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A Bladder Full of Stones Hershey, a seven year old spayed, female dog has been a patient of Paws of the Rockies Animal Hospital for about 4 years. Hershey loves to do work as a therapy dog. Hershey has been a very healthy dog in the time we have seen her as our patient. She comes in regularly for her annual examinations and vaccines and her owner has always maintained her overall preventative health care very well. Recently however, Hershey’s owner was concerned because Hershey had been urinating more often than normal and her owner had even seen blood in her urine. Hershey’s owner was able to collect a clean urine sample and bring it in to our hospital for analysis. After analyzing her urine, we determined that Hershey did in fact have evidence of a urinary tract infection. Her urine did have a large amount of microscopic blood, white blood cells, microscopic crystals called struvites and numerous bacteria on examination. Hershey was placed on 2 weeks of antibiotics and her owner was advised to recheck her urine after the course of antibiotics was finished. Hershey did have some vomiting while on the antibiotics and at times did seem lethargic. After about 1 week on the antibiotics, Hershey was still having signs of blood in the urine. She seemed to have an easier time urinating, but she was still urinating fairly often. We recommended that Hershey come in for a full examination, vaginal exam and radiographs (x-rays) of her bladder. We were concerned that Hershey could have a vaginal abnormality like a tumor or a bladder problem like bladder stones or a bladder tumor.
Bladder surgery was performed on Hershey to remove all of the bladder stones. It was very important to fully flush her bladder out, so that no stone was left behind. Hershey was placed on pain medication and 2 more weeks of antibiotics after her surgery. The stones that were removed from her bladder were submitted for analysis. This was to help us determine what the stone composition was. Within weeks, the stone analysis results determined that the stones in Hershey’s bladder were 100% struvite (magnesium phosphate) stones. Generally, it is believed that these stones form from chronic bladder infections. If the infection is controlled, the stone formation is controlled. In more rare situations, these stones may form as a result of a metabolic abnormality within the patient. Once the stones have been removed, it is extremely important to monitor these patients closely for urinary tract infection signs long term. Most patients with urinary tract infections show the following symptoms: blood in urine, straining to urinate and producing a small amount of urine at a time, painful urination episodes, frequent urination episodes, increase in the amount of water intake. Some patients will display signs of severe illness like vomiting, decreased appetite and pain in the abdomen.
This is a very interesting case for the following reasons: 1.) Hershey had not had a history of previous urinary tract infections. The first time she showed any symptoms of a urinary tract infection was one week before she was diagnosed with multiple bladder stones. 2.) Hershey had multiple stones in her bladder indicating that this had been ongoing for a very long time. These stones ranged in size from the size of grains of sand to large marbles. The surgeon estimated over 100 small and large stones removed from the bladder at the time of surgery. We estimate this could have been ongoing for months, if not years in Hershey. 3.) Hershey appeared to be a very healthy dog outwardly. She did not have difficulty urinating. She never displayed a urgency to urinate. She maintained a healthy appetite and good energy level. This teaches us that some patients are very good at hiding their illness. Therefore, it is very important to monitor the normal behaviors and activities of your pet. The more you know about what is “normal” for your pet, the easier it will be to determine when something is even slightly abnormal. 4.) Struvite crystals, when seen in the urine, can be a sign of infection. If left untreated, these can develop into larger more problematic stones. Stones can range in size from the grain of sand to the size of a baseball. 5.) There are four main categories of stones that can be found in dogs. The two most common types are Calcium Oxalate and Magnesium Phosphate (Struvite). Other less common types include Urate and Lysine.
Hershey has done very well since her bladder surgery. We rechecked a urinalysis after her antibiotics were completed and her urine looked completely normal. We will continue to monitor Hershey closely for signs of urinary tract infections. Because Hershey may hide her symptoms of urinary tract infections very well, we will also be monitoring her urine carefully.
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Hershey frequently comes in for nail trimmings and anal sac expressions and fortunately has not had any chronic medical conditions.
On exam, Hershey appeared overall very healthy. She did have some dental tartar. Her vulvar and vaginal areas appeared normal. She did attempt to urinate several times in the exam room. At times, she did not produce any urine; however, once she did produce a large puddle of bloody urine. Abdominal radiographs were performed. The radiographs demonstrated a bladder full of stones. There were numerous stones present in her bladder, too many to count, of varying sizes. Surgery was recommended to remove the stones immediately.
Frequent or recurrent urinary tract infections always require further testing,beyond urine analysis. First, we recommend urine cultures for chronic urinary tract infections. We culture to determine the specific bacteria that is causing the symptoms and the appropriate antibiotic for that bacteria. Sometimes it is a problem with the number or type of bacteria growing in the bladder. This may require a specific antibiotic. Other times, a chronic urinary tract infection may be the result of inappropriate length of time on the antibiotics. Often prolonged antibiotic use is necessary to clear the infection completely; frequently several months of antibiotics can be required in “stubborn” infections. Second, abdominal imaging is needed to determine whether there are stones in the bladder, bladder tumors, or evidence of inflammation in the bladder (cystitis). This can be done with abdominal radiographs or ultrasound imaging. When a dog has a bladder stone, it is very common for bacteria to begin to grow on the stone itself. This can make is very difficult to completely clear an infection without removing the stones.
6.) We cannot find what we do not look for. It is very important to allow your veterinarian to perform diagnostics when indicated, as in the case of Hershey’s owner. Generally, if a current treatment is not working, it is best to re-think the possibilities. In Hershey’s case, we believed that she had an uncomplicated, simple urinary tract infection. A it turned out, she actually had a large number of stones in her bladder. If we were not allowed to proceed with diagnostics, we would have not diagnosed her condition.