Urolithiasis

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Sex predisposition, Breed predisposition, Cost considerations, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Prevention, Control, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Phil Nicholls BVSc BSc PhD MRCVS MRCPath
Dr Melissa Wallace DVM DipACVIM
Synonyms Bladder stones, Cystic calculi, Ureteral calculi, Nephroliths

Introduction

  • Urolithiasis refers to the presence of stones anywhere in the urinary tract.
  • Most canine uroliths are found in the lower urinary tract.
  • Most common types: struvite (magnesium ammonium phosphate), calcium oxalate, cystine and ammonium urate.
  • Rarer types: calcium phosphate, silica, carbonate, xanthine and drugs or their metabolites.
  • Incidence estimated at 0.3-2.8%.
  • Cause : (and therefore treatment) depends on type of urolith; usually due to underlying inherited, congenital or acquired metabolic disorder or infection.
  • Signs : usually of lower urinary tract disease (may be none).
  • Prognosis : many uroliths recur unless underlying cause is corrected, eg infection.

Diagnosis

Clinical signs

  • Palpation of distended bladder.
  • Palpation of cystic calculi.
    Be gentle, palpation may be painful and is potentially traumatic, particularly in obstructed patient.
  • Pollakiuria, strangiuria, hematuria.
  • Oliguria.
  • Anuria.
  • Collapse.

Diagnosis

Differential diagnosis

  • Urinary tract infection Cystitis.
  • Prostatic disease Prostate disease in male dog.
  • Bladder or urethra neoplasia Urethra: neoplasia.
  • Pre-renal or acute renal failure Kidney: acute renal failure.

Sequelae

Prognosis

  • Fair: many uroliths recur.

Expected response to treatment

  • Improvement in clinical signs.
  • Radiographic evidence of dissolution of uroliths.
  • Normal urinalysis, negative urine cultures.

Reasons for treatment failure

  • Incorrect diagnosis of urolith type.
  • More than one type of mineral in uroliths.
  • Poor compliance with therapy.
  • Persistent urinary tract infection.
  • Individual metabolic predisposition despite therapy.

Sources

Publications

Refereed papers

  • Recent references from PubMed.
  • Hoppe A & Denneberg T (2001) Cystinuria in the dog - clinical studies during 14 years of medical treatment. J Vet Intern Med 15 (4), 361-367.PubMed
  • Caywood D D & Osborne C A (1986) Surgical removal of canine uroliths. Vet Clin North Am Small Anim Pract 16 (2), 389-407.PubMed
  • Osborne C A & Polzin D J (1986) Non-surgical management of canine obstructive urolithopathy. Vet Clin North Am Small Anim Pract 16 (2), 333-347.PubMed
  • Osborne C A, Klausner J S, Krawiec D R & Griffith D P (1981) Canine struvite urolithiasis - problems and their dissolution. JAVMA 179 (3), 239-244.PubMed

Other sources of information

  • Osborne C A, Lulich J P, Barges J W (eds) (1999) The Rocket Science of Canine Urolithiasis. The Vet Clin North Am Small Anim Pract 29 (1), 1-306.
  • Davies M (1996) Management of Canine and Feline Urolithiasis. In: BSAVA Manual of Canine and Feline Nephrology and Urology.Bainbridge J & Elliot J (eds). Chapter 17. pp 209.
  • Ling G V & Sorenson J L (1995) Management and prevention of urate uroliths. In: Current Veterinary Therapy XII. Kirk (ed) W B Saunders, Philadelphia. pp 985-998.
  • Lulich J P & Osbourne C A (1995) Canine calcium oxalateuroliths. In: Current Veterinary Therapy XII. Kirk (ed) W B Saunders, Philadelphia. pp 992-996.
  • Hope A (1994) Canine Lower Urinary Tract Disease. In: Waltham Book of Clinical Nutrition of the dog and cat.Chapter 19. pp 335. (Very useful overview.)
  • Osborne C A, Lulich J P, Bartges J W, Thumchai R, Felice L J, Unger L K, Koehler L A, Bird K A & Swanson L (1994) Canine urolithiasis - diagnosis, treatment and prevention. In: Renal Disease in Small Animal Practice.Trenton, NJ: Veterinary Learning Systems. pp 133-150. ISBN 1 884254 18 7 (Useful tables and flow diagrams).

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