Saturday, December 10, 2011

768. Dietary management to dissolve struvite stones in the dog - no surgery

Below is an update of what I wrote from Perth in Sep 2010 when I was there on holiday and sat down to read the very thick book "Small Animal Clinical Nutrition" far away from the distractions of practice in Singapore.

The website is at:

The following is copied from the website:

After the surgical removal of the struvite urinary stones or for medical and dietary treatment, how much of the prescription diet should the owner give the dog/day?

I took some time just to read about Canine Struvite Urolithiasis case studies in the sleep-inducing thick book "Small Animal Clinical Nutrition" by Hand et. al, 5th Edition while on holiday in Perth, Australia. The following is some general guideline for Toa Payoh Vets in advising on Prescription Diet s/d to dogs based on 3 case studies in the book.

How much of the s/d diet to be given?
1. Puppy X-breed, 9 weeks,
5 kg.
700kcal (2.83MJ)
1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg
1,800kcal (7.5MJ)
1.5 cans 2x/day
3. German Shepherd, 12 years, 27 kg
1,150kcal (4.8MJ)
1 can 2x/day
Other procedures to ensure compliance from the owner:
1. Antibiotics from 14-30 days and review using urine cultures
2. Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
3. Monthly x-rays of kidney (V/D view), bladder (lateral views).

Back to normal commercial food for the puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results. No commercial dog treats or snacks during the period of treatment. In practice, I advise initially 3 months of the S/D diet and get urine tests done monthly in most cases. The Singapore dog owner seldom complies with the above-mentioned procedures or with monthly urine tests! Till blood in the urine returns!

Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area, bladder tumours) if there is recurrent uroliths or UTI (see case study of the old Corgi with recurrent UTI.

Recurrent UTI in an old Corgi - Part 1

Voiding urohydropropulsion is used in cases where the uroliths are small. The owner must be informed that it takes 2-4 months or longer to get all struvite stones dissolved. The owner must be aware of the need for reviews and to note the costs involved in the dietary management to dissolve struvite urinary stones.

What is urohydropropulsion? Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.

ANAESTHESIA. May or may not be need.
APPROACHES. Two methods described in Small Animal Clinical Nutrition 5th edition.

POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.
POSITION 2. Lateral recumbency.

In both positions, catheterise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.

Dietary and medical treatment.
More information is at: Small Animal Clinical Nutrition" by Hand et. al, 5th Edition

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