Like humans, cats and dogs experience bladder stones, a painful medical condition in which blood or urine minerals and salts harden and clump together in the animal’s urinary tract. Bladder stones, also called urinary calculi, can form in the bladder, kidneys, ureters, and urethra. However, most form in the bladder and urethra.
There are two common bladder stone types: struvite and calcium oxalate. Both dogs and cats can develop struvite stones, which mostly result from urinary tract infections. Calcium oxalate stones, on the other hand, may form due to dietary factors and urine mineral concentration and are more common in cats than dogs. Female dogs are more susceptible to bladder stones than male dogs. However, male dogs are more likely to experience bladder stone obstruction than female dogs. Obstruction happens when bladder stones block ducts and other transport vessels in the urinary tract. For cats, males are more likely than females to develop both bladder stones and obstruction. Surgery is often needed for large bladder stone removal, since these stones can cause the animal to develop infections and experience excruciating pain. Veterinarians use two main surgical procedures, namely laparotomy (also known as traditional surgery or open surgery) and minimally invasive surgery (MIS). Laparotomy involves a surgeon cutting a large incision in the tissue to gain a full view of the affected bladder areas. Minimally invasive surgery involves surgical procedures requiring smaller incisions than the cuts required in traditional surgery. These procedures employ a cystoscope, a thin camera surgeons use to view inside the bladder. What makes minimally invasive bladder stone removal in dogs and cats superior to traditional surgery? This question can be best answered by examining a common MIS bladder removal procedure called percutaneous cystolithotomy (PCCL). Veterinary surgeons use PCCL to remove bladder stones in male and female dogs and cats. In this procedure, a veterinary surgeon makes a small incision measuring 6 millimeters into the bladder, then inserts a cystoscope to view the bladder and remove the bladder stones. Since the cystoscope magnifies what the surgeon views on a monitor, the chances of leaving any calculi behind are minimal. The cystoscope’s magnification, together with saline flushing, allows the surgeon to view the bladder and urethra with great detail. MIS bladder stone removal procedures are also superior to open surgery in several other ways. For instance, because they involve smaller incisions than those required in open surgery, the animal experiences less pain and heals more quickly. A 2012 to 2017 study on 68 dogs and cats sought to describe PCCL’s use and outcomes in bladder and urethral stone removal. The study reported that PCCL allowed bladder and urethral stone removal with faster recovery times and led to few postoperative complications. Notably, not all dogs or cats are good candidates for MIS procedures such as PCCL. The pet’s general health condition and size determine whether the surgeon will use open surgery or an MIS procedure for bladder stone removal. MIS procedures are most effective in large dogs and cats, since the surgeon can easily place portals and scopes during surgery. Nonetheless, some small dogs and cats have undergone successful MIS bladder stone removal procedures.
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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. Joseph Bisignano, a doctor of veterinary medicine (DVM) specializing in urinary tract disorders, is an internal medicine consultant at Alicam. He also heads the internal medicine department at Metropolitan Animal Specialty Hospital in Los Angeles, California. Additionally, Joseph Bisignano, DVM, has authored several veterinary publications and is particularly interested in canine health, including the effects of grapes on dogs.
Despite being safe for human consumption, recent research has demonstrated that grapes are detrimental to dogs, regardless of the quantity. Likewise, experts consider all grape derivatives, such as jelly, jam, and raisins, unsafe for dogs. According to the report on the American Animal Hospital Association's website, grapes contain а toxic substances known as tartaric acid that can harm dogs' kidneys. This acid can cause digestive issues and abdominal pain and even lead to kidney failure with time. Three experts reached their conclusion after observing the toxic effects of tartaric acid when a dog consumed playdough, a modeling material children use for crafts, which contains cream of tartar, a form of tartaric acid found in grapes. Individuals should avoid feeding dogs any grape product to prevent poisoning or other health issues. If a dog accidentally consumes grapes, a prompt visit to a veterinarian is vital to induce vomiting since grape poisoning lacks an antidote. Additionally, administering activated charcoal within one hour of ingestion can help minimize the release of toxins into the bloodstream, thus mitigating potential kidney failure. A holder of a doctor of veterinary medicine from the Western University of Health Sciences in Pomona, California, Joseph Bisignano, DVM, currently heads the internal medicine department of Metropolitan Animal Specialty Hospital in Los Angeles. Joseph Bisignano, DVM, has specialized in novel treatments and minimally-invasive procedures for various urological conditions, including kidney stones and urinary incontinence.
