Tuesday, June 4, 2013

1449. Vet surgery: The steps in bladder stone removal in the cat and dog

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   05 June, 2013  

Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Surgical Process in bladder stone removal & economics (video)
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   05 June, 2013  
Be Kind To Pets
Veterinary Education
Project 2010-0129

Vet surgery: The steps in bladder stone removal in the cat and dog

I surfed the net and found the following:
This is a good surgery video done by the Silsistra Veterinary Clinic in Bulgaria.

The process of surgery must be systematic so that a high standard of care is achieved.

1. Bladder is taken out and is packed and surrounded by gauze swabs so that there is no backflow of urine into the abdomen (seen in the video).

2. Two anchor sutures on either side of the incision. (I don't find this process necessary).

3. A syringe to take out a urine sample for analysis (done by me) if no urine sample had been collected earlier.

4. Bladder incision below the apex of the bladder.

5. Stone removal using forceps.

6. I do a 360-degree sweep of the inside of the bladder using artery forceps to feel for more stones. A gritty feeling.  (However, X-rays will show most stones).

6. Irrigate bladder with normal saline (via urinary catheter or syringe in saline).

7. Pass a catheter from inside the bladder into the urethra to ensure no stones obstruct the urethra, especially in the female cat (seen in the video).

8. 2 layers of inverting sutures. I find that artery forceps to anchor one end of the first continuous layer which is knotted at both ends. Then another artery forceps to anchor the other end of the 2nd continuous layer. These forceps are useful in providing traction in tightening the continuous sutures.

*9. A syringe of saline is injected into the cat's bladder to ensure that there is no leak from the sutured area (seen in the video).
Or syringe in saline from the penile urethra end catheter in male cats or dogs.

Dogs with stones behind the os penis may need to be syringed with a 20-ml syringe of saline to push the stones into the bladder so that they are removed via the bladder incision.

10. I account for all stones removed as shown in the X-rays. The stones are shown to the owner and the numbers are recorded in the medical records. Unless there are thousands. It will be good to take digital images for recording.

11. Some clinics do another X-ray of the bladder after stone removal to prove that no stones are present. This is an additional cost but may be wise in defensive medicine. X-rays show include the kidneys.

12. I make it mandatory for all my vets to send the stones for chemical analysis even if the owner does not agree to it. 

13. Advices on the regular monitoring of urine and special diet are ignored by most owners for various reasons. So, some cases of bladder stones do recur. 

P.S. 1.  I have a video produced on the cost of bladder stone surgery in the dogs and cats in Singapore. The video is at:
Video: Costs of bladder stone surgery. The costs just for anaesthesia and surgery are from $800 to $2,000 depending on the time taken to do the surgery.

P.S 2. It is like feast and famine. Sometimes bladder stone cases come together to Toa Payoh Vets.  Images of 4 recent bladder stone surgeries done by Dr Daniel at Toa Payoh Vets are shown below:
tpvets_logo.jpg (2726 bytes)6138 - 6141. Bladder stones

tpvets_logo.jpg (2726 bytes)6149 - 6156. A bladder stone in a Jack Russell. Video: Costs of bladder stone surgery

tpvets_logo.jpg (2726 bytes)6135 - 6136. Bladder rupture in a 12-year-old Maltese. The urethra had been obstructed with stones for some weeks. Owing to financial constraints, no detailed tests have been done. Blood tests in the vomiting dog showed kidney failure. 

tpvets_logo.jpg (2726 bytes)6170. Urinary stones in a Shih Tzu. The surgery was done yesterday, June 4, 2013. The bladder mucosa was 1-cm thick as the owner procrastinated on doing X-rays and surgery for many weeks. The big stone was >2 cm across.
A fifth case of a pug with calcium oxalate bladder stones is scheduled. Practice makes perfect is applicable for surgeries too. 
Updates will be on this webpage:

More info at: Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
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