Loobani AcademyAbstract
Canine bladder calculus is a common urinary tract system disease in dogs. It is a disease in which many mineral crystals and stones accumulate in the bladder of dogs. Clinically, it is characterized by abdominal pain, dysuria, and hematuria. Common uroliths can be divided into struvite, calcium oxalate uroliths, urate uroliths, cystic acid uroliths, and siliceous uroliths. According to statistics, Pekingese, Schnauzer, and Shih Tzu are the most affected dogs. The average age of onset is two years old. Male dogs are more likely to be affected than female dogs. Male dogs mainly have bladder stones accompanied by urethral stones, while female dogs mainly have bladder stones alone.
This article is a case of successful surgical treatment of bladder stones treated in a clinical outpatient clinic and is organized as follows.
1: Case information
1. Name: Xiao Hei
2. Breed: Cocker Spaniel
3. Age: 10 years old
4. Gender: male
5. Consultation time: 2022.12.11
2: Medical history investigation
1. Medical problems: poor appetite, hematuria, difficulty urinating, pain
2. Main statement: The dog has been urinating blood for two months. Before that, the appetite and stool were normal. From time to time, there will be blood in the back part of the urine. I think the dog is old, and I don’t want to toss it, so I didn’t take it to the doctor. Recently, it has been found that the dog has a loss of appetite, urination is not smooth, and there will be pain. The owner fed the dog Sanjin Tablets at home, but it did not improve, so he brought it to the doctor. The dog usually eats human food omnivorously. The dog has not been dewormed recently, has not been immunized with booster vaccines on time, and has not vomited.
3: Physical examination
1. Overall inspection
BCS: 4/9, good body condition, smooth fur, no dander, no dehydration, normal limbs, and bones
2. General inspection
BW: 16KG T: 38.6℃ HR: 120/min RR: 25/min
3. System check
Auscultate arrhythmia, palpate the abdomen for bladder pain and resist
4. Laboratory examination
Inspection items: blood routine, acute reaction protein, biochemistry, X-ray
Blood Routine
Check Item | Test Result | Reference Range |
WBC | 15.5*10^9/L | 6.0-17.0 |
LYMPH | 4.0*10^9/L | 0.8-5.1 |
MON | 0.7*10^9/L | 0.0-1.9 |
GRAN | 10.8*10^9/L | 4.0-12.6 |
LYMPH% | 25.7% | 12.0-30.0 |
MON% | 4.75 | 2.0-9.0 |
GRAN% | 69.6% | 60.0-83.0 |
RBC | 6.64*10^12/L | 5.50-8.50 |
HGB | 141g/L | 110-190 |
HCT | 47.7% | 39.0-56.0 |
MCV | 71.9fL | 62.0-72.0 |
MCH | 21.2pg | 20.0-25.0 |
MCHC | 295g/L | 300-380 |
RDW | 16% | 11.0-15.5 |
PLT | 440*10^9/L | 117-460 |
MPV | 7.3fL | 7.0-12.9 |
PDW | 16 |
|
PCT | 0.321% |
|
EOS% | 3.9% |
Acute Response Protein
Check Item | Test Result | Reference Range |
CRP | 42mg/L | ＜20mg/L |
Biochemical
Check Item | Test Result | Reference Range |
ALB | 1.7g/dl | 2.3-4.0 |
ALKP | 38u/l | 23-212 |
ALT | 17u/l | 10-100 |
AMYL | 588u/l | 500-1500 |
BUN | 27mg/dl | 16-36 |
CA | 10.8mg/dl | 7.8-11.3 |
CHOL | 151mg/dl | 65-225 |
CREA | 1.3mg/dl | 0.8-2.4 |
GLU | 104mg/dl | 74-159 |
PHOS | 3.4mg/dl | 3.1-7.5 |
TBIL | 0.1mg/dl | 0.0-0.9 |
TP | 6.7g/dl | 5.7-8.9 |
GLOB | 3.8g/dl | 2.8-5.1 |
X-ray
Blood test results: regular blood routine, normal biochemical liver and kidney function, mild elevation of acute reaction protein, acute inflammation of the body, X-ray film showed bladder stones. The owner did not do further B-ultrasound examination due to economic considerations.