Urinary incontinence, or the involuntary leakage of small to large amounts of urine, can happen to dogs of all ages and sexes. Still, it is most widespread among older dogs and females. The most common cause of urinary incontinence in female dogs is a condition called urethral sphincter mechanism incompetence (USMI). Dogs with USMI experience weakness in controlling the muscles of their lower urinary tracts. Previously referred to as hormone-responsive urinary incontinence, USMI often occurs in female dogs that have been spayed. The lack of the female hormone estrogen in these dogs weakens the tone of the sphincter muscle surrounding the urethra, the structure that transports urine from the bladder to outside the dog’s body. USMI can occur months to years after spaying. It is worth mentioning, however, that the risk of developing hormone-responsive urinary incontinence should not discourage pet owners from neutering them. Unspayed female dogs face a much higher risk of other more serious and potentially life-threatening conditions, such as pyometra (severe uterus infection) and mammary cancer. Other causes of urinary incontinence in female dogs include neurological diseases, kidney diseases, diabetes, and bladder and urethral tumors. Based in Los Angeles, Joseph Bisignano, DVM, is the department head of internal medicine at Metropolitan Animal Specialty Hospital and an internal medicine consultant at Alicam, also in Los Angeles. Over the years, Joseph Bisignano, DVM, has treated animals for a wide range of issues, including ectopic ureter.
Ectopic ureter is present at birth in some dogs. Dogs with this condition have irregular ureters, the tubes that move urine from the kidneys to the bladder. Most dogs have two ureters that manage this process nearly around the clock, allowing urine to steadily collect in the bladder until the dog needs to urinate. However, some dogs are born with ureters that do not attach to the bladder but feed directly into the urethra or, in the case of female dogs, the vagina. The condition is much more common in females. Irregular ureter placement can create several problem, including an inability to properly store urine in the bladder. The main clinical symptoms of the condition are urinary incontinence or dribbling, typically from a young age though potentially not until adulthood. Licking the area or discolored hair in the area result from constant urine leakage. In the past, surgery was the treatment for ectopic ureter. In recent years, however, cystoscopic laser ablation has gained popularity. The benefits of the new procedure include less pain for the dog and quicker recovery time. Joseph Bisignano, DVM, practices veterinary medicine in Los Angeles. He is a specialist and consultant in veterinary internal medicine. He specializes in capsule endoscopy, using camera technology to diagnose health issues in animals’ gastrointestinal tracts. Joseph Bisignano, DVM, is trained in handling both domestic animals and wildlife, providing diagnostic, treatment, and advisory services.
Although grapes are good and harmless for human consumption, they are toxic to dogs and can cause kidney failure. The particular substance responsible for the toxicity was previously unknown, but recent studies show that the tartaric acid is the toxic element in grapes that causes problems. Consuming any type of grapes or raisins can cause a dog to show signs of poisoning, which include weakness, vomiting, diarrhea, bad breath, and loss of appetite, among others. As a pet owner, if you know your dog has eaten grapes or raisins, you should take the animal to a veterinarian as soon as possible. The doctor will induce vomiting and administer activated charcoal to prevent further absorption of the toxins into the dog’s kidneys. Also, keep grapes, raisins, and products made from them away from your pets. It is also advisable to contact your veterinarian before introducing any new food product to your dog. An accomplished Los Angeles veterinarian, Joseph Bisignano, DVM, leads internal medicine at the Metropolitan Animal Specialty Hospital. Joseph Bisignano, DVM, is also an internal medicine consultant with Alicam, where he facilitates canine endoscopy studies using a pill-sized camera device that takes pictures as it passes through the digestive tract.
