3. INTRODUCTION - SAC (Speed, Accuracy, Completeness). Speed is especially important in the old dog as the heart may fail when surgery is prolonged. This video is to share my surgical experience and process in removing a big bladder stone in a 10-year-old poodle. I have had been in small animal practice for around 30 years and therefore the surgical time taken would be shorter.
4. Systematic Process & meticulous records
Examination - Palpation of bladder. Risks and complications esp. in old dogs to be discussed. Economics to be discussed. Dog on antibiotics for 7 days prior to surgery by Dr Sing Kong Yuen.
Medical advices of 4 test given to be recorded to prevent misunderstandings as the family members may not communicate with each other after visiting the vet. These tests are:
4.1 Urine test. Absence of urinary crystals do not mean no stones are present.
4.2 X-ray. The owner said he was not told about X-rays in this case. I advise an air-contrast radiography by injecting 30 ml of air into the bladder prior to X-ray. (X-ray image). The female dog should be catherised for the catheterrisation.
4.3 Blood test for health screening pre-op.
4.4 Stone analysis is important for prevention.
5. Videos x2 by one intern. Extract relevant clips.
Case of Kerri.
X-ray of urinary stones
6. Illustrations of vet surgery to be done to reinforce the surgical techniques or pull out clips from the video and write subtitles.
Reference to X-ray (image) pre-op
Sterile swabs isolates the bladder
Incision to be as small as possible
Irrigation of bladder to flush out smaller stones
Catheter into female urethra to dislodge any stone if present
First layer. 2 anchor sutures with artery forceps.
Death of old dogs in poor health. IV drips.
Performance indicators. How long it takes for an experienced vet to remove a bladder stone from a female dog.
http://www.sinpets.com/F5/20130615stones_urinary_poodle.htm. See below
Video clips to be edited by interns:
497 & 504. Location of Toa Payoh Vets in 2013. Industrial Park. Lorong 8 Toa Payoh. Near a Hindu Temple off Lorong 8 and Golf driving range from Toa Payoh East.
457 & 450. Patient before surgery. June 2013. Abdominal swelling is not ascites. It is a swollen bladder as big as a mango. Edit clip to show swelling. Not eating. Passing blood in the urine. Dribbling urine.
X-ray (image), catheterisation of female urethra to empty bladder and pump in 30 ml of air into bladder for contrast radiography. (image).
460. IV sedation given by Dr Daniel Sing.
465.Surgery by Dr Sing Kong Yuen. Bladder pushed out. Incise bladder as small an incision as possible. Stone taken out. Irrigate bladder with normal saline to flush out other smaller stones. Catheter inserted from bladder into female urethra to dislodge any stones stuck inside.
3/0 absorbable sutures used.
First of 2 rows of inverting sutures to close the bladder incision in this image. The submucosa is stitched in the first row in this video.
Clip of forceps anchoring suture at two ends of the knots. (Edit clip and highlight or illustration).
483. Submucosa stitched. Knot at one end. 2nd artery forceps anchor it. (Edi clip and highlight or illustration). 2nd row of sutures being placed.
484. Bladder incison fully closed. Some vets inject saline to check for leakage. Not necessary in this case as the two rows are tight.
485. 30 minutes after surgery.
490. Post-op bleeding seen. Back area bandaged. Subcutaneous blood vessel bleeding likely.
Dog vomited twice. Bladder stone (image). Struvite from stone analysis.
492. 3 hours after surgery. Barking loudly. Goes home. Dr Sing's comments on this old dog's barking as a good sign of health.
UPDATE IN AUGUST 2013. Dog recovers at home. Refused to eat the Prescription S/D diet which is recommended to dissolve the struvite stones in the kidney. X-ray shows stones in kidneys (image of X-ray).