4: Diagnosis and Treatment
Diagnosis: bladder stones
Treatment: surgical removal
Pre-operative medication:
1. Subcutaneous injection of atropine 0.05ML/KG
2. Subcutaneous injection of butorphanol 0.1ML/KG
3. Cefotaxime 0.1ML/KG subcutaneously
4. Intubation for respiratory anesthesia after induction of anesthesia
5. Catheterization is performed first to facilitate intraoperative flushing and postoperative urination
In surgery
1. Intravenous infusion of lidocaine diluted in one limb for intraoperative pain management and cardiac rhythm stabilization
2. Intravenous infusion of Lactated Ringer Sodium on the other side branch to maintain blood pressure
3. Surgical site: the surgical area is shaved and disinfected, and an incision is made on the abdominal wall close to the bladder, 3-5 cm away, the bladder is pulled out of the wound, and the urine in the bladder is drawn out with a syringe. The bladder is cut open, the stones are removed, and the bladder is flushed and sutured. After checking the airtightness of the bladder, it is returned to the abdominal cavity. The abdominal cavity is closed routinely, and the skin is sutured.
Medication after surgery:
1.5% 100ML + energy group 1.6ML/bottle, intravenous infusion of 30ML/H for three consecutive days
2.0.9%NACL100ML＋Ceftriaxone 1.6ML intravenous infusion of 30ML/H for three consecutive days
3.0.9%NACL100ML＋1ML Potassium Chloride Intravenous infusion 15ML/H a day
4. Ringer sodium lactate 200ML + vitamin B complex 1ML intravenous infusion 30ML/H for three consecutive days
5. Baili 1.6ML subcutaneous injection once a day for five consecutive days
6. Subcutaneous injection of Zhixuemin 1.6ML to see if there is blood in the urine
7. Ketezhuang 1.6ML subcutaneous injection once a day for five consecutive days
8. Elizabeth Circle
9. A piece of surgical gown
10. Wound Spray
11. Dog urinary tract prescription food one pack
12. Gou Shu Chang (fossil drug) twice a day, two capsules at a time, for 14 consecutive days
Postoperative pictures
Suggestion: Send the stones to relevant laboratories for component analysis, but the owner gave up sending them for examination due to economic considerations.
5: Precautions
1. Aseptic operation should be strictly observed during the process. If the gloves are contaminated by urine or stones during bladder incision, sterile gloves should be replaced in time. After the rocks are removed, repeated washing is required to avoid residual stones in the bladder neck and proximal urethra. After suturing, it is necessary to maintain the tightness of the bladder to prevent the leakage of urine and abdominal infection.
2. Surgery to remove the stones in the bladder, still in a dangerous state after the operation, need to be hospitalized for 24 hours to 72 hours after the procedure to observe the breathing, heart rate, blood pressure, and other conditions.
3.Other systemic lesions may be secondary to the operation, such as renal failure, liver, spleen heterotopia, hemorrhage, and atrophy of the adrenal cortex and medulla. The postoperative risk period is one week, and death may occur within one week.
4. After the operation, it needs to be treated for at least five days, and the drug can be stopped after rechecking the corresponding indicators. During the hospitalization, the wound and urine should be observed.
5. The medication may be adjusted at any time during hospitalization. The dog needs to wear an Elizabeth ring, and the urinary catheter should be checked regularly to avoid the dog biting and causing it to fall off.
6. Nutritious diet, diuretic infusion, drinking plenty of water
7. For wound care, the urinary catheter is usually removed in 5 days, and the stitches are removed after a week.
6: Prognosis
One week later, the stitches were removed, and the wound was normal. On the fifth day, after the removal of the urinary catheter, urination was expected, the spirit, appetite, and defecation were all normal, and the prognosis was good.
7: Disease pathogenesis and prevention
Bladder calculus is a kind of canine urinary tract calculus, which refers to the occurrence of an inorganic salt or organic solute crystals in the bladder to stimulate the bladder, causing inflammation, bleeding, and other symptoms. There are many organic and inorganic solute components in urine. When some specific reasons occur (such as changes in food, water, or urine pH, certain crystallization-promoting factors, etc.), the solubility of certain solutes changes and crystals are formed. These crystals aggregate and grow to form stones, or other organic components, such as epithelial cells, inflammatory cells, red blood cells, bacteria, etc., join to form stone cores. Stones form when crystals stay in the urine long enough, so increasing your fluid intake and, therefore, more frequent urination may reduce stone formation. Stone components can be divided into single parts and composite components. According to different stone components, the pathological formation mechanism is other. Some stones can be dissolved, such as ammonium magnesium phosphate stones, which can be treated conservatively with excessive drinking or infusion to increase urine, dilute urine and improve the solubility of rocks so that the body can excrete them by itself. Suppose the stone cannot be dissolved, such as calcium oxalate stone, and has already caused a series of clinical symptoms in the body. In that case, it is recommended to remove it by surgery as soon as possible to avoid acute kidney injury caused by secondary infection or urethral obstruction.
