Cats and dogs experience bladder stones, which are minerals that combine to form a stone ranging in size from a grain of sand to a small orange. The most common stones are made of calcium oxalate from excess calcium in the urine or struvite due to excess magnesium, phosphorus and ammonium, mostly from a nutritional imbalance and infection.
The common causes of bladder stones include genetics, dietary factors, and urinary tract infections. The removal procedure for the stones has traditionally been open surgery, also known as cystotomy, and medication to dissolve the stones. However, minimally invasive procedures are becoming popular due to their inherent benefits like minimal scarring and shorter recovery time. An example is percutaneous cystolithotomy (PCCL). One of the benefits of minimally invasive procedures is a smaller incision and less blood loss. A cystotomy involves an incision from the belly to the pelvis to access the bladder. The surgeon then opens the bladder to remove the stones and flush the bladder before suturing. Like regular open surgery, the procedure causes blood loss and scarring due to the large open wound needed to access the bladder. On the other hand, minimally invasive procedures like PCCL only require a small incision, about one to two centimeters, on the abdomen to expose the bladder. Then the surgeon makes a stab incision, approximately six millimeters long, on the bladder to insert the instruments to remove the stones using a scope that provides video. The procedure is virtually bloodless, and leaves a barely visible scar. Another benefit of minimally invasive procedures is shorter recovery time. The PCCL is an outpatient procedure, and you can take your pets home the same day with minimal urine signs. Open surgery requires extended days in the hospital for recovery, followed by additional recovery time at home. After the procedure, the pet will be groggy for 24 hours to 48 hours, with full recovery taking up to 4 weeks. The period, however, depends on the health of the pet. Also, cystotomy is marked by blood-tinged urine in the first few days and pain and inflammation for at least seven days. The veterinarian typically recommends pain relievers, anti-inflammatory medication, and antibiotics. Another reason the minimally invasive procedure is preferred is the efficiency in removing bladder stones. Studies indicate that only 3.7 per cent of PCCL procedures show remnants of the stones in the bladder after the procedure. This can be attributed to the magnifying evaluation capability of the bladder using the cystoscope, the primary instrument used in the procedure, that reveals even the smallest of stones. In comparison, in traditional surgery, bladder stones are left behind 20 percent of the time. Also, there is a risk of recurrence in traditional surgery, as some stones or crystals can be embedded in the bladder sutures, forming a site for other crystals from the urine to embed and form new stones. Control in removing bladder stones is important, as there are risks of injuring the urethra and bladder, wound infection from the sutures, bleeding out and reactions to general anesthesia. PCCL provides a video visualization of the urinary tract and, coupled with the flexible, magnifying cystoscope, enables the identification and removal of the stones. The control of traditional surgery often depends on the skill and knowledge of the attending veterinary surgeon. The control extends to aftercare. Cats and dogs tend to lick their wounds, which may lead to infections and dehiscence, or the opening of the wound. After the cystostomy, cats and dogs require an e-collar. PCCL does not require a collar, as the wound is negligible.
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AuthorA board-certified veterinary internal medicine specialist, Joseph Bisignano, DVM, recently completed advanced residency training before joining the staff of VCA West Los Angeles Animal Hospital as a veterinary specialist. Archives
September 2023
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