans, soybeans, wheat germ
urate stones prevention
- what are common causes we can look for?
- diets?
- what are appropriate treats?
- goal for urine ph?
- Chase the shunt or hepatic dysfunction
- Genetic test
- Low purine diet
> Prescription Diet u/d, RoyalCanin
Low Purine in dogs
> Hill’s prescription diet k/d in cats - Treats: carrots, apple slices, air-popped popcorn
- Urine alkalinization
