tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   27 February, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS.
Date:  27 February, 2010 
Be Kind To Pets
Veterinary Education
Project 2010-0129

2007 Case. Dysuria (difficulty in peeing)
Shih Tzu,
Female, 5 years. Peeing a bit here
and there many times a day for many months

Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets

Middle-aged and older dogs are seldom given much attention by many owners all over the world, unlike puppies. Such dogs don't live long lives if their sickness is not treated. 

After many months of painful urination, the owner consulted me. I palpated a large bladder stone and advised surgery after 10 days of antibiotics. The owner forgot about the surgery and the difficulty in urination problem recurred. Surgery was inevitable to resolve the problem. But was it too late and would the old dog survive the anaesthesia and not die on the operating table or after surgery? The owner understood the risk. The dog was alive after the surgery. The pictures of the surgery are shown below.  

Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets 8-mm thick bladder wall. Needs 2 layers 3/0 absorbable stitching to close. Toa Payoh Vets
I prefer to incise the ventral wall of the bladder and find no problem of "the heavy weight of the internal organs pressing down on the bladder" and therefore adversely affecting the healing. Thick and reddish bladder wall of nearly 5 mm in thickness indicates that the bladder infection has gone on for many years. Some dogs die as bacterial infection spreads to the kidneys and into the blood. The submucosa of the bladder is stitched with an inverting suture pattern. 
Chronic cystitis - large bladder stone. Stitching up bladder wound with 2nd layer. Toa Payoh Vets Shih Tzu, Female, 7 years. Large bladder stone. Toa Payoh Vets Shih Tzu squatted, cried and passed urine every few minutes. One spherical bladder stone removed 6 days ago. Toa Payoh Vets
2nd layer of inverting suture is now placed. Forceps on the left anchors the knot of the first layer. No omental fat layer is sutured onto the suture line although some vets do it. Dog warded 3 days for observation. Goes home. No complaint about difficulty in urination for the next 18 months. The gentleman owner was not interested in follow up health checks and urine testing. Urinary stone (right) is from the bladder of this Shih Tzu. The two stones (left) are from another dog.

2010 Case. Dysuria (difficulty in peeing)
 at the end stage of urination

Feb 26, 2010.  At 13 years of age, he just had dental scaling at another vet practice. The vet had performed 2 blood tests 3 weeks apart and this indicated excellent health. Then the owner consulted another practice (Vet 1) as the dog took a long time to pee at the end part of urination. Vet 1 advised surgery. The owner phoned me for advice after Vet 1 had been consulted. I had not seen the case and I asked "Was the dog's urine analysed?  Struvite urinary stones, if small, may be dissolved by the acidification of urine."  The young lady owner said, "No." Later, she told me that Vet 1 considered urinalysis unnecessary.    

I saw the case and got the owner's permission to do a urine analysis. The urine pH was 6.5 and there were no crystals in the urine on urinalysis. So, these tests indicated that the urinary stones might not be struvites and therefore acidification of the urine would not be effective. Surgical removal, as advised by Vet 1 was my recommendation. But will the dog that growled at me,  die on the operating table as he was so old?  

Conclusion: All owners need to be aware that difficulty in urination needs prompt veterinary attention if they want their animal companion to live to old age. FOR THOSE OWNERS WHO WANT TO DO URINE OR BLOOD TESTS TO CHECK THE HEALTH OF THEIR SENIOR DOGS:
e-mail, tel: 9668-6469, 6254-3326 for appointment at Toa Payoh Vets.
References: Some interesting urinary stone cases seen at Toa Payoh Vets by Dr Sing. 
Be Kind To Pets
Veterinary Education
Project 2010-0129
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research

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