Friday June 14, 2013
I share my surgical
experience with
regards to the
removal of a bladder
stone from an old
poodle and to
provide a benchmark
to enhance the
standard of care by
younger vets at Toa
Payoh Vets.
KPI FOR SURGERY
How long it takes to
remove one bladder
stone from a poodle?
Poodle, 10 years,
4.1 kg 38.8 C. Dog
was panting but
owner said this was
normal behaviour of
excitement. Urinated
blood yesterday,
incontinent and now
had abdominal
distension.
Had antibiotics for
past 7 days. Blood
in urine. Dark red
cloudy urine. Dog's
abdomen distended on
arrival.
Anti-spasomodic
injection and
antibiotics enabled
dog to pee and on
surgery, bladder was
empty but swollen
with 8 mm wall
(normal bladder is
around 3 mm)
2 packets of sutures
3/0 absorbable
Polysorb, 3/0 nylon
for skin
A: Injection of
Induction Drugs
2.50 pm
B: Isoflurane gas
first given:
2.55 pm
C: Isoflurane gas
stopped:
3.39 pm
D: First skin
incision:
3.11 pm
E: Completion of
skin stitching
3.41 pm
E-D =
30 minutes
for a vet with 40
years of
experience.
E-A = 51 minutes
C-B =
44 minutes
of isoflurane gas +
oxygen used.
ANAESTHESIA
1. Domitor +
Ketamine 0.1 + 0.11
ml IV in 3 ml of
saline
2. Dog intubated 5
minutes after Dom +
Ketamine IV. She was
intubated a few
times but seemed not
to be breathing the
isoflurane. Barked
twice. Eyes
blinking. I did not
want to waste time
to mask and intubate
as this is an old
dog and every second
counts towards her
survival rate. I
decided to use gas
mask which was
excellent
anaesthesia from 3%
maximum for
maintenance.
SURGERY
1. I palpated the
empty bladder with
stone. In female
dog, I do not
catherise unless
necessary.
2. I incised where
the bladder was
located. Spread out
the SC fat, linea
alba cut and pop out
the empty bladder.
3. I turned the
bladder backwards,
exposing the dorsal
part of the apex.
4. Incised 1 cm.
Popped out the stone
which would be
slightly >1 cm
across.
5. My assistant
flushed bladder with
saline. I squeezed
out any remaining
debris or crystals,
known to be
struvites.
6. A urinary
catheter passed from
inside bladder to
outside the vulva to
dislodge any stones
if present in the
urethra.
7. I suture the 8-mm
thick submucosa
first with a layer
of inverting
sutures, parallel to
incision.
8. At one end, I
anchored the artery
forceps and
proceeded to suture
a similar continuous
inverting suture
layer to the other
end from bladder
serosa and mucosa.
"Suturing is similar
to Caesarean section
uterus," I said to
Dr Daniel. I used
3/0 Polysorb sutures
and throw 5
knots/tie.
9. "Some vets inject
saline into the
bladder of the
female dog after
suturing to see if
there is a leak," I
said to Dr Daniel.
"I don't do it as
the closure is tight
with two layers." He
took a video.
10. Closure of the
linea alba (simple
interrupted &
continuous overlay).
11. Skin -
horizontal mattress
x 3 with 3/0 nylon.
12. There was some
profuse bleeding
post -op. "Probably
the bigger artery
from the caudal
epigastric blood
vessel," I said.
After bandaging, the
bleeding stopped.
POST OP
The dog
vomited
twice, yellow
gastric juice some
15 minutes after
surgery, but
seemed OK. "Barking
non-stop before
surgery," I said to
the owner who
visited. The dog
sprang onto him as
if she did not have
any major op. Still
barking non-stop as
at 7.35 pm when I
recorded this case.
Incredible. The
owner is advised to
give the S/D diet
but the dog did not
like it. There are
still small stones
inside the left
kidney and S/D may
dissolve them. But
the dog would not
eat the S/D. "Give
10% mixed with
home-cooked food and
increase daily," I
said. "It is
important to avoid
kidney stone
operation!"
An unusual old dog
so active 2 hours
post op. Compared to
the overweight Jack
Russell who is
drinking lots of
water and depressed,
lying down 2 days
after 10 small
bladder stone
removal surgery. He
would stand up when
the owner came.
UPDATE ON SUNDAY
JULY 16, 2013
The dog went back on
Saturday July 15,
2013, on the 2nd day
after surgery as she
was fit. The other
Jack Russell, on 3
bottles of IV drip
was more active and
barked on Saturday,
much to the joy of
the owners. He was
drinking and
drinking a lot of
water of Friday
lying on his chest
and looking
lethargic. He would
walk when taken out
but preferred to lie
down for the last
two days..
TOA
PAYOH VETS
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