Saturday, June 23, 2012

1051. Urethral catherisation in the female dog

I manage to find my article written in 2011.


http://www.sinpets.com/dogs/201006260catheterisation-female-urethra-dog-Singapore-ToaPayohVets.htm


In male dogs, every vet knows where to insert the urethral catheter, but in the female dog, it is very common to incorrectly insert the catheter in the clitoral fossa if the vet does not know the anatomy of the female urinary system! So, I am attaching an illustration for reference.





An X-ray of a Miniature Schnauzer that has urethral catherisation. Digital palpation and insertion of a soft catheter was done by Vet 1 as I had referred the owner to her. I was in Hong Kong at that time and the dog had difficulty peeing after passing out some stones. Did the dog owner agree to Vet 1 removing the urinary stones? No.

"Why?" I asked Vet 1 later when I returned to Singapore. She was willing to spay and remove the urinary stones at one surgery whereas I did not want to do two-in-one as I don't increase my anaesthetic and surgical risk by doing a prolonged surgical procedure.



She did not know the reason. "Is it the cost?" I asked her.



"No," she said. "The owners were agreeable to do the two surgeries when they consulted me."



First X-ray shows numerous stones. Advice to remove the bladder stones not taken up as the owners wanted a spay to be included at one surgery, i.e. 2-in-one operation.
Subsequently, second X-ray with urethral catherisation. I checked out this X-ray 24 hours before the spay
PHOTOS ARE IN TOA PAYOH VETS' WEBSITE


Vet 1's boss tries to send image to me via his Blackberry phone.



Owner shows me the 5 stones peed out

Spayed by me

"How much did you quote?"



"The usual rates," she would not give me the actual figure. A fuzzy reply.



"Did you do it immediately?" I asked.



"No, it was a Saturday and the cost would be much higher. I hospitalised the cat. They took back the cat on Sunday."



"Did you follow up?" I asked.



"Yes, but there was nobody answering the phone." This is a good vet as many vets don't do follow up.



"I am sure it is the cost," I said.



"No," she replied. "They had agreed to the surgery."



Other than cost, what could it be? Preference for a veteran?

Later the husband came to me to get the dog spayed. The husband would not give me the reason as to why they did not accept the combined surgery as that was what they wanted. A fuzzy reply saying that the dog could pee after the catherisation. Besides the dog could pass out the 5 stones. So, they did not want to operate. The husband asked: "Vet 1 says the bladder will rupture if I don't remove the bladder stones as they will increase in size. Is it correct?"

"The bladder will rupture if the urine can't flow out for a long time," I said. "The stones will irritate the bladder causing bleeding. As to whether the stones will rupture the bladder by themselves, I don't think they will as they are not sharp." It is a difference of opinion. Some vets will not agree with me.

The dog still has the 3 stones and apparently had no blood in the urine. I did not advise further as this would be like high-pressure selling. The husband had associated feeding 2 cans of S/D diet with the passing out of 5 stones (see image) and got another 6 cans. I had advised 1-3 months feeding of S/D diet for struvite stone dissolution but that means more than 6 cans!

Knowing the reasons of the client is important to improve the standard of care and service. If the vet does not bother to ask, the answers will never be known and the standard of care cannot be improved.

UPDATE: As at Jun 25, 2012, no complaints of blood in the urine. I have not phoned yet as it seems to be "pestering" if the owner has decided not to operate. The spay op was OK otherwise I would have heard from the owner. Since the stitches were dissolvable, I did not see the dog post-op to remove the stitches.
The first report of this case is at:

http://www.sinpets.com/dogs/20120246bladder-stone-spay-packaged-deal-singapore_ToaPayohVets.htm

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