Much can be learnt from experienced veterinary surgeons. These are his advices regarding kidney stones.
1. Around 4% of the urinary stone cases are kidney stones. Therefore, always X-ray the kidneys as well as the bladder.
2. All vets should get the urinary stone analysed. It is not enough to just remove the stones and not analyse it. He cited one case where a loyal client lost faith in the vet who removed the stones the 2nd time and stones recurred again the 3rd time. Some vets don't get the stones analysed if the client is on a tight budget but this against medical advice should be recorded.
3. He would removed the kidney stone in the renal pelvis if the renal incision needed is less than 20% of the length of the kidney. For example, 1 cm incision length for a 5-cm long kidney. If it is 50% and more, it is unlikely that the kidney will function normally post-op.
4. Struvite stones and other stones do recur and this must be told to the dog owner.
5. In the US, there seems to be a higher rate in the occurrence of calcium oxalate stones.
6. As long as the vet monitor regularly post-op, most struvite stones will dissolve if the Urinary Tract Infection (UTI) can be controlled. While stones are there, there will be bacteria inside the bladder. Hence there is a need to give antibiotics even if these must be given for a long period of time. Regular monitoring via urine analysis and ultrasound are recommended.
7. "Can large struvite stones really dissolve by the dog eating stone-dissolving diets?" I asked him. "Yes," he said. "There have been reports of such cases."
"Have you or your colleagues achieve success in such cases?" I asked.
"No," he said. "I just remove them surgically."
Personally, I doubt that large struvite bladder stones can dissolve using special dietary means because they are hard-shelled. The stones irritate the bladder causing blood in the urine and the bacterial infections come in. If dietary means are used, the owner must be highly motivated and is able to take the time to do urine analysis 3 weekly (pH, USG, crystals, bacteria, blood) and X-rays 3-monthly as well as giving the dogs a long course of antibiotics whenever there is urinary tract infection. The dog must be fed solely on the special diet and no other dog treats or food is given. How many Singapore dog owners are self-disciplined to do this? Family members do sabotage by giving the dog some treats and so surgery is the best option. But there still needs to be prevention from recurring and this is difficult for the time-pressed dog owner in Singapore. Therefore, Singapore dog owners seldom bother to do regular monitoring though.
Below are X-rays of one of my rare cases of kidney stones seen in a Miniature Schnauzer in Oct 2012. I advise the busy owner to do regular monitoring but this needs time from him to bring in the dog for examination. He has many things to do and so I don't know whether his dog will get a 3rd occurrence. It is costly to operate and some owners just get the dog euthanased. Yet this struvite stone disease can be prevented if the owner spends time to get the tests done.
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Images of
the bladder stone removal
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Toa
Payoh Vets