1146. A 7-year-old Shih Tzu has bladder tumour and many stones.

Sunday Dec 21, 2014

This 7-year-old male, not neutered Shih Tzu, born Feb 19, 2007 got his three vaccinations from me as a puppy. On Jun 29, 2012,  he passed blood in the urine for 2-3 weeks and lost appetite. The owners said was fed only rice and wet food and did not want surgery when X-ray showed bladder stones and urine showed triple phosphate crystals +, bacteria 3+ and blood 4+ , protein 2+. pH was 7.0. SG 1.015.

Dr Daniel advised surgery. The owner wanted conservative treatment using a special diet to dissolve the stones. She bought 6 cans of prescription diet S/D for the next 12 months. This is not the correct way to dissolve the stones. The S/D diet must be fed solely for 3 months and urine tests (monthly) and X-rays (3-6 monthly) need to be done.  The owner did not comply.


BLOOD TEST  22.12.14
Urea 8.5 (4.2-6.3). Creatinine  79 (89-177).  Haematology was normal and this was a good sign for surgery as there was little or no bacterial infections or septicaemia. 

URINE TEST
pH 7.0  SG 1.01. Nitrite +, Blood 4+, Bacteria 2+, no crystals.



Today, Sunday, Dec 21, 2014, the owner consented to the surgery as the dog was peeing blood in the urine for several weeks.

Now the catheter cannot pass into the bladder as urethral stones at the bend of the urethra obstructed the passage of the catheter. I palpated the bladder. It was still solid as a golf ball but not fully obstructed. The dog surprisingly had an appetite.  An IV drip with antibiotics, pain-killers and Vit Bs is given now and surgery was by Dr Daniel in the afternoon.

A globular submucosal bladder tumour 2.5 cm x 2.5 cm x 2 cm was surprisingly found. Many small stones with some sticking in clumps,  looking like calcium oxalate uroliths were taken out. 

CONCLUSION
Many Singapore owners are not aware that medical dissolution of triple phosphate stones need to be monitored regularly with urine tests and X-rays.  In this case, the owner bought 6 cans of prescription S/D in 2012 when the stones were found in the bladder and assumed all stones will be dissolved since they fed rice and wet food.

S/D must be fed 3 months followed by C/D and there must be regular urine tests and X-rays.