Sunday, June 15, 2014

Yangon Vet Talk - treatment of urethral stones - retrograde urohydropropulsion


DRAFT NOTES FOR THE SEMINAR

FELINE UROLITHIASIS


Case study. TP 45355.
Cat, Male, Neutered, 4 years old. Apartment has 2 other cats with no similar problem. 

HISTORY & SIGNS: Since being neutered at 8 months of age, dysuria is seen lasting around a few days every 2-3 months. No veterinary treatment as the cat recovers the recurring dysuria. However, on Jun 19, 2014, the cat hid under the sofa and could not pee for a long time. Dr Daniel of Toa Payoh Vets treated him. Signs of postrenal uraemia not obvious (e.g anorexia and vomiting).

PHYSICAL EXAMINATION. Signs of outflow obstruction: 
1.  Palpation of a large painful urinary bladder palpated.
2.  Detection of urocystoliths by palpation is unreliable.
2.  Examination of distal penis and penile urethra showed urethral plugs. A cat catheter passage is obstructed.

DIAGNOSIS
DIFFERENTIAL DIAGNOSIS.
1. Other causes of dysuria, haematuria and pollakiuria and outflow obstruction.
2. Analysis of uroliths or urethral plugs to differentiate struvites from other types. Tests include urinalysis, radiography, ultrasonography and cystoscopy.   

3. CBC/BIOCHEMISTRY/URINALYSIS
3.1    Post-renal azotemia (high BUN, creatinine and phosphorus) for complete outflow obstruction. Not done in this case owing to financial constraints.
3.2   Urine tests.
3.2.1 Microscopic examination of the magnesium ammonium phosphate crystals. They look like colourless, coffin-like prisms with 3 to 8 sides. The lab report shows triple phosphate crystals.
3.2.2 Bacterial urine culture and antibiotic sensistivity tests. Not done due to financial constraints.
3.2.3 Chemical analysis of urethral plugs. Not done due to financial constraints.

4.  IMAGING

4.1 Survey radiography. Two views of the abdomen must be taken, not just one view as is sometimes done by vets in Singapore to reduce medical costs for owners.
No struvite uroliths but some struvite urethral plugs are seen. Struvites are radio-dense on X-rays.   They are most common mineral (80%) in urethral plugs in cats (The 5-minute Veterinary Consult, 3rd Edition)
4.2  Contrast urethrocystography. Not done due to financial constraints.

5. ULTRASONOGRAPHY
determines the precise location, number and size of uroliths. Not done due to financial constraints. Does not indicate the degree of radiodensity or shape of uroliths

6. CYSTOSCOPY reveals the location, number, size and shape of urethroliths and urocystoliths.  Not done due to financial constraints.
  

 







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http://www.sinpets.com/20090530Canine_Uroliths_ToaPayohVets.htm


Retrograde urohydropropulsion - usually male dogs 
1. X-ray
2. Health of dog
3. Technique - Best is to use a 30-ml syringe, soft or hard catheter, saline as 30-ml syringe provides excellent pressure as compared to 10-ml or 60-ml syringes. Some vets use 10-ml syringes and find it difficult to flush the urethral stones back into the bladder.











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