All dog owners should be aware that grapes are toxic to their canine pets when they enter the digestive tract. The same holds true for the grape-derived raisin. Specifically, grape poisoning can lead to rapid and catastrophic kidney failure. Although medical professionals have been aware of this fact for quite some time, they didn’t know the pathology behind grape poisoning until 2021. The breakthrough came after an investigation into a dog that experienced medical problems after eating homemade playdough that was made with cream of tartar. ASPCA Animal Poison Control Center scientists found that the tartaric acid in the playdough was the culprit. Because grapes are also high in tartaric acid, they immediately drew a correlation. This revelation has since opened new horizons in the testing, prevention, and treatment of canine grape poisoning. In practice since 2010, Joseph Bisignano, DVM serves as the department head of internal veterinary medicine at Metropolitan Animal Specialty Hospital in Los Angeles. Joseph Bisignano, DVM focuses on diseases of the urinary tract in dogs and cats and provides treatments and procedures such as urethral stents.
The urethra is a tube extending from the bladder through which urine passes. Pets whose flow is obstructed or severely reduced can benefit from a stent, a non-invasive device that keeps the urethra open. If the cause of the blockage is not cancer-related, the stent will permit a normal lifespan with a good quality of life. The patient may only survive roughly nine months to a year if cancer is present. The stent does not cause pain and will not react adversely with the surrounding tissue. The stent is a small, flexible tube inserted while the doctor observes with fluoroscopy, which displays moving X-ray images in real-time. In most cases, the patient can go home the same day. Most of the time, the stent ensures an immediately smooth flow, although a minority of pets may be incontinent or strain during urination. A veterinary internal medicine specialist, Joseph Bisignano, DVM, specializes in gastroenterology, inflammatory conditions, and autoimmune conditions. With a career of more than two decades, Joseph Bisignano, DVM, has helped manage numerous diseases, including Addison’s disease in dogs.
Addison’s disease, also known as canine hypoadrenocorticism, occurs when a dog’s adrenal glands fail to produce sufficient amounts of corticosteroid hormones. The adrenal glands, situated next to a dog’s kidneys, produce corticosteroid or “stress” hormones. Glucocorticoids such as cortisol influence sugar, protein, and fat metabolism and are often stored and used to respond to threatening situations. Mineralocorticoids such as aldosterone help control potassium and sodium. When animals are under stress, their adrenal glands become stimulated and produce stress hormones that manifest in ways such as visible anxiety or joy when pet owners return home. Dogs with Addison’s disease cannot generate enough hormones to sustain normal stress levels, which can cause severe behavioral issues or even death. Doctors diagnose Addison’s disease with an ACTH stimulation blood test. Doctors perform the ACTH test by drawing a tiny blood sample to measure baseline cortisol levels. They then inject ACTH, which contains a brain hormone tasked with corticosteroids release during stressful situations. After about an hour, doctors take another blood sample to evaluate how the dog responded to ACTH. If the test reveals a low baseline cortisol level, there is little response to the stress hormone, which confirms Addison’s disease. With proper diagnosis and treatment of Addison’s disease, a dog can live a normal life. A board-certified veterinary internal medicine expert, Joseph Bisignano, DVM, draws upon more than two decades of veterinary experience. Joseph Bisignano DVM, specializes in minimally invasive procedures for removal of bladder stones, including percutaneous cystolithotomy (PCCL).
Percutaneous cystolithotomy is a minimally invasive procedure to treat animals with bladder and urethral stones. Doctors can perform the procedure on dogs and cats of any size or species by inserting a cystoscope (camera) into the bladder via a small incision. With the help of the camera and a stone basket, doctors remove the stones from the animal’s bladder and perform comprehensive surveillance to ensure that no stones are left behind. Advanced visualization of the urinary tract, from the bladder to the urethra, significantly lowers chances of stone reoccurrence. Doctors can discharge animals that have undergone PCCL the very next day with minimal pain and complications. Any active infection should be treated with antibiotics prior to any intervention unless there is concern for obstruction. For this reason, a urine culture is checked during the preoperative clearance process |
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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